Since the rapid advancement in information and communication technology (ICT), digital health service has been a widespread concept with enormous opportunities to revolutionize the healthcare sector. It is even more important in developing countries like Bangladesh where the healthcare workforce shortage remains a critical issue.
The rising non-communicable diseases (NCDs) such as diabetes, stroke, ischemic heart disease, lung cancer etc which are the main reasons for causing deaths in Bangladesh, induces the need for early detection of disease and regular counseling. The air pollution in Dhaka and poor dietary patterns are triggering the NCDs. Besides, the aging population (aged 60 or above) in Bangladesh is expected to reach over 40 million which currently stands at 12.5 million.[1] Therefore, the use of digital health services can be a potential lifeline to enhance the capacity of the sector improving access to health services for all classes of people.
e-Health Services in Bangladesh: A Dire Need
Bangladesh is a country that suffers both from shortage and regional maldistribution of health workers. The country has only 6 doctors, nurses, and health assistants per 10,000 population which is far less than the minimum threshold of having 23 doctors, nurses, and midwives per 10,000 population set by the World Health Organization.[2]
FIGURE: Doctor-patient ratio and nurse-patient ratio in South Asian Countries / Source: World Health Organization
The doctor-patient ratio in Bangladesh is 5.26 which is less compared to other South Asian countries. Bangladesh also falls behind from its neighboring countries in the nurses-patient ratio as it has only 3.06 nurses to provide services per 10,000 population.[3]
FIGURE: Distribution of doctors by division / Source: Directorate General of Health Services
On top of that, a centralized health system leads health workers to be concentrated in urban hospitals even though 70% of the population dwells in rural areas. According to Directorate General of Health Services (DGHS), all the divisions except Dhaka have at least 40% vacant posts where Dhaka alone has 2,514 more doctors than the total number of posts authorized.[4] In such a condition, the inclusion of e-health services in the health sector has become a crucial need.
Ongoing e-Health Initiatives
e-Health refers to the process of leveraging ICT to connect healthcare providers, patients and governments. Telemedicine, electronic health records, digital platforms, mobile health services (m-Health) and clinical decision support fall under the umbrella of e-Health services. It helps to provide quality health service in real time reducing the hassle of scheduling appointments and waiting in lines.
In 1998, the e-Health initiative in Bangladesh began with the Ministry of Health & Family Welfare (MOHFW) undertaking the Health & Population Sector programs (HPSP) to increase the efficiency of health program implementation. Currently, e-Health is being given special emphasis by the Government as the nation moves towards the vision of Digital Bangladesh 2021.
FIGURE: Timeline of e-Health initiatives in Bangladesh.
In 2018, a National Digital Health Strategy was initiated as an essential step for using technology to improve the affordability, accessibility and quality of health services.[5] This strategy is intended to strengthen the healthcare system by providing direction for attempts to use digital technologies in a more coordinated manner.
m-Health Services in Bangladesh: A New Paradigm
Distance of hospitals, long waiting time and high cost of visit play an important role in availing treatment. Due to the high out-of-pocket expenditure (USD 24 in 2016) which is over 70% of the total health expenditure (USD 34 in 2016), 17% of the patients are discouraged from taking treatment.[7] 58% of the patients consult unqualified persons like pharmacy sellers, homeopaths, hakims etc. m-Health services can reduce cost, wait times by bringing doctors in people’s pockets.
With 147 million people using mobile phones, mobile health services appear to be an affordable, cheap and easy-to-use solution to tackle the shortage of healthcare resources.[6] m-Health services emerged in Bangladesh in mid-1999 when a mHealth link was established between the Centre for the Rehabilitation of the Paralyzed (CRP) in Dhaka and the Royal Navy Hospital in the UK.
FIGURE: Digital health service platforms of different telecommunications companies
From the private sector, telecommunication companies and various digital health startups have come up with innovative health solutions to help bridge the shortages of trained medical professionals in rural areas. Grameenphone has recently launched a digital health service titled ‘Tonic’ to provide increased access and aspirational support for people to combat illness through healthy dietary behavior and lifestyle. With a similar vision, Banglalink has launched its digital health service platform ‘Daktarbhai’ while Robi and MILVIK Bangladesh have collaboratively started ‘MyHealth’ service.
