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Innovation: Healthcare at the doorstep

Pakistan is a developing country and as such, it is struggling hard to provide even the basic necessities to many of its citizens. Unfortunately, access to quality health care for a large part of the population, especially those living in rural and remote areas, is practically impossible.

It was to address the needs of people like these that the concept of eHealth came into being. EHealth has been defined as “the use of electronic information and communication technologies to provide and support health care when distance separates the participants” (Justin Starren, 2005). It is a new and emerging field in Pakistan and is seen as a possible route to providing health care in remote areas

The eHealth Association of Pakistan [eHAP] was established in 2008. EHAP is a non-profit organisation which aims to augment knowledge and advocate policy support for the widespread execution of eHealth programmes across Pakistan by providing a common platform to eHealth experts and other stakeholders from various segments of Pakistan.

Besides eHAP, there are also many NGOs that have utilised eHealth as a way to provide medical relief in unaccessible areas. One such project has been recently set up by the Aga Khan Development Network (AKDN) whereby 12 health centres were selected to provide eHealth services. Nurses and doctors, using computer networks, send pertinent information and images of the patients to the next level care facilities from where they receive expert advice and treatment regimens.

The eHealth initiative in Gilgit Baltistan is a wonderful example of how the use of technology can bring relief to a community.

Most of the areas in Gilgit Baltistan have a tough geography and a harsh climate; these communities are sometimes wholly or partially deprived of even basic health care facilities due to weather conditions and poor infrastructure. Moreover, health care providers serving in remote areas also get isolated due to these conditions.

EHealth addresses these constraints by connecting primary, secondary and tertiary health facilities through online software where the health care provider at the remote end sends patients’ details to the consultant at the next level facility who in response give his/ her suggestions on the case. The initiative has shown great success with high rates of satisfaction among healthcare providers and patients. Several success stories emerged in the first year of eHealth implementation, which show the benefits of this initiative.

In January 2010, a pregnant woman was lying with obstructed labour at a primary health centre (PHC); the roads were closed due to snow so she could not be shifted to a better facility. The LHV at the PHC consulted the doctor at the next level facility using eHealth, who prescribed medication to relieve pain and helped online and via phone to conduct the delivery. It was one of the first major successes which convinced health providers and the community to use eHealth.

In March 2010, when a landslide disaster isolated the Gojal (Northern Hunza) region, a boy came with severe dehydration to a nearby health centre. No boats or helicopters were operating due to heavy winds in the area. In this situation eHealth service was used for consultation with a paediatrician at the tertiary health centre. The child got the required treatment and his condition improved in a few hours. Few days later another primary health centre faced shortage of medicines; they attached the list of required drugs on iPath (an eHealth Service). On receipt of requisition, medicines were immediately sent by the field office using an army helicopter.

The Attabad landslide disaster lead to an increase in psychological cases such as depression and anxiety, which were difficult to address because of unavailability of any psychologist or psychiatrist in the entire area. EHealth assisted in this situation by allowing psychiatrists based in Abbottabad and Karachi to conduct online consultations, and train nurses and doctors to screen and provide initial treatment for mental health problems.

One might argue that eHealth is not a feasible solution in our context as we have a number of challenges. Some people raise the issue of shortage of electricity which puts computers out of use at any time without notice. The point is valid but UPS and generators can be installed for back-up. In addition, when we talk about eHealth equipment or devices, it includes cell phones as well.

Cell phones are being widely used in eHealth and are accessible to nearly everyone. According to statistics mobile phone users in Pakistan have increased from 300,000 in 2001 to over 100 million by the middle of 2011 (Pakistan Telecommunications Authority). These days there are user friendly softwares available, which can be installed in cell phones and can be utilised for various healthcare purposes such as imparting health education messages, getting expert health related opinion, etc. There are even apps that could record your heartbeats and convert them into MRI reports. Now imagine the scope and the endless possibilities.

Some may argue that the cost of equipment is unfeasible for a poor nation. But for organisations providing eHealth, it will be a one time investment and, in the long term, this would translate into saving for both the institutions and for the public. Imagine, one of the world’s leading surgeons, from any corner of the globe, supervising an operation in the remotest of rural areas in any part of the underdeveloped world; think of the implications of having access to such resources. The thought is mindblowing.

However, eHealth is still in its infancy; much effort is required to implement and fully exploit it at the local level. The need now is to build the capacity of all health care providers in the area of eHealth to transform the health care system in Pakistan.