Nepalese across Nepal are often deprived of basic healthcare due to the excessive burden of Out-Of-Pocket payments, inaccessibility due to geographic location, hefty opportunity costs, and limited local medical support. These adversities that the low-income and low-middle-income families face greatly reduce and limit their access to basic healthcare facilities.

In terms of healthcare, Nepal has a rich mix of public and private entities that the local people can choose from, yet there is a clear gap between what the urban and rural regions have access to. Thick clusters of private healthcare facilities are present in urban areas, while the rural communities have less than minimum healthcare services at their disposal. The Nepal government has been trying to fill these facility gaps through the establishment of local health posts, the hiring of local health care experts and volunteers, as well as rolling out health campaigns with the support of local NGOs and INGOs. One of the best examples of these efforts include the Safe Motherhood Program, a subsidized government program through which a pregnant woman can attend a minimum number of pregnancy checkups, opt for institutional delivery, and get essential medications for free along with additional cash incentives. These initiatives and incentives, however, fall short on addressing other problems involved with the medical journey, such as travel costs, loss of wages, and information gaps, just to name a few. Therefore, if a mother were to simply deliver a child in a hospital, what was assumed a free service would actually end up totaling the massive sum of $305.76 USD.

This does not only cause a great disparity in the final fee of healthcare among different geographical regions and families of various classes, but also in their individual healthcare demands. The output results in increased Out-Of-Pocket (OOP) payments for low income and low-middle income families, while families coming from regions that have comparatively low development indicators are more likely to bear Catastrophic Health Expenditures (CHE). Studies have shown that households with educated household heads are more likely to incur CHE as a result of them being more cautious towards their family’s health. Therefore, families who do not bear CHE may not exactly be receiving affordable healthcare, they might just be avoiding it altogether.

One of the current focuses of the healthcare industry is on various innovations that aim to reduce the problems that patients have seeking healthcare, one such recent innovation is e-consultation applications. E-consultations, or electronic consultations, allows patients and health experts to communicate from a distance through a mobile application. Up until 2020, the Healthtech industry in Nepal was progressing at a snail’s pace, since then, the demand for contact-free and distant health facilities has been rising. As a result, e-consultation applications in Nepal have been rising and have been welcomed, being widely used by care seekers mostly from urban areas of the country. Just a few hundred kilometers away from the major cities of the country, however, such as Kathmandu, Nepalgunj, and Pokhara, the rural communities are deprived and unaware of these colorful healthcare innovations.

Families that come with little to no technical knowledge and literacy may not opt for e-consultation applications right away, but it is clear that they would be able to make use of these services even more than the urban population. These applications could easily solve the problems mentioned earlier, including geographical, financial, and medical limitations.

E-Appointment bookings against opportunity cost

Using telemedicine, general consultations can be performed virtually, saving a large proportion of the low income and low-middle income population time and money. They can decrease their time spent waiting through pre-appointment bookings, thus minimizing their opportunity cost. When general consultations are assured through virtual platforms, healthcare institutions will receive a lesser and more manageable number of footfalls. Furthermore, medicine can be prescribed virtually, for which virtual pharmacies will be readily available to deliver medical essentials. Various applications have also tailored their features to cater to the particular needs of patients with complicated long-term conditions. For example, the current leader of the telemedicine application industry, Jeevee, has features that allow users to upload a prescription while a pharmacist can digitize it. The application additionally allows users to request a blood supply, while also helping them to manage blood glucose.

At-home consultation against geographical adversities

At the convenience and consent of both the patients and the doctors, consultations at relevant time frames become possible. Virtual consultations additionally give the patient the option to choose amongst doctors that are practicing in different hospitals across multiple regions. Patients who are unable to use these applications on their own can get help from family members who are able to, and consultations would also be provided at the convenience of the family caretaker, if necessary.

