Telemedicine for Bangladesh: Bridging the Doctor-Patient Gap

    LightCastle Analytics Wing
    LightCastle Analytics Wing
    Telemedicine Industry Bangladesh LightCastle

    The Bangladesh healthcare system has improved by leaps and bounds over the past few decades. The country has outperformed many of its South-Asian neighbours and has been lauded for its achievements worldwide in reducing maternal, infant, and under-5 mortality rates (63% decrease in child death rate over 20 years)[17] , increasing vaccination coverage and increasing life expectancy at birth.[1] Despite so many milestones, the shortage of doctors is quickly becoming one of the most pressing concerns for the country and has severely limited access to healthcare for all citizens.

    Healthcare in Bangladesh Right Now

    The country currently has only 6 doctors for every 10,000 citizens.[2] This is extremely problematic because about 64% of the population resides in rural areas and thus have to travel very long distances for access to healthcare services.[3] Moreover, due to this shortage people are facing very long queues at healthcare facilities and getting very little time for each appointment.

    Figure: Distribution of Doctors by Division / Source: Directorate General of Health Services

    With most divisions having major vacancies, Dhaka has 43% more doctors than total posts. This suggests that our healthcare system is heavily focused on the capital while most places go underserved.

    Telemedicine: Expanding the Scope of Healthcare

    Telemedicine allows healthcare professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. This practice has reduced costs and time and has saved lives. As a result, the global telemedicine market has been growing rapidly for the past few years and promises future growth according to multiple industry estimates with an estimated CAGR (Compound Annual Growth Rate) of about 15.1% up to 2027.[7]

    Figure: Telemedicine Market Growth (in USD Millions) / Source: Grand View Research

    The telemedicine market is a subset of the greater telehealth market. Although there is promise for rapid growth, North America alone accounted for around 60.3% of the total Telehealth market in 2019 and is forecasted to stay the leaders at least upto 2025. During this period, the Asian market is forecasted to grow the fastest.[5]

    Figure: Telehealth Market by Region (USD Billion)/ Source: Markets and Markets

    Telemedicine in Bangladesh

    A Jittery Start

    Telemedicine practices began in Bangladesh through the Center for Rehabilitation of Paralyzed (CRP) with the funding of the Swinfen Charitable Trust of the UK in 1999. This ushered some other projects that relied on technology and telecom services to reach patients.

    First Telemedicine Projects in Bangladesh

    OrganizationOperation Summary
    Center for Rehabilitation of Paralyzed (CRP)1. Uses store and forward based Telemedicine 
    2. Digital camera is used for capturing images
    3. No real time technology is used 
    4. Indoor patients are free for Telemedicine and outdoor patients need 1000 taka for consultation.
    5. No Storage of Patient Data
    Telemedicine Reference Center Limited (TRCL)1. Telemedicine services between Bangladeshi physicians and United States
    2. Used Icare software 
    3. Internet is used for the service
    Sustainable Development Network Program (SDNP)1. VSAT is used for this project 
    2. Connected different nodes of Bangladesh.
    3. Different consultancy and diagnostic support are given
    BUET and Comfort Nursing Home1. Uses store and forward based Telemedicine 
    2. This project was running for a short period of time.
    Bangladesh DNS diagnoses Centre, and Comfort Diagnoses & Nursing Home1. This project was discontinuous for financial reasons 
    2. Lack of promotional activities found 
    3. Patient disinterest also observed 
    DAB and Faridpur General Hospital1. Hardware failure was found in this project
    2. Internet connection was disrupted 
    3. Power failure was frequent 
    4. Performance of the camera used was not satisfactory 
    5. Radio link was used for Internet connectivity 
    6. 600 taka was the fees for consultation 
    Mobile Maternal, Newborn, and Child Health (MNCH) BRAC1. Slum people are the beneficiary of this project 
    2. Patient data is stored in the BRAC data center for further use and treatment plan 
    3. Limited cost for the service 
    4. Android phone is used for the information entry and update
    Table: The First Telemedicine Services in Bangladesh [6]

    Although some of these efforts gained initial success, they eventually lost customers to traditional hospitals and healthcare services. 

    Why did the Forerunners Fall Short?

    There are multiple opinions about why these initial efforts did not work out. Some of the most credible ones are:

    1. Lack of Marketing: Given how people were asked to go against traditional healthcare systems, changing consumer behaviour was very necessary. These early telemedicine approaches lacked the outreach and operated in a very small market. Thus people eventually opted out of these services and chose traditional face to face consultations over remote help.
    2. Poor Logistics: It is pretty evident from their mode of operation that these projects operated with very poor infrastructural support. Only one actually used real time data and few just relied on telecommunication support instead of video conferences.
    3. Connectivity: The lack of internet access back then in Bangladesh is responsible for this failure too as it made expansion of services very difficult, if not impossible. Cities were usually the areas with good internet and tech savvy people and most healthcare services are concentrated around cities in Bangladesh anyway. So these services felt redundant to people who could already easily visit a doctor.

