Bishal Raj Paudyal

The rise of telehealth -- delivery of medical services through electronic means of communication -- has remarkably emerged owing to the COVID-19 pandemic. In the US, the Centres for Disease Prevention and Control (CDC) recommended that healthcare facilities and providers offer clinical services through virtual means such as telehealth as a result of which growth in telehealth usage peaked in April 2020 but has since stabilised at 38 times higher than before COVID-19 hit. Needless to say, the US was amongst the first adopters of telehealth and has also been a mature user of tele-ICU services, with an estimated 11 per cent of American ICU beds under telemonitoring.

Adoption of telemedicine which was once tepid in Latin America (Chile, Argentina, Costa Rica, Mexico, Peru, and Columbia) due to insufficient communication infrastructure and status quo biases plus regulation deficiencies witnessed a breakthrough during the pandemic, thus making the virtues of telemedicine apparent. Argentina had passed legislation to validate electronic prescriptions and launched Tele-COVID, a public telemedicine provider.

Growth of telehealth
In the Asia Pacific region, Australia, Singapore, Indonesia, and the Philippine governments have been making consistent efforts to advance the use of telehealth through subsidies, funding, and loosening certain health regulations during the pandemic. In the developed countries, this was enabled by three factors. First is the willingness of increased number of consumers to use telehealth, second is the increased number of telehealth service providers and finally, regulatory changes enabling greater access and reimbursements.

While it is evident that government interventions and public sector support has been the key to creating favourable business environment for telehealth in those regions, it is yet to make headway in Nepal. As the country reels from the third wave of the coronavirus, many start-ups and corporate businesses provided telemedicine and digital health services to meet the growing needs of the mass market. But, will the surge in telemedicine services be sustainable post-pandemic? This may be a fruitful discourse for telehealth businesses in Nepal, and this article aims to shed some light on it.
In Nepal, the majority of dispensaries, hospitals, and doctors are located in urban areas where only 21 per cent of the population resides. Most of the medical practitioners are concentrated in metros, especially in prosperous areas. Rural, peri-urban, and urban slums lack adequate access to quality primary healthcare. Much of the care delivered in underserved areas is through private unlicensed providers commonly called Health Assistants (HA) or "quacks" or through public sector primary or community health centres.

Health tech start-ups and firms have made a successful market entry (i.e. timing) at the height of the pandemic, leading to an exponential boom in online consultations via apps, medicine delivery, and even health service at the patients' door, yet those quick wins should not serve as a precursor to reverse the focus of care, i.e., enabling access to specialist and super-specialist care to the untapped population of Nepal.

As the government's telemedicine strategy in twenty-five of the remote districts in Nepal has already proven defunct due to financial and operational constraints, the creation of strategic choices and the manner those choices cascade to the bottom of pyramid (BoP) markets will determine the sustainability status of health tech startups and corporate looking to gain a foothold in a challenging health care market.

During the COVID-19 pandemic, telehealth companies recorded an average growth of 70 per cent in basic telemedicine demand as compared to 2020. As promising as it sounds, online consultations on their own may not be enough for it to thrive post-pandemic phase, it has to be integrated into other services like home healthcare where the physicians go to the patients' home to provide the needed medical services including routine check-ups, administering medication and collection of medical samples for diagnostic purposes.

Fully integrated patient record allows clinicians to serve the patients best, no matter whether they present physically or remotely. Home delivery of prescribed medications adds to the safety and convenience of patients. Another emerging trend in the industry is modern healthcare subscriptions which may help expand the service offerings through the app and make services financially accessible to patients.

Built on proprietary technology, telehealth apps are seen to be the core products of telehealth companies in Nepal. Through the app, patients or their dependents are able to avail services of online video consultations, book hospital appointments, or even order medicines online. As this may be considered a good enough product 'app' for a nascent telehealth industry, acquiring and retaining customers may be challenging due to changing customer needs and preferences in the long run. It is for this reason that companies have to offer more than the basics, thus giving rise to better user engagement and experience imperatives.

Potential
Such imperatives must undergo a great amount of business analysis and planning exercises, phase-wise implementation, regular updates, and zero errors leading to faster processing of information and lower latency. Globally, telemedicine has the potential to revolutionise healthcare by bringing down provider and patient costs as well as improving the accessibility to quality medical professionals. In Nepal, it would be naïve to say that the government’s stay-at-home orders and the risk of COVID-19 transmissions at health care facilities were policy-level changes for boosting telemedicine service.

Unless the need for virtual health care doesn't come from the 'horse's mouth', the state of public health infrastructure and services would never overhaul for digitised health care. Due to its uncertainty in the future, the private sectors' efforts to bring innovation and improvements towards digitalisation in the health care ecosystem in Nepal shall always become a precursor to the country's healthcare transformation. Thus, the sustainability of telehealth companies is something that must be reviewed time and time again.

(Paudyal is a CA and holds MBA from AIT, Bangkok. bishalrajpaudyal@gmail.com)