Necessity of telemedicine in Covid-19 outbreak

Coronavirus and COVID-19 are currently two distressing names to people around the world. The World Health Organization (WHO) has declared it as a "pandemic", with total deaths around the world surpassing 31,000. It has spread to almost 195 countries, including both developed and underdeveloped countries, and 6 lakh people around the world have already been affected by it.

With lockdown in place almost all over the whole world, cities have become deserted and lackluster.  Because of the highly contagious nature of the virus, it has created panic among the doctors, nurses and patients alike. Not only the patients, but many doctors have also died from COVID-19 within the last few days.

Consumed by fear, many doctors are now reluctant to render service directly. In order to prevent the outbreak of the COVID-19, the government has imposed restrictions on the movement of the general people by declaring public holiday from March 26 to April 4, directing everyone to stay home.

At such a moment of crisis, the inability to physically consult doctors has emerged as a crucial obstacle for patients seeking medical assistance. The need for "Telemedicine" is imperative now more than ever.

Simply put, telemedicine is the provision of distance clinical services using electronic information and communication technologies, irrespective of the distance between the doctors and the patients.

The World Health Organization (WHO) has defined Telemedicine as, "the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of diseases and injuries, research and evaluation and for continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities".

Essentially, it is an approach to bridge the gap between two geographic locations and enable effective medical diagnosis.

Though telemedicine is a new buzzword in Bangladesh, it is widely used in developed countries. The history of telemedicine goes back to the invention of the telephone in the late 19th century.

It was first developed in USA in 1993. Among the developing countries, Brazil is considered one of the pioneers of telemedicine. In India, National Cancer Network, National Tele Ophthalmology, National Rural Telemedicine Network are the main national projects where telemedicine program has already been implemented.

In Bangladesh, the first telemedicine service was initiated by "Swinfen", a charitable organization in 1999, which established a link between the Centre for the Rehabilitation of the Paralyzed (CRP) in Dhaka and a senior medical consultant abroad.

Gradually, Diabetic Association of Bangladesh (DAB) introduced telemedicine as a pilot project. Banglalink launched a digital health service named "Health Link" in 2008, followed by Grameenphone, who launched their digital health service named "Tonic" in 2016.

The Ministry of Health and Family Welfare launched an official call centre named "Health Centre 16263" on 24 April 2016, where people can dial "16263" for any health advice and consult doctors. Later, BRAC launched "Maya Apa" in 2014and Distress Children & Infants International (DCI), a US-based NGO that introduced its telemedicine centre in 2014.

The demand for specialized doctors is not being met in Bangladesh. Nowadays, the lack of healthcare provision in rural areas is putting stress on the already strained urban healthcare services, with the rural population flocking to the cities to avail medical service.

Currently, we have 663 government hospitals in district headquarter and thana levels. The total number of hospital beds available in both public and private hospitals is 51,648. The ratio of hospital bed to citizen is around 1:2,57,1 with doctor to citizen being 1: 43,660.

However, the country's best doctors generally prefer to practice either in Dhaka or Chittagong, which results in the people living in rural areas not being able to access them.

According to a survey conducted by Bangladesh Health Watch, 86% of the doctors, 75% of the nurses, render services in urban areas, where only 20% of the population live.

That's why our government is trying to promote and mainstream the use of telemedicine to improve access to medical service provision.  According to the Bangladesh Telecommunication Regulatory Commission, currently there are 92 lakh mobile phone users, most of whom use smartphones.

By using smartphone apps, video conferencing, online management systems, a patient can consult doctors from anywhere, anytime through telemedicine.

It is assumed that if diagnosis is done properly, nearly 75% of patients would not need to be physically present before the doctors. Telemedicine is not only comparatively less costly than onsite doctor's visit, but it also improves the patient's satisfaction level through effective utilization of time and money. 

Currently, in Bangladesh, telemedicine is offered by 18 government institutions: Bangabandhu Sheikh Mujib Medical University, National Institute of Chest Disease and Hospital, National Institute of Cancer Research and Hospital and etc.

In the private sector, United Hospital provides telemedicine services to its patients. Moreover, 63 community clinics across the country are also rendering telemedicine services.

The government has taken an initiative to establish one community clinic for every 6,000 people. Telemedicine service has been piloted using Skype in 22 Union Information and Service Centre (UISC) operated by Access to Information (a2i) under the Prime Minister's Office. 

While the telemedicine industry is growing, there are still a few limitations. Resource limitation is one of the major problems in our country for initiating a new program. Although the prospects of telemedicine seemed promising, its high setup cost, poor infrastructure and lack of technical expertise came in the way. 

The most important obstacle for the implementation of telemedicine is gaining the trust of the patients and ensuring their privacy, especially for the rural population. The success of telemedicine will not only depend on the availability of the logistic supports but also the familiarity of the general people with this new practice.

In the 21st century, massive technological advancement has led the healthcare sector to develop drastically. It is said that healthy citizens are the greatest asset of any nation. Bangladesh is considering the health sector as one of the strongest pillars of sustainable development.

The importance of health has been reflected in our government's five-year plan where the healthcare sector has got one of the highest priorities. In the last national budget, our government allocated BDT 29,464 crore to the health sector. The government is taking initiatives to bring healthcare services to the doorstep of the grassroots people. 

COVID-19 pandemic has plagued the entire world. It is leading us to rethink and rebuild our entire medical care sector, hoping to capacitate it to best meet the growing demand for enhanced service provision. In that regard, telemedicine can be considered as one of the components that pave the way for better and uninterrupted medical care provision.

The author is a Banker, working at Pubali Bank Limited, Board Division, Head Office, Dhaka.