Page 107 - ITU KALEIDOSCOPE, ATLANTA 2019

ICT for Health: Networks, standards and innovation

(?) Smart Health Nepal 2017 convenience by being able to analyze and visualize data,
Private (3, 15%) monitor data collection and management in real time, and
˟ HealthNet Nepal Telemedicine Program 2004 more importantly improve data quality, have been well
* Health at Home Nepal 2007 received by impacted teams and stakeholders. The ability to
make informed decisions will soon be available at multiple
√ Safe SIM 2015 levels of the health system in Nepal due to these efforts.
*Ongoing √ Completed ˟ Discontinued (?) Unknown Ultimately, these efforts, if sustained, will strengthen health
sector governance and improve the availability and quality
Table 2 identifies the 20 projects, affiliated organizations, of health service delivery [32]. However, doing so will
implementation launch year and their current require forethought and development of data strategies with
implementation status. More projects had been completed feedback loops into implementation strategic plans. Our
(45%) compared to ongoing (40%) ones based on our review. review did not find any mention of either of these activities
At least one identified program, the earliest telemedicine happening in Nepal to date.
program offered in Nepal (HealthNet Nepal) has been
discontinued citing financial viability as their primary barrier 3.3 Health workforce
[26]. To understand these initiatives in greater depth, we
have categorized them per WHO health system building Frontline workers were the target audience for over half of
blocks [16]. the identified projects (55%) especially female community
health volunteers (FCHVs) [24,28,33-37]. Mid-level
3.1 Health service delivery medical personnel and health staff at remote locations were
also other beneficiaries of digital health initiatives in Nepal
Telehealth programs are the most prevalent form of service [19,23,29,38,39,42]. Scarcity of a readily available
delivery format for digital health solutions implemented in workforce trained and skilled in digital health
Nepal. Focus areas for digital health solutions ranged from implementation result in projects relying on internal training
health surveillance, adolescent, sexual, and reproductive to sensitize project staff in the use of technological solutions
health, detection of disease outbreaks, maternal and child [18,28]. Our review did not find existing academic digital
health, and mental health issues [25,26,35,36]. Services health programs in Nepal. Significant issues at the workforce
provided by digital health solutions focused on bolstering level cited by the initiatives reviewed in our study were poor
health information systems, increasing access and utilization coordination between ground level and higher-level staff and
of health services, increasing access to health information, educational, digital and data illiteracy within the workforce.
providing health education and generating health awareness, Readiness to utilize developed solutions was assessed
developing referral mechanisms, providing specialized infrequently.
healthcare via telemedicine, and improving technical
capacity among health professionals and frontline workers 3.4 Technology
[27,28,29,30].
Telecommunication-based digital health solutions were most
3.2 Health information prevalent. These solutions ranged from smart-phone
applications for patient monitoring, care or diagnosis, data
Health information systems developed for population health collection via a simple SMS-based reporting, telemedicine
surveillance, data collection and management, and patient [21] or population-health surveillance via health information
monitoring and support are the major focus areas for digital systems [38]. Challenges that hindered technological
health solutions implemented in Nepal. According to a implementation were weak mobile networks [40], slow
country profile on HMIS capacity developed by Measure Internet service [27], unreliable power [27,40], technical
Evaluation, the existence of a national health information difficulties such as unanticipated system errors and reliance
system (HIS) policy is unknown [31]. Currently, there is an on undeveloped ICT infrastructure [28].
HIS strategic plan and a national HIS coordinating body was
established in the past, but their current activities are also 3.5 Leadership and governance
unknown [31]. In 2016, the Nepalese MoH transitioned from
HMIS to DHIS-2. The DHIS-2 serves as a subnational level There are a few notable policy and strategic frameworks in
electronic system for aggregating routine facility or Nepal that speak towards the utility and uptake of digital
community service data. Its roll-out is in an early phase, health solutions. In 2014, the Nepal Health Sector Strategy
starting at the national level followed by the district level (NHSS) 2015-2020 was published by the Government of
then extending to health posts and primary care facilities in Nepal [41]. It functions as Nepal’s guide to graduate from
a few districts. Remote locations, underdeveloped “Least Developed Country” to “Middle Income Developing
information communication technology (ICT) infrastructure, Country” by 2022. Additionally, it articulates the nation’s
difficult terrain, digital data and technological literacy, and a commitment towards achieving universal health coverage
lack of data standards and interoperability have challenged (UHC) by placing health at the center of the overall
the implementation of health information systems [32,38]. socioeconomic development efforts. Per the NHSS, the GoN
However, substantial time savings in data collection and in collaboration with its development partners, aspires to
entry have helped mitigate these challenges. The increase in leverage novel technologies to address health challenges in

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