Lack of government initiative, clear policy, and investment has hindered the success of Bhutan’s telemedicine project, a possible solution that could have alleviated problems for rural patients, like high rate of referrals to regional hospitals, caused by the chronic shortage of medical specialists in the country.
Introduced in 2000 to improve health care services by providing hospitals and basic health units (BHU) with the capability of sharing medical information, using information communications technology (ICT), the project today has achieved little success, despite pouring in more than Nu 5.4m.
“I wouldn’t say it’s been successful, but neither has it been unsuccessful,” said the telemedicine technician at the Thimphu national referral hospital, Jigme Dorji. He agreed that the project had not been expanded despite the benefits it could achieve for the medical system. So far, only 39 medical service sites, out of a possible 170, have telemedicine capability despite the project’s length. Of these 39 sites, 15 were included only this year in April.
Jigme Dorji said that the delay was caused by lack of electricity and, therefore, telecommunications facilities at some locations. But even when electricity was available, only dial-up internet connectivity could be provided, which limited the application of telemedicine. Uploading and downloading images, a vital part of telemedicine, was slow and tedious and discouraged its use, he said. “Telemedicine in Bhutan will only succeed with broadband,” said Jigme but, even then, he expressed doubt whether it would still be fully utilised.
Asked whether the project had been implemented too early, Jigme said that the capacity of the country’s infrastructure and medical system should have been taken into account before implementing the project. Broadband connection nationwide will be possible only by 2011.
Where the service is available, doctors and medical specialists either did not have adequate computer literacy or were “bogged down” with routine work, which led to the system being underutilised, he said. So far, only about 300 medical consultations took place, using the facilities since 2000.
Gaki Tshering, a senior ICT officer at the health ministry, said that enough effort was not made to integrate the project into the medical system. Even after providing IT training, doctors and specialists were reluctant to use the system, because it was seen as “extra work”.
Further exacerbating the situation, the medical system’s frequent transferring of medical staff meant that, sometimes, trained staff suddenly found themselves in remote locations with no telecommunications or even electricity.
The lack of an e-health policy also contributed to under utilisation of the system. Gaki Tshering said that, with no e-health policy, doctors and specialists were not obligated to use the system. She said that, if doctors and specialists recognised telemedicine as part of their jobs, they would devote more time to it.
Similarly, Jigme Dorji said that the project could be prioritised if the government converted it into a program. As a program, the government would be directly responsible for direct investment and ensuring its effective operation. Till now, the project has been financed by non-government organisations like WHO.
But both IT officers pointed out that the project, despite the challenges and slow rate of implementation, had achieved success when utilised. Early diagnosis and reducing the number of referrals had reduced costs of the medical services for rural patients.
To address the problem of under utilisation, JDWNRH has acquired 80 new computers that will be distributed to various medical departments when the new hospital complex is opened at the end of August. Doctors and medical specials have also requested for internet connections at home.
The health ministry will also be conducting a year long study of the 15 new sites that were added to the telemedicine project this year, to identify problems and their solutions, according to its secretary, Dasho (Dr) Gado Tshering.
“This is the only way forward for the medical services,” said Gaki Tshering on the future of telemedicine in Bhutan.
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Autor(en)/Author(s): Gyalsten K Dorj
Quelle/Source: Kuensel, Buhutan's National Newspaper, 03.08.2009
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