The power of telehealth: Improving access to care

The IHF created a special interest group focusing on telehealth as its adoption accelerated rapidly during the COVID-19 pandemic. The group shares knowledge and experience with this type of technology-driven transformation in hospitals and healthcare services throughout the world, providing lessons on how to optimize their clinical capacities and responding to chronic workforce shortages.

But telehealth’s potential extends far beyond the pandemic. Did you know that half of our planet lacks the vital access to medical expertise that they need?

Increasingly, telehealth technology is recognized as a sustainable solution to the complex problem of disparities in the delivery of core healthcare services: advancing diagnosis, treatment, and prevention for patients in remote and rural communities as well as providing training to local healthcare providers. With the capability to provide live videoconferencing, asynchronous video, remote patient monitoring and mobile health, telehealth can bridge the gap in access to care within the world’s most hard to reach communities.

The following case studies were presented in a special webinar on 16 March 2022, co-hosted by the International Hospital Federation and the Africa Healthcare Federation, in collaboration with the World Telehealth Initiative. Sharing on-the-ground testimonies from Bangladesh, Nigeria and Ethiopia, these case studies exemplify the ways in which telehealth can be used to improve patient outcomes and build medical skills and capacity in hard-to-reach communities.

Case study 1: Hope Foundation, Bangladesh

In Bangladesh, patients in remote and rural communities are most likely to experience disadvantages in healthcare as a result of a shortage of physicians. In 2021, the Hope Foundation for Women and Children of Bangladesh had almost 500,000 patient contacts with women and children across 68 facilities in Bangladesh, including a huge population of Rohingya refugees.

Dr Iftikher Mahmood, Founder and President of Hope Foundation, is a strong advocate for the integration of telehealth in primary care. Beginning in 2018, Hope’s telemedicine programme was established to enable specialist physicians from overseas to support the treatment of their patients.

Two devices are in use at two of Hope’s hospitals, one of which is a field hospital serving the Rohingya refugee population. International specialists in a range of fields, from internal medicine to neurology to psychiatry, volunteer their time and expertise in free, high-quality consultations. These specialisms are not available within the healthcare workforce of the remote communities served by Hope so, without telehealth, these patients would not be able to receive the specific care they need.

Dr Mahmood shared the story of one of hundreds of successful outcomes. A Rohingya patient, aged 63 and living in a refugee settlement, benefited from a telehealth consultation with a specialist in the USA. Presenting with a burning sensation in the upper abdomen, shortness of breath and a cough, the tests led to a diagnosis of peptic ulcer disease with acute exacerbation of bronchial asthma. With the simple treatment of an inhaler and dietary changes, the patient is now well and enjoying life.

With reports of so many successful outcomes, the government in Bangladesh is increasingly supportive of expanding telehealth care, particularly in rural areas, to complement the healthcare system and widen access to quality care.

Reflecting on the dual benefits of implementing telehealth devices, Dr Mahmood explains:

“Our patients are getting benefit, but our providers are also learning. We are using these devices for training our doctors, who are learning from the very experts from all over the world. That is a benefit that we sometimes overlook, but we should not.

To achieve the sustainable development goal of universal healthcare is not possible without telemedicine.”

Case study 2: Precious Gems, Nigeria

Nigeria has a population of almost 200 million people, the majority living in remote areas. With a lack of health services in rural communities, patients are forced to travel long distances to large cities for treatment.

In Opoji, Edo state, it was discovered that the majority of patients suffered from high blood pressure. Over several months, a telehealth programme was designed by Precious Gems in collaboration with the World Telehealth Initiative. The ambition was to enhance access to preventative and rehabilitative services, as well as to build local capacity through a clinical mentoring programme.

Dr Nosa Akpede, Executive Director of Precious Gems, coordinated the project. Extensive training was provided on using the device onsite to conduct patient care with the support of volunteer doctors overseas. Citing one recent example, Dr Nosa talked about a boy aged 3 years who was unable to hold his neck, crawl, stand, talk, or eat by himself. With the input of a specialist paediatrician in the USA, a diagnosis of cerebral palsy was made, and the local doctor and the boy’s mother received the support they needed to provide the appropriate care.

The local medical team report multiple benefits, including expanding their clinical knowledge, improving patient management, and the positive experiences of the patients who are able to interact with international experts.

