– SAHESHA Upadhyay
The WHO recommends a minimum of 2.5 health workers per 1,000 population as a general benchmark to ensure adequate access to essential health services. This ratio appears as an unconvincing goal for Nepal given its current ratio of 8.52 per 10,000 (or 0.85 per 1,000 population). This presents a major challenge in terms of healthcare access, particularly in rural areas where mountainous terrain has impeded infrastructure development. The emergence of digital healthcare technology, including telemedicine, tele-visits, remote monitoring, IoT equipment, wearables, and digital healthcare database management, offers a promising solution to bridge this gap. The successful integration of a digital healthcare system requires efficient and dependable energy infrastructure as a foundation. Nepal, therefore, needs to align its healthcare and energy goals if it is to fully realize the potential of digital healthcare technology.
Snapshot of Digital Healthcare in Nepal
In recognition of the potential impact of digital health on healthcare accessibility and quality, Nepal’s Digital Framework 2019 has identified health as one of its eight priority sectors and established seven initiatives aimed at leveraging digital tools and technologies that include:
- National Digital Healthcare Platform
- Next-Generation Digital Healthcare Facilities
- Electronic Health Records 2.0
- Mobile Health Units
- e-Maternal Care
- Drones for delivery of emergency medical supplies
- Centralized Telemedicine Center
Several online platforms, including Jeeve, Hamro Patro, TeleCareNepal, Tele Upchar, and Hello Health, have successfully been delivering digital healthcare services in Nepal. Their services range from e-consultation and drug prescription to drug delivery to electronic management of healthcare records. Post-COVID-19, Nepal’s telehealth and digital health technology sector has witnessed a significant growth. Despite Nepal’s healthcare system being on the brink of collapse during the pandemic, the need for innovative solutions that could deliver healthcare services to people remotely was amplified. As a result, the utilization of Internet and telephone technologies for consultations skyrocketed in both hospitals and clinics, with numerous new and cutting-edge applications emerging. Furthermore, the country experienced a remarkable transformation in digital payment technologies and services, contributing to the widespread adoption of digital health channels.
Electrification and Healthcare
Despite all the possibilities that digital technologies offer, the challenge is to equip these technologies with the best resources that will keep them running smoothly. Electrical power remains the backbone of hospital operations; we need it not only for powering specific healthcare devices and technologies but also for basic office operations works including lighting, communication, and refrigeration. We cannot emphasize the term “reliability” enough when discussing the availability of electricity in regard to healthcare access. Interruptions in electricity, even for just a few minutes, can have dire consequences, such as life-saving devices failing during medical procedures, or critical medicines becoming spoiled due to loss of refrigeration. Likewise, tele-visits and remote-diagnoses are out of the question, when electricity is simply not dependable. Electricity must be ubiquitous in Nepal for healthcare access to be universal.
We cannot overemphasize the term “reliability” when discussing the availability of electricity in regard to healthcare access. The Energy Progress Report 2020 indicates that 90 percent of Nepal’s population has access to electricity, yet despite this achievement, frequent power cuts in rural areas continue to pose difficulties for the proper functioning of healthcare facilities. According to the Nepal Electricity Authority, several districts, including Ilam, Panchthar, Taplejung, Okhaldhunga, Khotang, Solukhumbu, Bhojpur, Sankhuwasabha, Udayapur, Kavre, Makwanpur, Dhading, Nawalpur, Darchula, and Dolpa have very low electrification; Dolpa, Mugu, and Humla of Karnali Province have no connection to the national grid at all. The World Health Organization (WHO) also reports that only 65 percent of hospitals and 56 percent of non-hospital healthcare facilities in Nepal have a steady supply of electricity. Likewise, four percent of healthcare facilities in the country do not have access to any electricity supply. The issue of limited access to reliable electricity in healthcare facilities affects nearly one billion people globally, as reported by the United Nations.
For telemedicine and remote-diagnostic technologies to be successful, it is not only crucial for hospitals but also for individual households to have access to reliable electricity. Despite the widespread availability of affordable mobile devices and the expansion of 3G and 4G networks, which have led to a 90 percent coverage of wireless networks in Nepal, there are still significant gaps in coverage, particularly in rural areas. These limitations hinder effective telemedicine visits and remote diagnostics. As such, ensuring access to reliable electricity is essential for both powering devices and providing reliable broadband internet access.
The integration of alternative energy sources such as solar panels holds great promise as a transformative solution that can revolutionize healthcare services in Nepal. In many rural areas, solar power initiatives have already been successful, with 15 percent of the population gaining access to electricity through solar grids as reported by Nepal News news portal. Moreover, the cost of solar panels has decreased significantly in recent years, making it a more viable option for expanding healthcare services. By expanding these programs to rural healthcare facilities, Nepal can significantly improve the digitization of its healthcare technology and make healthcare facilities more reliable.
One way to achieve this is by implementing projects aimed at decentralizing electricity by providing every remote healthcare facility with its own solar panel grid. This not only has the potential to enhance service delivery but also make electricity access more resilient. Catastrophic climate events or any other national emergency will not interrupt the operation of specific healthcare facilities. A great example of this is St. Luke’s Hospital in Ethiopia, where a private renewable energy company provided assistance in implementing a groundbreaking solar hybrid system that delivers 320 KWh of electricity. This resulted in significant cost savings and improved service delivery.
In addition to its impact on healthcare delivery, the electrification of healthcare facilities can also have a profound effect on the distribution of healthcare professionals. A study has shown that access to reliable electricity and digital healthcare technology can serve as a powerful incentive for healthcare professionals, particularly in rural and remote areas. By making healthcare facilities more appealing and attractive, electrification can help attract and retain healthcare professionals in these areas, thereby increasing the availability of healthcare services for communities in need.
To ensure the longevity and effectiveness of these projects, regular maintenance of power plants and medical equipment, as well as personnel training, must be prioritized in the healthcare project design and budgeting process. Effective collaboration between stakeholders from both the healthcare and energy sectors, including public and private entities, can guarantee that healthcare needs are taken into consideration during the design and implementation of electrification projects. Finally, it is also important to draw attention to the fact that the adoption of digital healthcare, particularly telehealth, has far-reaching benefits that go beyond just improving individual health outcomes in rural areas. In addition to providing convenient access to medical services, by eliminating the need for frequent doctor-patient commutes, telehealth significantly reduces the carbon footprint associated with transportation