Written by APF Pakistan Virtual Fellow (2023) Hamna Khuld

In the summer of 2023, the APF fellowship allowed me to work with Sehat Kahani, an innovative telemedicine network in Pakistan dedicated to delivering high-quality healthcare services to underserved communities. Their innovative model bridges the gap between patients and doctors by offering a convenient and comprehensive solution for accessing healthcare services. Sehat Kahani's model addresses social determinants of health, promotes health equity, and implements evidence-based strategies to positively impact individuals, families, and communities.

I worked on a case study to investigate telemedicine services through mobile units during flood emergencies and how these services improve health outcomes, reduce mortality rates, and enhance healthcare system resilience in disaster-affected areas.

It was evident that telehealth is the future of healthcare, making it possible for anyone anywhere to access a doctor or specialist. This is significant in developing countries, where many people reside in rural areas with limited healthcare resources.

Research Design:

One of the most enlightening aspects of this fellowship was delving deep into the realm of telehealth's impact during times of disaster. I had the opportunity to conduct semi-structured interviews with key stakeholders through the convenient medium of Zoom and email. These stakeholders included Sehat Kahani staff, healthcare providers, beneficiaries, funders, donors, and top-level management at Sehat Kahani. These interviews shed light on the methodologies employed in developing and sustaining telehealth services, especially in disaster-prone scenarios.

Sehat Kahani first implemented the physical camps and then a two-tier telehealth model. Physical camps were set up in the disaster areas and offered one-on-one medical assistance. The mobile units served as lifelines to underserved and remote areas when disaster struck in 2022. A van traveled across the affected areas, providing awareness and understanding of telehealth, and enhancing patient access, outcomes and experiences. The van traveled to 12 districts, 26 tehsils, and 86 villages – helping N=25,702 (Women=6,740; Girls=7,014, Elderly Women=883; Men=4,291; Boys=6,004; and Elderly Men=770). This rapid response undoubtedly saved lives and offered a glimmer of hope to communities in distress.

Simultaneously, the app ensured accessibility and on-demand healthcare services. It facilitated medical consultations, disseminated crucial health information, and offered unwavering support. The range of healthcare services available through the app was impressive, covering routine check-ups, chronic disease management, mental health support, and health education. It streamlined healthcare processes by reducing administrative overhead, offered the convenience of digital health records, and enabled remote monitoring of chronic conditions.

Findings:

From Sehat Kahni's innovative telemedicine model, the key findings included:

• Healthcare Needs and Telehealth Services:

  • The importance of comprehensive assessments, budget analysis, and collaboration with government agencies, community organizations such as colleges and mosques, and corporate partners like Lifebuoy and Zong.

• Accessibility Concerns in Telehealth Services:

  • Sehat Kahani's multi-tiered model combines mobile clinics and a "One Window" telehealth app–removing barriers to care and meeting the community's needs. Sehate Kahani collaborated with mosques and community elders to share resources. They also had healthcare providers who spoke the dialect of the region.

• Security, Privacy, and Confidentiality:

  • Safeguarding patient information and data protection regulations like HIPAA. But also maintained doctor-patient confidentiality in physical clinics and mobile units through spatial separation through curtains. 

• Effective Training for Healthcare Professionals:

  • Online training programs emphasize empathy, rapport, and technical proficiency for healthcare providers. Sehat Kahani had a constant stream of doctors trained every 15 days. By continuously training and updating healthcare professionals, they ensured the readiness of their teams to utilize telehealth technologies effectively in disaster situations.

• Managing Surge in Patient Volume:

  • Sehat Kahani's scalability measures and preparedness for increased patient volume ensure effective telehealth service delivery during disasters.

Fellowship experience:

Participating in the virtual fellowship with the Sehat Kahani team was a transformative experience that opened my eyes to the immense potential of telehealth services, particularly in disaster relief. Throughout the fellowship, I was privileged to engage with the dedicated individuals behind Sehat Kahani weekly. Our interactions ranged from meticulously planning research endeavors, including literature reviews and methodological approaches, to engaging with guest speakers who were healthcare professionals in Pakistan. These guest speakers provided invaluable insights into the intricacies of the healthcare system in the country and how telehealth could have a profound impact on it.

This experience taught me that disaster-affected communities possess remarkable resilience. Introducing telehealth services provided vital medical care and restored confidence in the healthcare system. It was evident that telehealth is the future of healthcare, making it possible for anyone anywhere to access a doctor or specialist. This is significant in developing countries, where many people reside in rural areas with limited healthcare resources.

My fellowship with Sehat Kahani was a profound journey of discovery. It showcased the incredible impact of telehealth services during times of crisis and underscored the importance of accessibility to quality healthcare, regardless of one's geographical location. The experience left me inspired by the resilience of communities in the face of adversity and convinced me that telehealth is a powerful tool for improving healthcare outcomes worldwide.