Healthcare moving from hospitals to homes


The spread of telemedicine is one of the most remarkable spillover effects of the Covid-19 pandemic worldwide, and could also transform healthcare in Nepal.

In the US, the Center for Disease Prevention and Control (CDC) specifically recommended that health care facilities and providers offer clinical services through virtual means as a result of which growth in telehealth usage is 38 times higher than before the pandemic.

The US was amongst the first adopters of telehealth and has also been a mature user of tele-ICU services, with an estimated 11% of American ICU beds under telemonitoring. 

Adoption of telemedicine was slow to catch on in the developing world due to insufficient communication infrastructure and status quo biases plus regulation deficiencies. 

But it witnessed a breakthrough during the pandemic, thus making the virtues of telemedicine apparent. Argentina had passed legislation to validate electronic prescriptions and launched TeleCovid, a public telemedicine provider.

In Australia, Singapore, Indonesia, and the Philippines, governments have been making consistent efforts to advance the use of telehealth through subsidies, funding, and loosening certain health regulations during the pandemic.

In developed countries, this was enabled by three factors: increased consumer willingness to use telehealth, greater provider willingness to use telehealth, and regulatory changes enabling greater access and reimbursements.

While it is evident that government intervention and public sector support have been the key to creating favourable business environments for telehealth in those regions, Nepal seems to stand out.

Read also: Covid crisis can spur digitisation, Ashutosh M Dixit

During the pandemic, many startups and corporates in the country launched telemedicine and digital health services to meet the growing need. But, will the surge in telemedicine services be sustainable post the pandemic or will it retreat? 

In Nepal, the majority of dispensaries, hospitals, and doctors are located in urban areas where only 21% of the population resides. Even then, they are concentrated in better off urban centres.

Which means rural, peri-urban, and urban slums lack adequate access to quality primary healthcare. Much of the care delivered in underserved areas is through public sector primary or community health centers.

Health tech startups and firms have made a successful market entry at the height of the pandemic, the result of which led to an exponential boom in online consultations via apps, medicine delivery, and even health service at the patients' door.

These gains should not detract from the need to enable to specialist and super-specialist care to the untapped population of Nepal.

The government's telemedicine strategy in 25 remote districts in Nepal is defunct due to financial and operational constraints. How strategic choices and the manner of those choices cascade to the bottom of pyramid markets will determine the sustainability of health tech startups.

During the Covid-19 pandemic, telehealth companies recorded an average growth of 70% in basic telemedicine demand as compared to 2020. As promising as it sounds, online consultations on their own may not be enough for it to thrive post-pandemic.

It has to be integrated into other services like home healthcare where the physicians go to the patients' home to provide medical services including routine checkups, administering medication and collection of medical samples for diagnostic purposes. 

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Fully integrated patient record allows clinicians to serve the people best, no matter whether they are present physically or remotely. Home delivery of prescribed medications adds to the safety and convenience of patients. 

Another emerging trend in the industry is modern healthcare subscriptions which may help expand the service offerings through the app and make services financially accessible to patients.

Built on proprietary technology, telehealth apps are seen to be the core products. Through the app, patients or their dependents can avail services of online video consultations, book hospital appointments, or even order medicines online.

However, acquiring and retaining customers may be challenging due to changing customer needs and preferences in the long run. It is for this reason that companies have to offer more than the basics, with better user engagement and experience.

This means business analysis and planning exercises, phase-wise implementation, regular updates, and zero errors leading to faster processing of information and lower latency.

Globally, telemedicine has the potential to revolutionise healthcare by bringing down provider and patient costs as well as improving the accessibility to quality medical professionals.

In Nepal, telemedine should not just be an off shoot of the pandemic lockdowns but a deliberate strategy to improve the state of public health infrastructure and services with digital connectivity options.

But the private sectors' efforts to bring innovation and improvements towards digitalisation in the health care ecosystem in Nepal can be a precursor for the country's healthcare transformation. 

Due to this the sustainability of telehealth companies must be reviewed time and time again.

Read also: Digital path to social buffers in Nepal, Ashraya Dixit

Bishal Raj Paudyal is a Chartered Accountant and an MBA from Asian Institute of Technology in Bangkok. 

Sonia Awale


Sonia Awale is Executive Editor of Nepali Times where she also serves as the health, science and environment correspondent. She has extensively covered the climate crisis, disaster preparedness, development and public health -- looking at their political and economic interlinkages. Sonia is a graduate of public health, and has a master’s degree in journalism from the University of Hong Kong.