A Participatory Action Research approach to telemedicine supported health care delivery in rural Nepal
Rural and geographically isolated, the majority of Nepalese communities have very low incomes, poor transportation, and scarce health care resources; these people provide the context for this study. The consequences of these deprivations include high maternal and infant mortality rates, high prevalence of infectious disease and poverty. There are therefore exceptional challenges and disparities in meeting health care needs. However the recent advent of modern information communication technology (ICT) or Telemedicine has unleashed a new wave of opportunities for supporting the delivery of health care services.\ud \ud Despite suggestions that telemedicine will offer hope in developing countries there is only limited published evidence to support this claim. Telemedicine is and must remain a process of the delivery of care rather than a technology. The system must connect patients and healthcare professionals in a chain of care, rather than follow the wide array of existing or new and advanced technology.\ud \ud The successful introduction of telemedicine with tangible outputs requires an in-depth understanding of the existing health care system of the country and its challenges; strongly expressed ‘genuine need’ for the service by all the stakeholders as interested partners (patients, practitioners, health care service providers and the public); the actual status of ICT infrastructure in the country and costs. This study used a Participatory Action Research (PAR) approach to explore the feasibility, acceptability and impact of a telemedicine system in partnership with Dhulikhel Hospital: Kathmandu University Hospital and with three of its 12 rural, remote outreach centres, and the populations they serve. Participatory, repeated data collection methods included surveys, interviewing, listening and being with staff and communities over a two year period. The researcher and researched engaged in a complex inter-locking journey from which the Unlocking, Unblocking and Validation concepts emerged.\ud \ud The findings of this study emphasise the pivotal role that the rural health care workers play. Telemedicine not only has a place in improving access to healthcare through enhanced communication but it also empowers health care workers. These people need continued support to develop their competencies and boost their confidence within the changing health care environment.\ud \ud In conclusion telemedicine is primarily about people rather than technology. Effective and holistic telemedicine development is built upon a combined, interactive model involving access, communication and empowerment.
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