‘Nepal needs to step up efforts for implementation of telemedicine’
Nestled in the Himalayas, Nepal is a beautiful landlocked country in South Asia. The country is listed among one of the underdeveloped countries with low human development index, i.e. 0.540. Geographically, most of its area is a hilly terrain and 83 per cent of its total population is still living in the rural areas with minimum access to healthcare. In Nepal, both the public and private sector are involved in the delivery of health care services but health systems are woefully understaffed and ill-equipped. Rising incidences of chronic diseases, ageing population and unavailability of skilled healthcare professionals underscore the huge need for quality healthcare in the Himalayan nation.
This is where virtual care platforms like telemedicine and e-health, come to rescue. Web meetings and online conferencing ensure that expert care is available anywhere. It’s no secret telemedicine has had a profound impact in improving rural healthcare and it holds the promise to significantly lower some of the most challenging problems of Nepal’s current healthcare system: access to care, cost effective delivery, and distribution of limited providers. Effective implementation of telemedicine can change the current paradigm of care in the country and allow for improved access and better health outcomes in cost effective ways.
Government of Nepal has realized this and has implemented the rural-telemedicine programme to support the healthcare delivery system. Currently rural telemedicine programme is implemented in total 30 districts out of 75 districts of the country. The government also started a service- “Hello-Health”- a 24 hour service that attends to the healthcare concerns of the population. Annually the government spends nearly NRs 2 lakh per district on telemedicine and since the programme is implemented in 30 districts annual estimated budget is about NRs 60 lakh. Though telemedicine is already seeing some positive outcomes, few factors like lack of internet penetration, electricity issues and lack of training for healthcare workers in using telemedicine is posing a major challenge to its success. In an interaction with BioSpectrum Asia Magazine Ramesh Bhatta, Secretary, Nepal Public Health Association and Principal, Yeti Health Science Academy Bhatta shared the challenges in healthcare sector and steps taken by the government to promote telehealth.
Excerpts of the interview.
According to you what are the major challenges Nepal faces when it comes to healthcare sector?
Nepal is a hilly region and has many geographically inaccessible terrain making quality health facilities difficult to the citizens. Population is generally poor and citizens are facing triple burden of diseases (communicable diseases, non-communicable diseases and accidents and injuries). Obesity is increasing in urban areas while there is still high prevalence of malnutrition among under five children and women of reproductive age. Non-communicable diseases such as cancer, heart diseases, diabetes, kidney diseases, liver and lung diseases, psychiatric illness and dental diseases are also increasing. Health systems are already understaffed and to top it there is also difficulty in the retaining health professionals in the rural health
institutions. Private hospitals have high cost of health care services which is unaffordable to many.
How is telemedicine important for Nepal?
The government of Nepal has a challenge to overcome the poverty and geographical barriers to reach the rural peoples and provide them effective and affordable health care services. Hence telemedicine provides opportunities to overcome such barriers and increase the options to deliver the health services. We have limited health human resources working in the health care delivery system and they are also more concentrated in the urban areas, hence use of telemedicine will support to overcome these issues and ensure the health service for the rural and remote population. Nepal has poor indicators in maternal and child health status, large number of population doesn’t have easy accessibility to the health facilities and if they have also, the health facilities doesn’t have competent human resources to provide quality service, hence use of telemedicine service is needed to address these challenges. Telemedicine in Nepal will further help in strengthening preventive health. It will also be supportive for rural health personnel to exchange information and to get necessary expert opinion for better delivery of health services.
What are the initiatives taken by the Nepal government to promote telehealth?
National Health Policy of Nepal 2014 has acknowledged the importance of telemedicine and emphasized its use throughout the country for improving the accessibility of the health services. Nepal Health Sector Strategy (2015-2020) has stressed on the use of evidences in decision making by increasing the availability of information through the use of ICT. Similarly, the strategy has also focused on making the health information system interoperable. National ICT policy has focused on increasing the investment in ICT based healthcare system and promote telemedicine program to increase access to the modern health care service. Similarly, Government of Nepal, Ministry of Health has also endorsed e-health strategy, 2017 with the goal to “harness the potential of ICT technologies to improve health services, health governance and management”.
How effectively the government has implemented the telemedicine program in Nepal?
Government had formally started the ruraltelemedicine programe in the 2011 in 30 different rural districts. Rural-telemedicine programme has followed three different approaches (i.e. video-conference, store and forward method (email-based consultation) and hello-health (telephone-based consultation). However, the activities are still not well established in the districts. It is due to the lack of readiness among the health workers to use the available service and lack of supporting environment (such as regular availability of internet and electricity, clear protocol of government on handling the patients who approach to take service through telemedicine, lack of maintenance of the equipment). Some of the I/NGOs has also implemented the telemedicine service in small scale in limited clusters of the country, however due to the lack of clear vision of government health planners and managers, the implemented activities are not regularly monitored and evaluated. Hence it has been difficult to show the effectiveness of the programme.
What are the gaps / loopholes in this telemedicine scheme that need attention from the government?
There is a lack of appropriate technology and infrastructures to support the telemedicine service at large. The equipment and infrastructure used for the service are expensive, so it is challenging to upgrade them as needed. Slow internet, irregular electricity add to the above challenges. Fragmented approach in programme implementation and lack of readiness among the health personnel to use the technology especially in remote areas is another major issue. Health workers also lack enough IT knowledge making telemedicine all the more tough. There is no official training or protocols designed by the government that discuss on how the health workers/doctors should will handle the patients that take service through telemedicine. Government needs to step up efforts for successful implementation of telemedicine and this will definitely improve healthcare in Nepal.
Aishwarya Venkatesh email@example.com
Secretary, Nepal Public Health Association
Ramesh Bhatta, Secretary, Nepal Public Health Association