Page 105 - ITU KALEIDOSCOPE, ATLANTA 2019

#RINGINGTHEALARM: CHRONIC “PILOTITIS” STUNTS
DIGITAL HEALTH IN NEPAL

1
Ichhya Pant ; Anubhuti Poudyal 2
1 George Washington University School of Public Health
2 George Washington University School of Medicine and Health Sciences

ABSTRACT mortality by 73%, infant mortality by 67%, and maternal
mortality by 76% over the course of a few decades after the
Nepal Health Sector Strategy (NHSS) 2015-2020 aspires to Millennium Development Goals (MDGs) declaration in
leverage digital health to improve health outcomes for 1990 [2]. In parallel, advances in mobile (138.59%) and
Nepalese citizens. At present, there is a paucity in evidence Internet market penetration (67.23%) have facilitated an
on digital health projects that have been implemented in uptake of electronic health (e-health) and mobile health (m-
Nepal. This study aims to map past and extant digital health health) tools and solutions within the health sector [6,7].
projects using Arksey and O’Malley’s scoping design
framework and assess projects using the World Health Globally, there is great enthusiasm for the potential of digital
Organization (WHO) building blocks of a health systems health solutions to radically improve population health
framework. Our findings shed light on the current actors in outcomes especially in low-resource settings [8]. Studies
the digital health space, the spectrum of health services have, however, recognized challenges in integrating m-
offered, along with opportunities and challenges to move health interventions into existing healthcare systems [9,10].
beyond “pilotitis”. In total, 20 digital health solutions were These challenges range from regulatory to technological and
identified through our review that were implemented user-specific [10]. Competing health priorities, under-
between 1993 to 2017. The momentum for digital health developed infrastructure, lack of knowledge among country
projects in Nepal is sporadic but continuous. Overall, digital or regional e-health policy makers concerning the potential
health solutions in Nepal are limited in scope, focus areas, applications of m-health and its recognition as an approach
target audiences and sustainability potential. At the national to health-related issues are some of the key barriers to digital
level, implementation of digital health projects is frayed, health uptake and institutional adoption [11]. However,
issue and organization-centric, and primarily driven by insufficient evidence remains the primary reason for the
donor or non-governmental organizations. Engaging the inability of governments to establish the effectiveness of
private sector, especially telecommunications companies, is digital health efforts in improving access or affordability of
an underutilized strategy to move beyond “pilotitis”. preventative, curative or rehabilitative services [11,12,13]
Existing pioneers in the space must engage in strategic and Nepal is no different. There is a paucity of
collaborative partnerships with the private sector or documentation and evidence related to digital health
incentivize independent commercial health technology solutions implemented in Nepal to date.
ventures.
To bridge this gap in documentation and evidence, this study
Keywords – Digital health, ICTs, Nepal, pilotitis aims to scope digital health solutions implemented in Nepal.

1. INTRODUCTION 2. METHODS

The health system in Nepal is fraught with systemic The study uses a scoping design to obtain information on
challenges due to factors such as the country’s status as an digital health initiatives in Nepal. Research activities were
economically least developed country, inaccessible conducted between June 2017 to September 2018. The
mountainous terrains and sociological and topographical George Washington University Institutional Review Board
diversity. Economic and demographic transitions, migration and Nepal Health Research Council (NHRC) approved this
and unplanned urbanization adversely influence the health of study. Scoping review is a method of synthesizing
the population as well [1,2]. A decade-long civil conflict and knowledge on studies when: it is difficult to employ a narrow
political turmoil has also contributed to worsening mental review question; synthesizing information from studies that
health outcomes, disruption of service delivery in impacted have used a wide variety of data collection and analysis
areas, and a compromised health policy and governance techniques; there is a scarcity of prior synthesis on the topic;
system [3,4,5]. Despite these setbacks and challenges, Nepal or a quality control mechanism of the reviewed sources will
has made significant progress in reducing under-five not be conducted [12,14,15]. This study replicated a scoping

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