‘Nepal needs to step up ef­forts for im­ple­men­ta­tion of telemedicine’

BioSpectrum (Asia) - - Bio Content -

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 aish­warya.venkatesh@mmac­tiv.com

Ramesh Bhatta,

Sec­re­tary, Nepal Pub­lic Health As­so­ci­a­tion

Ramesh Bhatta, Sec­re­tary, Nepal Pub­lic Health As­so­ci­a­tion

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