Tele-health and Telemedicine interventions for the Prevention and Management of COVID-19, its effectiveness and limitations in Nepal.

Research Report.

ABSTRACT:

Background: Due to COVID-19 pandemic, Nepal faced Public Health emergency with its extremely serious consequences on human life and economic activities. Government of Nepal imposed lockdown and made restriction in the movement that affected the entire health care delivery system. During the period, government had great challenges to manage the health services and provide treatment to the COVID infected cases as well as to manage the quarantines, and mobilize the health human resources. To address such issues during the pandemic period government and various private organizations initiated the tele-health and telemedicine services to improve the accessibility of healthcare services to the COVID and non-COVID patients. Government also focused on providing necessary information and counseling to the public through such services. This study aims to explore the use of tele-health and telemedicine interventions for the prevention and management of COVID-19, describe its effectiveness, and point out the limitations and challenges that were faced while implementing the service.


Methods: This is a cross-sectional study and has employed a mixed method (quantitative and qualitative) approach to collect data. Study information was collected from 10 different public and private organizations, from where 15 study participants were included who were involved in managing and delivering the tele-health and telemedicine services. Similarly, service users' perspective was taken from 20 respondents who were randomly selected from the caller list. The survey tool and interview questionnaire guideline was used, which were tested before collecting study data. The obtained qualitative data was transcribed through thematic analysis.


Results: The study findings show that the implementation of tele-health and telemedicine was the innovative approach to address the health need of patients during the COVID-19 pandemic. Patents were able to seek medical services and advice from their own home or from quarantine and isolation centers. It also supported patients to share their fear with the health workers and get psycho-social counseling as needed. The tele-health and telemedicine services provided during the pandemic period were provided at free of cost to the patients. The service users also highly appreciated the hotline services implemented by Ministry of Health and Population (MoHP) and Epidemiology and Disease Control Division (EDCD). Such services supported them to get the information timely in right way. Due to the restriction in the movement and lockdown, it was the only means to reach the doctors and health workers to get their support. However, the study shows the need of stronger commitment from the government side to form a regulatory unit to monitor the ongoing activities under tele-health and telemedicine service at both public and private organizations. Similarly the health worker involved the service delivery should be motivated and retained to improve the service delivery. At the service delivery sites, required infrastructure, technology, supporting accessories including internet service should be maintained to improve the communication between the health workers and patients. Similarly, the continuity of service has also remained as challenge due to the unavailability of necessary fund to support the program.

Conclusions: Tele-health and telemedicine services are innovative and effective means to provide the health care services and necessary information during the COVID-19 pandemic. The service was supportive for the patients during lockdown as they were able to consult with health workers and medical doctors without movement. However, the service was only available for the limited number of population due to low coverage of service. During the pandemic period most of the private organizations had provided the tele-health and telemedicine services on voluntary basis. So, it is necessary for the government to ensure the continuity of service by increasing the coverage of service area and also by promoting the private organizations by providing them with necessary technical and financial support and guidance.