The spectrum of medical fees against CHE and OOP

Patients can seek facilities from Medical Officers, Health Experts, MBBS graduates, or long-term experience holders. Doctors with different levels of qualifications can charge different fees for the consultation timeframe, therefore a patient can sign up for their consultation according to their budget. Elaborated medical profiles in these applications allow patients to search through a complete list of medical experts.

Virtual pharmacy against inventory gap

Virtual pharmacy applications are rising in number compared to e-consultation applications. These apps can warn medical customers about gaps in supply or goods shortages beforehand. Alongside this benefit, the prescription outputs of these e-consultations can be sent directly to virtual pharmacies, leading to a swift and hassle-free medical delivery.

Health information against biased assumptions

Databases including contact information of ambulances, pharmacies, clinics, and hospitals are available even in offline mode. Other applications, such as Hamro Doctor, allow doctors to upload blogs in response to general medical queries. Jeevee allows patients to be a part of chat groups in the Viber Application, one of the most widely used communication apps in Nepal. This gives patients the control to scan through already published FAQs and responses in the case of a similar medical condition. On top of this, information regarding a patient’s medical history will be digitally recorded for both patient and doctor to view conveniently, instead of relying on physical records.

Ultimately, virtual healthcare redistributes the limited resources of a low-income family for more efficient purposes. Care that may have been too difficult to seek is now available right at their fingertips, this not only reestablishes people’s faith in the rural healthcare system, but also motivates them not to neglect any health issues that they might come across. Financial resources are now saved, thus contributing to a better standard of living. The family would no longer have to fear catastrophic health expenditures. If a family member is sick, in most cases they will now be able to seek care on their own, especially if they are taught the inner workings behind telemedicine or other such facilities. Daily wage earners need not compromise their income in order to assist a family member in receiving healthcare in a distant health post or city area. Out of pocket expenditures for healthcare reduces drastically, and the family can focus on more important expenses such as food, education, agricultural expenditures, and much more.

Since the healthtech industry in Nepal is still maturing, we need added investments in technology, training, and consumer education. One of the best performing applications, Jeevee, almost doubled its user base from 34,000 to 60,000 in just a year, which is a positive sign, but still not good enough considering that these are urban-community based numbers.

Way forward: Assessing the digital gap

Understanding the gaps in technical investments, the Digital Nepal Framework 2019 has expanded digital healthcare opportunities while bringing to light to all of the potential projects and initiatives that can strengthen the digital service for consumers. Some of these plans include establishing the internet as an essential service, leading 5G networks deployment, establishing the National Cyber Security Center, and ensuring every citizen has a digital signature and a national biometric card. Under its healthtech initiatives, the Nepal Government aims to introduce the National Digital Healthcare Program under which there will be the virtual stop for receiving numerous kinds of public healthcare facilities. Focusing on the need for ad-hoc maternal care, it also aims to bring services like e-Maternal Care and Mobile Health Units. Other plans include a Centralized Telemedicine Center, drones for transporting emergency medical facilities, and establishing the E-Health Record System 2.0.

Even though we see a number of revolutionary technologies and digital journeys being mapped out by healthtech innovators, they are still in need of proper investment, preferably backed by the government. Healthtech can also be promoted by private institutes, such as private insurance companies, but when healthtech is a priority for the government, chances are that these services are more likely to be subsidized and developed, without the fear of aggressive policies that can pull apart the healthtech ecosystem. Investment and enthusiasm from private bodies have been witnessed and are still welcome, since their interests solely lie in the progress of the technology and the consumers that are excited about it, making healthtech more convenient, comprehensible, and market-friendly.

The key element that can bring about this rural healthtech revolution is digital literacy. Once the user is digitally empowered, using remote consultation portals can strengthen the healthcare supply chain module without physical interventions from any organizational body. This would bring about a much-needed healthtech revolution solely on the shoulders of the existing breakthrough technology.

Authors: Anushruti Adhikari, Nepal Institute for Policy Research