Page 108 - ITU KALEIDOSCOPE, ATLANTA 2019

2019 ITU Kaleidoscope Academic Conference

the country. Recognizing that health is a critical indicator of alignment with the results of a global e-health survey
economic advancement, NHSS stipulates ICT such as digital conducted by the WHO which note that financial
health tools as essential in improving access and quality of management in e-health and m-health is largely fulfilled by
health services delivery [43]. Nepal's eHealth Strategy was donors [50]. Among the identified projects, 85% were
published in 2017 which documents the vision of using e- conducted in multi-sectoral collaborative partnership
health to facilitate the delivery of accountable, equitable and between donors, non-governmental organizations, or the
high-quality health service delivery [18,37]. GoN. Some of these actors collaborated directly with the
GoN at the national level. Other collaborations were with the
Evidence supports the notion that investments made to regional or local governing bodies. Direct financial
bolster ICT infrastructure result in tangible improvements in assistance from the government was not apparent in our
economic growth and achievement of human development review aside from the allocated funding for the Hello Health
milestones especially for developing countries [39,44]. telemedicine program. Financial stability was an important
However, mirroring the economic divide between developed, indicator of the sustainability of identified projects. Irregular
developing and least developed nations is the digital divide funding has been noted as a significant hindrance to the
defined as the difference between the uptake and utilization effective implementation of projects [27]. Assessing
of ICT in the daily lives of citizens [45]. Reflecting this economic feasibility was also a rarity among identified
digital divide, Nepal ranks 165th in the e-government initiatives despite most projects indicating monitoring and
development index [38,46]. The ICT policy environment in evaluation frameworks at the project level. One identified
Nepal does not meet modern demands mired by endemic project ended their feasibility trial without plans for scaling
corruption, political instability and civil conflict [6,47]. A up despite improvement in project indicators after
detailed strategic framework has been put forward to performing an economic evaluation which determined the
improve access to quality healthcare using ICT and modern program was not worth the financial and human costs
technologies in the latest update to the national ICT policy. incurred by their organization [28].
This will be achieved through an increased investment in
ICT-based healthcare systems with a special emphasis on Very few projects discussed the potential of sustainability.
telemedicine programs. These systems and networks will be Identified projects were primarily feasibility trials in early-
developed and implemented through a collaborative phases (85%) conducted in rural areas (65%). Since most of
approach involving public, private and civil society actors. these projects were short-term, the results ended with no
Regulatory frameworks will be developed to guide and plans to continue the initiative after the end of the funding
govern health information and ensure security measures period. The GoN was identified as the appropriate lead actor
curtail any privacy and ethical concerns [48,49]. So far, three in taking ownership of the space and assessing the
policies have been established that address digital health effectiveness of digital health solutions in Nepal then
efforts in Nepal: Nepal E-governance Interoperability working towards scaling them up through integration and
Framework, Electronic Transaction Act and institutionalization with national-level systems [27].
Telecommunication Policy [18]. The Nepalese Ministry of Leadership turnover, especially when multiple partners were
Health (MoH) has identified the formulation and involved, was identified as a contributing factor for the
institutionalization of a national e-health steering committee failure of digital health solutions [23,28,40].
and task force to govern strategic planning,
institutionalization of an e-health unit at the MoH, 4. DISCUSSION
procurement of resources and technical assistance,
development of prioritized e-health plans. This is reflected in Due to a recent constitutional mandate, Nepal is currently in
annual work plans and budgets, development of legal the process of transitioning to a federal state. Local
provisions such as a Health Information Act to address data municipal governing bodies will soon fully assume the
use, privacy and confidentiality issues, and development of responsibility of health-sector planning, budgeting and
monitoring and evaluation frameworks embedded into oversight of health service delivery. In parallel, the country’s
NHSS as prerequisites to achieving the goals set forth in the commitment to UHC and its quest to develop high-quality
national eHealth strategy of 2017. health systems to meet Sustainable Health Development
Goals (SDGs) by 2025 place Nepal at an opportune juncture
3.6 Financing and sustainability to map out its strategic course of action within the health
sector. This is an apt time to assess where digital health
More than half of the 20 initiatives were implemented by solutions fit within the current health system and how they
international or national-level non-profit organizations can be leveraged in impactful ways. The implementation
(I/NGOs) such as RTI International, USAID, GIZ, Possible timeline and trajectory represented by our review indicate
Health, Nick Simon’s Institute, and One Heart Worldwide that the momentum for digital health solutions has been
(Table 2). This contrasts the findings of Ahmed et al. [12] in sporadic but continuous in Nepal. Its evolution is still in
Bangladesh where the private sector leads the development nascent stages thus presenting opportunities to influence it
and implementation of digital health solutions. In Nepal, the with evidence-based and data-driven strategies. In the past
private sector is the least prolific in this space (15%). Digital 25 years, there has been an absence of diversity in the
health solutions in Nepal appear to be mainly donor (55%) application, utilization and uptake of digital health solutions
and government driven (30%). Our findings, however, are in in Nepal demonstrated by the limited scope, focus areas,

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