EHS-COVID (475) Q2 How have you responded to the challenges of COVID-19? (3) Digital health

25 November, 2021

Digital health, and particularly telemedicine, has been widely promoted and implemented throughout the pandemic. This perspective paper from Bangladesh provides a concise description of barriers to telemedicine and recommendations for the future. Citation, abstract, extracts and a comment from me below.

CITATION: Saifur Rahman Chowdhury,Tachlima Chowdhury Sunna,Shakil Ahmed

Telemedicine is an important aspect of healthcare services amid COVID-19 outbreak: Its barriers in Bangladesh and strategies to overcome

The International Journal of Health Planning and Management.

First published: 28 August 2020 https://doi.org/10.1002/hpm.3064

https://onlinelibrary.wiley.com/doi/10.1002/hpm.3064

ABSTRACT

The current pandemic of coronavirus disease 19 (COVID-19) has been a global concern since early 2020, where the number of COVID-19 cases is also on a rapid surge in Bangladesh with the report of a total of 276,549 cases after the detection of the first three cases in this country on 8 March 2020. The COVID-19 pandemic has made a seismic shift in the healthcare delivery system, where physician offices have accelerated digital health solutions at record speed, putting telemedicine (i.e., telehealth) at centre stage. Amid the severely contagious COVID-19, telemedicine has moved from being an optional service to an essential one. As the developing country, there are some barriers to get evenly distributed advantages of this approach due to the digital divides and disparities. In this commentary, we have described the importance of telemedicine service amid the outbreak of COVID-19 in Bangladesh, the barriers and challenges that the country is facing to implement this approach and the strategies to overcome these barriers in this developing country.

SELECTED EXTRACTS

Due to the highly contagious nature of the virus, it has made panic among the doctors, nurses and patients alike. In Bangladesh, after its outbreak, not only the patients, but many doctors and nurses have also become the victim of COVID-19 and died from it. Because of the fear and anxiety, many doctors are now reluctant to render services directly and many of them have stopped their private practices also.

BARRIERS OF TELEMEDICINE SERVICES IN BANGLADESH

Limited ICT access...

Lack of Internet awareness... 67% of people in Bangladesh do not have Internet awareness, they do not know how to use the Internet and even 27% do not know how to use a basic mobile phone.

Lack of infrastructural support...

Lack of motivation... Older administrative staff in the hospital sectors of Bangladesh has a lack of motivation to start up a new system and resistance to change.

Patient dissatisfaction and lack of trust and effective communication

Low health literacy... a study conducted in 2017 found that 7% of respondents had very poor, 49% had poor and 41% had fair oral health literacy level.

Lack of digital security in the telemedicine sector...

RECOMMENDATIONS AND PATH AHEAD

Expansion of ICT access...

Expansion of equipment facilities and infrastructural support...

Accommodations for patient language, literacy and disability...

Increasing awareness and telehealth literacy training...

Digital empathy and webside manner. It is more challenging to emanate compassion and empathy in a digitally connected platform for those who deliver care. So, medical education must update and needs to include the approach of conveying empathy to patients during telehealth care. Just as bedside manner has been central to medical education for over the period, ‘webside manner’ must also be learned and ultimately richly embedded into the fabric of training and practice.

Increasing patient's satisfaction by ensuring qualities of care...

Making telemedicine laws and reimbursement policies...

COMMENT (NPW): Much of the above is familiar, although it's interesting to read there was 'panic among the doctors, nurses and patients alike' and that many health workers were reluctant to provide direct care. To what extent has fear driven changes in health workforce deployment in Bangladesh as compared with other countries? In the UK, I think the vast majority of the health workforce continued to work, and many who were recently retired signed up to contribute. The term 'webside manner' is new to me, but is indeed likely to be important for communication, trust and patient experience. There was a very good article in the BMJ last year on how to do virtual consultations: https://www.bmj.com/content/371/bmj.m3945

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org