Mr Vincent Isemoegua, a patient at Opoji Comprehensive Health Center, expressed what the programme means for the local community:

“That somebody in Esan Central can discuss with doctors in the US has not happened before. This has opened our eyes for medical check-ups. Our people have been going overseas for consultations which are now happening in Opoji. We appreciate you and are expecting more expansion with the telehealth machine.”

The future of telehealth is certain in Opoji. Healthcare workers and patients are enthusiastic about its use and the potential for expansion. Challenges remain, such as network connectivity, a lack of local laboratory equipment, and requirements for ongoing technical maintenance. However, Dr Nosa anticipates that there will be an emergence of people showing leadership to drive continuous development and to replicate the project not only across Nigeria but across the whole of Africa.

Case study 3: Bahir Dar Outreach for Neuroscience Education (BORNE), Ethiopia

Neurological diseases are one of the top burdens of noncommunicable disease in the world. Stroke remains the second leading cause of death worldwide with an annual mortality rate of 5.5 million.  The burden of stroke is especially high in Africa, where a complex set of problems contribute to the current difficulties, including lack of awareness, poverty and poor infrastructure.

Dr Mehari Gebreyohanns, Associate Professor, Department of Neurology, University of Texas Southwestern, was an early adopter of telehealth. Analysing the research, and with conclusions from his own practice, he has identified the proven advantages of telehealth for patients suffering strokes. For example, in underserved communities, the use of telehealth increased rates of thrombolysis treatment and resulted in fewer patients being transferred to primary stroke centres. It is also a cost-effective solution, especially taking into account the cumulative lifetime expenses for follow-up care.

Dr Gebreyohanns developed the Bahir Dar Outreach for Neuroscience Education (BORNE) initiative in north-west Ethiopia in 2017. At the time in Bahir Dar, no neurologists or stroke units were available for the local population of seven million. In fact, there was not even a word for “stroke” in Amharic (the local language) as the awareness of stroke as a medical condition was so low.

A formal partnership was established between the faculty of UT Southwestern and Bahir Dar University Hospital to provide a long-term commitment to facilitate collaborative educational, clinical, and research activities. Ongoing capacity-building activities include virtual lectures, online training and workshops. In care delivery, thrombolytic and stroke units are being created, the workforce is trained in acute stroke care, and adaptation of the NIHSS scale for stroke patient assessment are being adapted to fit the local language and culture.

Dr Gebreyohanns tackles challenges such as the “brain drain” of losing local skilled doctors head-on. An example of this is the identification of a talented local general practitioner who, when advocated for, was able to train as a specialist in Addis Ababa and is now running the BORNE neurology programme in the Bahir Dar region. He neatly sums up his approach to breaking down barriers for access to healthcare:

“Where there is will, where there is passion, there is a way. If you have very strong, very committed partners then anything is possible.”

To monitor the impact of telehealth programmes, measures include the frequency of usage, patient satisfaction with the care protocol and access to specialist care, and on-site health provider satisfaction with strengthened knowledge and reduction in patient transfers.

The World Health Organization is collaborating with World Telehealth Initiative to establish a roadmap of telehealth for the under-served. Established good practices include clarity of roles and responsibilities, and formal agreement around quality and confidentiality. For example:

  • the local provider always maintains full responsibility for patient care;
  • providers, both on-site and remote, join each telehealth session as an educational exchange, rather than for medical intervention;
  • participants are appropriately licensed;
  • providers maintain the standards of care in their current practice (don’t go outside, or encourage others to go outside, their scope of practice, etc.);
  • technology is of the highest security standards and is compliant with applicable regulations;
  • on-site partners provide a list of medicines and supplies available to the supporting physicians;
  • the patient signs a release if their story is to be shared.

These case studies shine a light on the power of telehealth as a sustainable solution to address the disparities in the delivery of core health services. For African countries, with large populations living in remote and rural communities, the potential is vast. In the words of Dr Amit Thakker, President of the Africa Healthcare Federation:

“The pandemic has revealed that if there’s one major change to bridge the geographical barrier to health, it’s going to be telemedicine.”

The webinar is available to watch in full: https://www.youtube.com/watch?v=dJ3BnlkjU6Y

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