FIGURE: Health tech startups in Bangladesh
Over the last decade, healthcare tech startups have come forward to fill the gaps addressing major issues in creating quality discrepancies. With the number of smartphone users on increase, internet-based health solutions are expected to create noticeable impact. The startups can be clustered into the following areas according to their services.
| Type | Services | Start-up |
| Telemedicine | Facilitating remote service delivery | Jeeon |
| Appointment Scheduling | Assisting people to schedule appointments with doctors | Doctorola |
| Preventative Healthcare | Educating users to keep tracks on various parameters of health | CMED, Rx71 |
| Emergency Response | Ensuring emergency services | Criticalink |
| Pharmacy Delivery | Allowing online purchase of pharmaceutical products | e-Pharma, Pharma71 |
| Mental Health | Providing on-demand consultation | Maya Apa |
| Community Health | Providing consultation through helpful content for expecting mothers | Aponjon by D.net,
Health Nutrition and Population Programme by BRAC |
Key Obstacles in Adopting Digital Health Services
The need for adopting digital health services is indisputable in the current context of Bangladesh. Several factors are affecting the growth of these platforms.
Inadequate ICT Infrastructure: High cost of internet, unstable electricity supply and poor ICT infrastructure in rural areas make the e-Health systems ineffective.
Usability and User-Acceptance: The service recipients in rural areas are mostly not literate enough to use the systems. Rural people prefer to take the traditional treatments as they are not being familiarized with the concept properly. Moreover, a lot of people remain unaware of the systems due to the lack of promotions.
Resistance to Change: Having a skeptical mindset, elderly people in administration resist to get out of the manual system and adopt new technologies. Lack of motivation and the fear of being redundant due to the computerization of healthcare services causes this resistance to change.
Interoperability of Systems: Bangladesh lacks in developing interoperability between multiple systems which is crucial for establishing a fully functional e-Health system. No central database has been designed with health records of citizens to use in an emergency healthcare situation for which identifying the needs of patients becomes extremely difficult for doctors.
The Future: Reshaping the Healthcare Sector
As a heavily populated country, Bangladesh will keep continuing to face an ever growing demand for healthcare which is why eHealth and m-Health show a promising future in transforming and ensuring healthcare delivery to both rural and urban areas. This can be fostered with the right policy support.
Building ICT Infrastructure: Strong ICT infrastructure should be built from urban to the village level to make the successful execution of e-Health. Widespread promotion of e-Health needs to be done since it is still a new concept.
Providing Training: Physicians, nurses and administrative people should be given extensive training to adopt digital technologies for overcoming their resistance to change.
Developing e-Health Policies: Comprehensive national e-Health policy and strategies should be framed as well as electronic health records need to be developed to support the system and enable the acceptance of e-Health.
It is quite feasible to create a digital revolution in healthcare as the required components already exist. Policy implementation needs to be executed with a collaborative effort by the government and the private health sector to facilitate the digital health service platforms to reach every corner of the country.
Ishrat Jahan Holy, Trainee Consultant at LightCastle Partners, has prepared the write-up. For further clarifications, contact here: [email protected]
References
- 1. Bangladesh faces a challenge to ensure welfare of its aging population – Inter Press Service
- 2. Patient, doctors, nurses ratio: Bangladesh lags far behind its neighbours – Dhaka Tribune
- 3. Physicians (per 1,000 people) – The World Bank
- 4. Dhaka faces doctor glut while 20.4% DGHS posts lie vacant countrywide – Dhaka Tribune
- 5. Bangladesh initiates Digital Health Strategy -World Health Organization
- 6. Mobile Phone Subscribers in Bangladesh – Bangladesh Telecommunication Regulatory Commission
- 7. Over half of Bangladesh patients do not get proper treatment – Prothom Alo
