According to a report by the World Health Organization, more than 800 million people spend at least 10% of their total household budgets on health expenses. Inequalities in health services exist within countries as national averages mask low levels of health service coverage in disadvantaged populations. Wide gaps are seen in the accessibility, affordability, and availability of quality, specialized health services in low- and middle-income countries (LMICs) of South-Central Asia.1 Patients and their family members, living in the isolated and marginalised communities, face many obstacles in accessing health care services. Geographical barriers, harsh weather conditions, poor transport networks, sociopolitical instability and inadequately resourced health facilities pose limitations for these populations, contributing to high morbidity and mortality rates for diseases that can be easily treated. Consequently, they incur unnecessary financial burden while travelling long distances to access quality health care services available in major cities.
AKDN dHRC published a cross sectional study in 2020, which evaluated the impact of the technology by assessing the economic benefits awarded to patients availing teleconsultation services through the Programme in remote and rural areas of South-Central Asia. The dataset contained more than 25,000 teleconsultations (between 2013 and 2017). Patients using the teleconsultation services experienced a significant increase in average time savings (p-value < 0.05) and considerable increase in average cost savings (p-value = 0.05) compared to patients who did not. For each person using teleconsultation, the study found cost savings of USD 454 in Afghanistan; USD 191 in Pakistan; USD 40 in Tajikistan; and USD 56in Kyrgyz Republic. The average user also saved 83 hours in Afghanistan; 37 hours in Pakistan; 49 hours in Tajikistan and 13 hours in Kyrgyz Republic for each teleconsultation visit. These findings are suggestive of the large travel costs and time associated with accessing specialist health care in these hard-to-reach areas.2
AKDN Digital Health Programme
The AKDN Digital Health Programme, initiated services in 2007 when the French Medical Institute for Mothers and Children (FMIC) in Kabul, Afghanistan was connected to the Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan for teleradiology services. Currently, the AKDN Digital Health Programme provides telemedicine services, eLearning services and telesurgery services for a network of 37 health facilities across four countries in South-Central Asia, including Afghanistan, Kyrgyz Republic, Pakistan and Tajikistan. The Programme also supports Tele-ICU services, provided by the Aga Khan University Hospital, Karachi (AKUH, K) to select facilities of remote regions in Pakistan.
As countries across the globe enforce social distancing and self-isolation to fight the novel coronavirus (COVID-19) pandemic, telemedicine has played a vital role in connecting healthcare providers with patients dealing with chronic clinical conditions3, minor ailments and/or COVID-19. Innovative and unconventional solutions, like telemedicine, are being leveraged more ever than before, to help provide healthcare services to isolated populations - not only those who are affected by the COVID-19, but also those may who require healthcare services but are unable to access those services due to lack of resources, precautionary isolation or self-quarantine protocols, as enforced by governments and recommended by the World Health Organization (WHO).4
Through the COVID-19 pandemic, the AKDN Digital Health Programme continued to provide quality, non-urgent, remote, teleconsultations for populations, helping ease health burden on health facilities and reducing the risk of exposure to COVID-19 that comes with visiting a health facility. In addition to routine services, to help ease the health burden, AKDN dHRC in collaboration with the Aga Khan University and the Aga Khan Health Service, Pakistan (AKHS, P) has helped launch the first of its kind COVID Tele-ICU services and is now providing technical support for the services.
The Tele-ICU services allow COVID-19 patients in the ICU to receive live online assessments and consultations from specialist clinicians and practitioners at the Aga Khan University Hospital, Karachi. This allows bedside staff to provide improved critical care aligned with best practices, under guidance from ICU specialists at a distance. The Tele-ICU service also supports critical care trainings for ICU doctors, nurses and paramedical staff to improve acute critical care patient management.
The Tele-ICU services connect the Aga Khan Medical Centre, Gilgit and the Aga Khan Medical Centre, Booni as spoke sites with the Aga Khan University Hospital, Karachi (AKUH, K) as the hub facility for live teleconsultation services from the ICU. Learn more about AKU’s Tele-ICU services here.
The AKDN Digital Health Programme leverages ICTs to connect health care institutions and health care providers within and across Afghanistan, Kyrgyz Republic, Pakistan, and Tajikistan. The live and store-and-forward teleconsultations under the telemedicine services, connect multiple AKDN and government facilities, building public-private partnerships (PPP). Diagnostic services include teleradiology, telepathology and teleopthalmology while live teleconsultation services cover several specialties, including obstetrics and gynaecology, paediatric neurology, and psychiatry, among many others.
The AKDN Digital Health Programme also helps to build capacity of the healthcare providers through eLearning. The eLearning services not only build clinical capacity, but also enhance their management skills, their ability to deliver care and reduce professional isolation. In the resource scares regions, eLearning services enable health care professionals to continue their professional development without spending time and other resources to attend expensive courses in distant locations.
In May 2017, a comprehensive, hybrid telesurgery solution was implemented in Kyrgyz Republic under the AKDN Digital Health Programme to enable health care professionals in Bishkek and Naryn to perform telesurgeries in real-time and receive second opinions and conduct eLearning sessions directly from the operation theatre.
1 World Health Organization. (2017). World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. Retrieved from: https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
2 Sayani, S., Muzammil, M., Saleh, K., Muqeet, A., Zaidi, F., & Shaikh, T. (2019). Addressing cost and time barriers in chronic disease management through telemedicine: an exploratory research in select low- and middle-income countries. Therapeutic advances in chronic disease, 10, 2040622319891587. https://doi.org/10.1177/2040622319891587
3 Maxwell, Y. L. (2020, March 25). Telehealth Offers a Lifeline for Cardiology Patients During the COVID-19 Pandemic. TCTMD. Retrieved March 27, 2020, from https://www.tctmd.com/news/telehealth-offers-lifeline-cardiology-patients-during-covid-19-pandemic
4 Chauhan V, Galwankar S, Arquilla B, Garg M, Somma SD, El-Menyar A, Krishnan V, Gerber J, Holland R, Stawicki SP. Novel coronavirus (COVID-19): Leveraging telemedicine to optimize care while minimizing exposures and viral transmission. Journal of Emergency Trauma Shock 2020;13:20-4
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