EFFECTIVENESS OF TELEMEDICINE HEALTHCARE SERVICES IN RURAL AREAS OF BANGLADESH: A STUDY ON SELECTED VILLAGES
Background: Bangladesh's healthcare system faces challenges in providing equitable access and quality healthcare to rural and remote communities compared to urban areas. To address these issues, the country has incorporated telemedicine into its healthcare system.
Aims: This study aimed to assess the effectiveness of telemedicine services in rural Bangladesh.
Methods: The study employed a mixed-method approach, including survey questionnaires and in-depth interviews. 100 participants were selected for the questionnaire survey for quantitative data, and 20 in-depth interviews were conducted to collect qualitative data.
Results: The findings indicate that telemedicine has garnered a positive reception among rural residents. An overwhelming 86% regarded telemedicine as a cost-effective healthcare option. 44% reported accessing telemedicine services within 10 minutes, demonstrating their accessibility. Furthermore, a majority (54%) expressed satisfaction with telemedicine services. However, dissatisfaction was noted concerning the physical environment of the telemedicine centers.
Conclusion: Overall, telemedicine in Bangladesh has proven effective in cost savings and time efficiency and has gained significant acceptance among rural residents. To further improve healthcare accessibility, expanding telemedicine centers to reach every remote union in Bangladesh is imperative. Additionally, raising awareness, providing ICT and telemedicine education, and ensuring affordable and reliable internet connectivity will maximize the potential of telemedicine services, ultimately benefiting underprivileged rural populations.
Keywords: healthcare, rural Bangladesh, telehealth, telemedicine
Introduction
Healthcare in Bangladesh is still a burning issue due to its high-density population and inadequate organizational and infrastructural capacity. The current population size of the country is 165 million, among which 113 million people live in rural areas . With this vast population in the rural area, it becomes the government’s responsibility to provide equal health services and access to the rural people as to the urban. However, reaching rural people with equal health services is still challenging due to geographical, infrastructural, and human resource barriers. The HRH (Human Resource for Health) Data Sheet 2019 shows an estimated 8.3 doctors, nurses, and midwives per 10,000 population(Health & Welfare, 2019). Addressing these barriers, the Government of Bangladesh (GoB) developed an innovation in its health sector with telemedicine. Telemedicine uses electronic communication technology to exchange health or medical-related information from one place to another to improve the patient’s clinical health status(Association, 2017). Instead of visiting the doctor physically, telemedicine allows patients to communicate with a doctor using technology. Considering the challenging healthcare conditions of the country, telemedicine service can be a blessing(Akhtar et al., 2019). It is an effective instrument for providing healthcare from a distant location(Prodhan et al., 2016). Telemedicine has been defined by the World Health Organization (WHO) as
“the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation and the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities”
(Organization, 2010). The primary intention of telemedicine service is to enhance healthcare services to geographically underprivileged and medically underserved populations by delivering high-quality care at a reduced cost as well as with greater convenience(LeRouge & Garfield, 2013).
The concept of telemedicine is not very new in Bangladesh. The Ministry of Health and Family Welfare (MOHFW) initiated e-health services in 1998 to improve public healthcare systems, though telemedicine was founded in 1999(Hoque & Bao, 2015). However, it has remained beyond the reach of much of the underprivileged population due to inadequate attention(Nessa et al., 2008). In partial fulfillment of the Digital Bangladesh Vision 2021, telemedicine was adopted under MOHFW in several public hospitals in 2010(Zobair et al., 2020). Since then, a number of public and private telemedicine initiatives have been undertaken within the country.
Telemedicine could serve as a less expensive and easier means to deliver medical services to a large number of people in remote places while utilizing limited resources(Hudson, 2006)(Chavula, 2013). A previous study found that telemedicine has significantly reduced the cost and travel time of patients as compared to its counterpart conventional approach(Sorwar et al., 2016). It has the potential to improve access to quality health services in remote places(Nessa et al., 2008).
In addition to economic considerations, consumer satisfaction is an important issue to consider when designing a telemedicine program because it indicates how effectively the medium satisfies patients' expectations(Kruse et al., 2017). Prior research identified that factors like social influence, perceived usefulness, and satisfaction positively affect an individual’s intention to use telemedicine services. In contrast, other factors like resistance to change and technology anxiety negatively influence it(Rahman & Hoque, 2018). Another study found that patients’ expectations for adopting telemedicine health services are highly influenced by self-efficacy, telemedicine experience, enjoyment, and prior satisfaction(Zobair et al., 2019).
However, the journey of telemedicine in Bangladesh has never been so flawless. Several impediments still affect the successful implementation of telemedicine services within the country.(Hakim, 2016)mentioned that lack of adequate funding, patients' worries concerning telemedicine, a lack of public education for the use of e- health services, software weaknesses to deal with growing workloads, a lack of technically competent workers, lack of a complete legal structure regarding telemedicine, shortage of telemedicine- related policy, and an absence of telecommunication network in a few parts of the country are some of the issues that affect telemedicine implementation in public hospitals of Bangladesh. This is supported by(Khatun & Sima, 2015)have also agreed to the facts; however,(Zobair et al., 2020)argued that organizational ineffectiveness, quality of care, motivation of the health staff, and patients’ trustworthiness are the prevalent barriers to telemedicine service in rural public hospitals. Moreover, the patient’s data security in the existing telemedicine system is a matter of concern(Nusrat et al., 2019).
The above literature indicates that a few studies have been conducted considering the potentiality and the prevalent challenges and barriers to implementing telemedicine services. However, very little or no exploratory research is available on the consumers’ perception regarding telemedicine in the local context of Bangladesh; particularly, no studies have been conducted in the study area. Therefore, this study aims to explore the effectiveness of a telemedicine healthcare service among rural people in Bangladesh. The geographic variances and people’s orientation to various localities have substantially made the paper unique, and it will further assist the concerned authority in taking the required actions to improve the service effectiveness and acceptability among rural people in Bangladesh.
Method
Research Design
A mixed-method research technique was used, which combined quantitative and qualitative approaches. Mixed-method data collection facilitates exploring, unraveling, and understanding
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