Tele-health as a starting point for establishing primary healthcare in low-to-middle-income countries. (Preprint)

UNSTRUCTURED We read with great interest about challenges of digital health interventions in Pakistan.[1] This issue is pertinent, as even during a global pandemic, many more people might die from preventable conditions than from COVID-19 in Low-to-Middle-Income Countries (LMICs). This reiterates the need for establishing a viable primary healthcare (PHC) structure in LMICs, as opposed to avalanching funds from donor agencies. As a group of ethnic medical students training in London, we would like to share our unique perspective on healthcare in different economies. Hiring staff on a contracted salary, devising catchment areas and the running costs of practices are just a few of the major drawbacks to developing a PHC structure; changes must be made on an institutional level to implement a structure of this magnitude. On the contrary, tele-health services are currently operational in some LMICs (e.g. Aman Health in Pakistan) and can be a pragmatic solution for the time-being. PHC is innovating, and with time we have seen a rise in tele-health services such as NHS 111 in the UK. Most of the population in LMICs are able to access a phone calling service through feature phones and landlines, allowing access to local advisors and eliminating language barriers entirely. Tele-health is essentially used to direct patients to correct services, such as referrals to local specialists and hospitals. Using pre-existing services means this model can run at a low cost, and acts effectively as a ‘mediator’ between the general population and the appropriate service. By doing so, tele-health can play a vital role in preventing mortality down the line due to early intervention. Patients can also be given safety-netting advice if they have milder issues, which reduces unnecessary visits to doctors and alleviates burden on oversubscribed services. Furthermore, staffing for tele-health is made attainable by the use of software-based algorithms, as callers do not necessarily need a medical background. Achieving a sustainable PHC structure means money is saved on the treatment of preventable conditions. This can be used to incentivise governments, and points for further research include an evidence-base that a PHC structure is actually a wiser option for the economy in the long-term. However, this is ambitious. For now, tele-health services can serve as a realistic starting point.