What is telemedicine and how can it ease pressure on Pakistan's healthcare system?

Telemedicine is one of the fastest growing markets in the world. According to a research conducted by Allied Market Research, the market is set to grow at a CAGR 25.90% from 2021 to 2030. The market size, which was valued at $40.21B in 2020, is poised for an expansion by nearly 11 times to reach a whopping $431.82B by the end of 2030, globally.

What is telemedicine? Telemedicine allows health care professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology. Recently, especially after the Covid-19 pandemic, it has become increasingly clear that telemedicine is likely to become a major aspect of primary healthcare.

For a country like ours, whose primary healthcare needs are not adequately met so much so that almost half the population has no access to qualified doctors, telemedicine can play a crucial role in bridging the gap that currently exists in the market. To give perspective, the author would like to highlight that according to the Pakistan Medical Commission, there are 271,560 doctors registered in the country out of which 46.9% are females and 53.1% are males. Mathematically, there are, on paper, 1.18 doctors registered for every 1,000 people in Pakistan, which has a population of about 230 million. By ‘on paper’ the author assumes that all the registered doctors are practicing in Pakistan.

The trouble with the current stats is that it does not depict the ground reality. If one were to go by the stats only, it would mean that one would find a doctor in every area where there is a population of a thousand lives. However, in reality it is highly skewed because of multiple factors which include a high population of non-practicing female doctors who are not practicing courtesy the environment which is not very conducive for them, immigration of doctors for better opportunities abroad and unwillingness of qualified doctors to practice in smaller cities and towns owing to a lack of earning opportunities.

It should not be surprising that around 25,000 doctors are working abroad. To make the matter worse, in Pakistan while the percentage of female doctors in medical colleges is as high as 80-85 percent, the percentage of female doctors in the medical force remains below 50%.  It is estimated that half of the female students will not pursue medicine following graduation. In one of the research papers authored by Farhat Moazam and Sualeha Sheikhani, they have highlighted the fact that parents in Pakistan actively channel their daughters in medical education considering it to be the most respectable and a safety net should something go wrong with the marriage. However, they only end up being doctor-brides.

As far as performance of our healthcare system is concerned, Pakistan ranks 130 on the list of 195 countries by securing a 30.4 Index Score on Global Health Security Index (GHSI) according to the report issued by the organization in 2021. Having no or limited access to doctors for primary care is a major reason why ailments which can be easily prevented or managed by having early diagnosis get out of control, which subsequently pushes the patient to require secondary or tertiary care hence resulting in more burden than our health system is perhaps capable of handling.

Given the above, it becomes an absolute need of the hour to formulate policies that would encourage the use of telemedicine technology by the government as it is impossible to produce the required number of doctors so as to meet the demand. Our universities simply do not have this much production capacity. Even if, by any chance, they could, the problem would remain untampered in suburbs, villages and small districts as it does not make commercial sense for most of the doctors to practice there. A doctor, once qualified, would naturally want a better lifestyle and practice opportunities in larger cities.

The author would like to put forth a few suggestions that can help in reducing the gap. The government should make it a policy of having a teleconsultation before visiting a clinic or a hospital in person. The patient should only visit a clinic or a hospital if there is an emergency of nature that requires physical intervention or when he/she has been advised by the teleconsultant to go and see a physician in person. This will not only help in reducing the load on the healthcare system in Pakistan but more importantly would democratize healthcare access and cut on the fuel and time costs that patients incur when they are required to go and see a physician in person. Unignorably, the female doctor population, which is presently deprived of opportunities to practice will also be able to serve the country.

Fortunately, we live in a time where people are now more open to adapting technology for most of their needs and the private sector too is aggressively working on developing holistic solutions. There are now a lot of companies that have come up with web and mobile applications that have made it very easy to consult online with physicians. However, the government needs to incentivize the sector and provide them with their full support so that it not only helps in reducing the burden of our health system but more importantly opens avenues for remote employment of out-of-practice doctors especially female doctors and the supporting staff. The government needs to act now!