Telehealth can be of great benefit in developing nations where access to healthcare is a concern as it can be used as a means to easily connect healthcare services to patients. To explain, my home country, Nepal, is a landlocked nation with a diverse geographical area consisting of hills, mountains & plain lands which makes accessibility to adequate healthcare scarce. Approximately 80% of the citizens live in the remote Himalayan region, where there is limited access to vehicles and the nearest hospital can take days to arrive (Siddiquee et.al, 2019). These citizens face many barriers based on geographic location, financial status, availability of healthcare facilities and professionals (Siddiquee et.al, 2019). The beautiful but destructive geological plane combined with the poor economic condition creates a landscape where receiving proper health care is an unattainable dream to many.
The traditional model of health service is via physical visits to health care facilities (Ashworth et al., 2019). However, Nepal does not have a robust infrastructure, thus many citizens especially those living in rural locations face numerous difficulties when accessing healthcare. Approximately 22 million citizens have limited access to health care, where it takes an average of 2.25 hours (135 minutes) to visit a health site in rural Nepal (Ashworth et al., 2019). Due to the long time it takes to reach healthcare facilities, many rural populations choose not to seek healthcare services when needed (Ashworth et al., 2019). Many citizens rely on public transportation or travel by foot to reach healthcare facilities as they do not have a personal vehicle, thus, due to the mode of transportation and the long travel time many citizens suffer fatalities from preventable illnesses or conditions such as snakebites (Ashworth et al, 2019). Furthermore, women are less likely to access healthcare, face larger transportation barriers, and tend to be less satisfied with their transportation methods (Ashworth et al., 2019). The 2011 Nepal Living Standards Survey (Central Bureau of Statistics) indicated that 41% of the rural population do not have access to a health clinic or a sub health care clinic (Ashworth et al., 2019). In addition, there is one doctor per 6000 people, with many of the specialists located far from the rural population (Roodenbeke et al., 2011).
Telehealth Benefits- Studies on the impact of telehealth in Nepal have shown favorable results, with an increase in the number of rural communities gaining access to healthcare services (Roodenbeke et al., 2011). Telehealth addresses the issue regarding the shortage of medical professionals as it allows for health professionals in rural areas to connect with other professionals while continuing their work in the communities which reduces isolation and improves collaboration (Roodenbeke et al., 2011). Using telecommunication services such as mobile phones allows for medical professionals to be more responsive and increases the capacity of the services they can provide (Siddiquee et.al, 2019). Many of the households in rural Nepal face financial issues and telehealth has provided an opportunity to seek healthcare while reducing costs as money spent on travel and lodging expenses is saved (Roodenbeke et al., 2011). Additionally, through the implementation of telehealth services many patients will not need to travel to a specialist’s location nor will the specialist have to travel to the rural community to provide their services, which reduces costs for both patient and health professional (Siddiquee et.al, 2019). Telehealth services increase accessibility to those limited by geographical barriers such as individuals living in the Himalayas or those affected by landslides etc (Siddiquee et.al, 2019). Overall, telehealth provides a range of benefits to patients through the reduction in treatment costs, increased accessibility, access to specialized care, and improved referral systems (Parajuli & Doneys, 2017).
One of the most significant advantages of the implementation of telehealth services is its positive impact on the health & wellness of females in Nepal. Nepal is a patriarchal society where women are bound by many gender norms. For example, the marital status of females impacts the type of healthcare services they can seek out, with many single, unmarried females unable to receive services pertaining to their sexual and reproductive health (Thapa, 2019). A study assessing the role of telemedicine in women in rural Nepal found that with access to video conferencing and mobile phones, women felt more comfortable seeking consultations and other telehealth services(Parajuli & Doneys, 2017). With telehealth services, there has been an increase in women reaching out to receive health services, especially regarding their sexual and reproductive health as they can speak anonymously over the phone, which has contributed to a reduction in the maternal mortality rate (Parajuli & Doneys, 2017). Additionally, telehealth services allow for women to get around gender-based travel restrictions and manage their time to fulfil their household duties while receiving care as travel time is reduced significantly (Parajuli & Doneys, 2017).
Telehealth Challenges -
Although Telehealth has a myriad of benefits, it is also important to consider its limitations. On some occasions, providing services via telehealth could lead to fragmented care thus causing gaps in the services provided (Mayo Clinic Staff, 2020). In addition, a study was conducted in Nepal to examine the government’s implementation of telehealth services as a means to improve access to healthcare specialists in thirty district hospitals (Bhatta et al, 2015). The results of the study showed that while telehealth offers numerous benefits, there are many challenges in relation to infrastructure issues, lack of human resources, and financing (Bhatta et al., 2015). Furthermore, one of the major challenges to take into consideration is internet services as telehealth relies heavily on them. Nepal has been actively working to expand its internet services and is planning on extending its broadband internet service to remote locations in forty-one districts, which will improve the country’s telehealth services (Prasain, 2020). The main focus is to ensure public spaces such as healthcare facilities, government offices, and outdoor areas have access to the internet (Hetting, 2017). With a population of 28 million, nearly 22.8 million individuals across Nepal have access to the internet (Himalayan News Service, 2020).
Conclusion -
Despite the challenges, telehealth services should be adopted by countries as it provides a variety of benefits, especially in underserved locations, and has the potential to significantly transform the future of healthcare. Digital technology has transformed modern life and the world has become smarter and more connected than ever. With the rise of technology, the health industry must keep up and not be left behind. Telehealth can overcome issues pertaining to costs, shortage of services, and geographic barriers. The current Covid-19 pandemic highlights the importance of telehealth in minimizing risks of transmission while providing healthcare services (Monaghesh & Hajizadeh, 2020). Due to the rise of Covid-19, the adoption of telehealth has been expedited with the emergence of many telehealth service providers in Nepal such as Dyo Health (DyoHealth, 2021). Overall, Telehealth allows for equitable and accessible health services to many marginalized groups and should be adopted by public health agencies across the world.
