Telemedicine in Nepal (Part One)

A small nation beginning in republican federalism, wedged between two emerging economic powers of Asia – China to the North and India to the East, West and South – and with an open border, Nepal is least developed, landlocked, geographically disadvantageously placed, an economically vulnerable nation of enormous ecological, cultural and ethnic diversity (Dahal and Inoue, 1994:1-15).

Nepal is the least developed country with per capital income of $220 where approximately 32% of the population is living below the poverty line and 85% of the population lives in rural areas. With health services being an essential service for human life, it has been accepted as the most important element of human rights. In view of the campaign initiated by the WHO urging “Health for all by 2000 AD”, along with the commitments made in various international health conventions, Nepal has formulated and implemented Health Service Policy (1991). During the last 8th and 9th plan periods, by extending health establishments to rural areas, preventive, promotional, curative and rehabilitation, as well as a family planning program, have been brought into the village level.

For the development of health services, attempts made in the past have had some improvements in the public health status; however, major health indicators of Nepalese people have shown that their health status is far below that of other developing countries. The status of the health indicators till the end of the 9th 5 year plan is presented below.

No. Health indicators Target Achievement
1 Accessibility of Basic Health Services (%) 70 70
2 Delivery services by well-trained health personnel (%) 50 14.3
3 Rate of contraceptive users (%) 36.6 39.3
4 Total Fertility Rate / TFR (15-49 years) 4.2 4.1
5 Crude Birth Rate 33.1 34
6 Orphan Death Rate (per 1000) 61.5 64.2
7 Children Death Rate (under 5 years) per 1000 102.3 91
8 Crude Death Rate 9.6 10
9 Life expectancy 61.9 61.9
10 Total Hospital Beds (Government Hospital) – 5023    
11 Primary Health Centre – 160    
12 Health Posts – 710    
13 Sub Health Posts – 3167    
14 Trained Health Personnel – 48549    
15 Hospitals of various types – 85    

Source: The 10th 5 years plan

The aforementioned indicators show that the health conditions of the country are not satisfactory. This shows the alarming situation of health care in context of Nepal. Malaria, tuberculosis, leprosy and immunization-oriented preventive diseases have been controlled to a great extent; however, due to the lack of apparatus and equipment at hospitals, people have not obtained expected health services from the extended health institutions. Therefore, health services need to be made more service oriented and commitment by the relevant stakeholders is necessary to make need-based interventions in improving the public health status.

The remote and rural populations are as yet not accessed by basic health services. These people have been facing exclusion from normal service delivery mechanisms on the grounds of issues such as inaccessibility, flaws in the intervention process, care, treatment, basic health information, approaches, based on gender, caste, ethnicity and remoteness. There lacks proportionate distribution of health services among the target communities owing to topographical inaccessibility, pressure of population growth, and lack of general information regarding health issues, and illiteracy among the Nepalese people. There is a lack of wider expansion of family planning services in the country. An overwhelming majority of pregnant women are compelled to give birth to their children at their own homes due to a lack of effective accessible service delivery to them, resulting in several incidents of death during pregnancy and delivery. There is a shortage of health personnel/manpower, planning and mobilization of manpower due to lack of coordination among government, nongovernmental and private sectors.

The spreads of HIV/AIDS among new populations have been a major threat to Nepal because of mass poverty, illiteracy and lack of awareness. There seems to be a growing prevalence of various diseases like diabetes, cancer, heart disease, respiratory diseases and so forth. The noble and financially well off families can afford the huge amounts of their money needed for health care, but the overwhelming majority of poor, remote and rural people are deprived of basic health services. Lack of adequate medicines and medical equipment, lack of proper use of existing supplies, lack of maintenance of infrastructures of health institutions such as health post, sub health post, dispensaries and so forth, as well as a lack of supervision at different levels of the health system are among the constraints of health sector development in Nepal.

There is a lack of information and awareness regarding basic health care services, and though there are various means of communication, there is still lack of proper information. Most of the developmental activities are confined within the Kathmandu valley, making the problems for outlying areas even worse. In Nepal there is acute shortage of doctors. The total number of allopathic doctors is 4000 (as of 2004) and majority of them are concentrated in more developed areas. Rural communities which constitute majority of the population are deprived of specialist support and updated information. Even within the Kathmandu valley, there is lack of correct and appropriate information regarding healthcare. People still don’t know which doctor to consult, how many doctors are available for particular illness, their availability in which health centre, where the nearest test centers of X-rays, ultrasounds are located and which health centre to contact when different kinds of symptoms occur.

The right answer here to address many of these problems is Telemedicine, a help line for overall health care or related queries. Telemedicine is the use of telecommunications to transfer medical information for diagnostic and educational purposes. It can be used to bridge the distance barrier in delivering health care to the population at large. It is the help line for health care of people of any kind. The advent of Telemedicine has unleashed new opportunities to the delivery of health services. It may in fact have a more profound impact on developing countries like Nepal than on developed countries.