    The Current Market Players

    Both government and Non-Government projects are active in delivering telemedicine to patients all over the country.

    Public Projects

    Under the Directorate General of Health Services (DGHS), high quality telemedicine services have been established at 2 specialized hospitals (Bangabandhu Sheikh Mujib Medical University and National Institute of Cardiovascular Diseases), 3 district hospitals (Shatkhira, Nilphamari and Gopalganj) and 3 sub-district hospitals (Pirgonj, Dakope and Debhata). Additionally, webcams have been given in each sub-district, district, medical college and post-graduate institute hospitals

    The service enables patients admitted at districts and sub-district levels to take advice and suggestions from specialists through telephone and webcam services.[11]

    Private Projects

    1. GrameenPhone runs a “Dial 789” service that uses mobile phones for consultancy purposes at district and upazila levels. This is very effective in suggesting OTC (over the counter) medicine and has more reach since there are no internet requirements.[6]
    2. Jeeon” has been one of the key players in the telemedicine industry for some too. They entered the market by signing an agreement with Paperfly. Paperfly will deliver life-saving medicine to remote areas pharmacies of the country as a partner of Jeeon.[12] Currently, Jeeon has 2084 pharmacies in their network with a countrywide distribution channel.[13]
    Figure: Geographic Distribution of Jeeon Pharmacies/ Source: Jeeon.Co[13]

    The Future of Telemedicine in Bangladesh

    As time has progressed, internet reach and smartphone use in Bangladesh has increased and that has eventually made the ecosystem better and more accessible for both service providers and customers. 

     Figure: Number of Internet Users in Bangladesh (in Millions)/ Source: IDLC[8]

    Access to the internet has grown at around 19% per year from 2012 and so has the access to smartphones.[8] This has enabled more businesses to roll out smart phone specific offerings and create a market for themselves. 

    Figure: Number of Mobile Phone Subscribers in Bangladesh (in Millions)/ Source: BTRC

    Access to telecommunication services has grown significantly too over time. This has made providing service over phones more convenient and easier. With increased coverage and customer base, there is ample opportunity for telemedicine services to excel in the current business environment.

    Startups Leading the Way

    The E-health segment is currently regarded as a good prospect for investors in the country. Primary research from Lightcastle suggests that it stands 3rd in the list of most preferred investment segments in the country with preference from 67% investors

    Figure: Top Sectors Preferred by Investors in Bangladesh/ Source: LightCastle Partners[9]

    There are multiple startups operating in the segment in the country at the moment and although they have different niches, most of them have managed to establish a trusted network and are currently working for creating more customer awareness. Here is a summary of their activities:

    Figure: A Comparison of the Health-tech Space/ Source: Financial Express[10]

    Among these startups, Doctorola is backed by BD Venture[14] and Maya has also received total funding of USD 178,500 from different investors.[15]

    How the Government can Help

    The government has recently increased its focus in funding tech projects with the ICT ministry funding around 40 in 2019. But there is much room for improvement in these steps by the government. Improving these would also translate to the healthcare ecosystem eventually. 

    1. Funding has to be increased and made accessible to more startups. Currently, venture capital investments are not considered as allowable investments for tax rebates. This can be reformed to attract more investment. Only 2 percent stamp duty has been waived on declaring a venture capital fund as a trust. Waving the entirety of the stamp duty can make startups investments more lucrative.[16]
    2. Entrepreneurs face a very hard time getting trade licences, intellectual property rights and other licences. Foreign investors are usually unsure about investing in businesses without proper documents and are hugely concerned about their safe exit of funds.[16]
    3. More efforts need to be made into expanding into rural areas. The rural areas are the most deprived and have to travel very long distances to see a decent doctor. Investing in rural-based health startups is the only way to come out of this. The pharmaceutical companies can pitch in and provide more direct services to rural areas as in the case with Jeeon.
    4. In this COVID-19 pandemic where social distancing measures are more than ever, these telemedicine outlets have become vital as people have been able to get non-emergency consultation from their homes through conferencing and phone calls. 

    Although privacy is one of the major concerns, only time will tell whether or not people will be able to trust these services with their sensitive data. Although the higher income class can be expected to adapt quickly, lower and middle income groups might take some time to catch up to these new methods. But, given the recent success of other tech based startups, it can be safely inferred that technological literacy is on the rise in the country and it is only a matter of time before telemedicine services gain popularity because of their ease of access and lower costs. Most of these services have started in the urban market. Therefore, the main long term challenge for the telemedicine industry will be to expand to remote areas and bring healthcare to the people that are the most deprived.

    Eqra Mohammad Resalat Ohee, Content Writer at LightCastle Partners, has prepared the write-up. For further clarifications, contact here: [email protected]

    References

    LightCastle Analytics Wing

    LightCastle Analytics Wing is the research division of LightCastle Partners. It is tasked with producing periodic reports on the different sectors of the economy, analyzing trends in markets and making methodical, thorough and intelligent analysis to improve strategy and drive business growth.