Does Bangladesh need more Telemedicine providers?

In one of the most densely populated countries with frequent natural disasters and poor primary care facilities, need for telemedicine was realized at least 15 years back. About 80% of Bangladesh’s population stays in rural areas. However, the unequal distribution of physicians and healthcare providers is more alarming than many of its neighboring nations. The density of formally qualified registered Health Care Providers is 7.7 per 10,000 population, and constitutes only about 5% of the total health workforce.

While public and private healthcare entities need to exhibit higher traction, telemedicine is expected to:

  • Improve referral processes
  • Propagate specialist care to vast rural populations
  • Reduce waiting lists
  • Reduce travel costs for patients

 How do the rural healthcare facilities look?

  • While doctor to patient ratio is 1:1500 in urban areas; it is 1:15000 in rural
  • High vacancy in public rural health system – 40% of the Upazila Health Complexes (UHCs) have no RMO (Resident Medical Officers), and up to 74% of UHFWCs (Union Sub-centers) have no Medical Officer
  • Fairly young doctors with limited work experience
  • Rural health centers run by infirmary technicians with limited training
  • No specialists at Thana or Upazila levels

Current challenges towards implementing successful telemedicine models

  • Lack of adequate infrastructure to enable telemedicine
  • Inadequate monetization / revenue realization for private telemedicine entities
  • Concerns around security and patient confidentiality
  • Computer illiteracy and resistance among patients
  • Lack of medical devices (ECG/blood glucose/heart rate measurement etc.) for initial tele-diagnosis
  • Inadequate promotion and awareness creation
  • Low traction within doctors to participate in telemedicine networks owing to unclear medico-legal implications
  • Low internet bandwidth despite availability of optical fiber link in most districts

What are the current efforts targeted at?

Telemedicine efforts in Bangladesh started around 1999 and have been aimed at connecting various rural healthcare facilities with Dhaka based hospitals. A majority of these have been promoted by private entities as pilots. Some of them have yielded tangible results at a small scale while most have faded away due to lack of financial viability and government support.

Some of the key clinical areas where telemedicine initiatives are being conducted in Bangladesh include:

Diabetes: There have been efforts in telemedicine for various lifestyle related disorders such as diabetes in the country. In 2009, Telemedicine Reference Centre Limited (TRCL) in collaboration with Entra Health Systems of the U.S. had launched an mHealth service for diabetic patients.  This included routine home test of blood glucose using a Bluetooth glucometer connected to a mobile phone.

General consultation: TWgBD has also been pioneering various telehealth initiatives including its Android mobile app mDoctor. This is aimed at conducting video and teleconferencing via smartphones from patient’s home. The prescription is then sent to the mobile phone directly.

 



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