Date of Award

12-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Shifa Habib

Second Advisor

Dr. Ahsana Nazish

Third Advisor

Dr. Hasan Nawaz

Department

Community Health Sciences

Abstract

BACKGROUND: Telemedicine in Pakistan was increasingly recognized for its potential to expand healthcare access, especially during the COVID-19 pandemic's strain on health systems. Although it could significantly mitigate healthcare resource limitations in rural settings, its growth was curtailed by policy and infrastructure inadequacies. A comprehensive policy analysis was essential for the strategic enhancement of telemedicine services to effectively cater to underserved communities. Addressing these policy gaps paved the way for a robust telemedicine framework, fostering equitable healthcare provision in remote and rural areas.
STUDY AIM: The study aimed to conduct a comprehensive analysis of Pakistan's telemedicine policy, examining its context, content, and key players. It identified the main barriers and facilitators to the adoption of telemedicine and offered policy recommendations to overcome these challenges and enhance telemedicine's advancement in Pakistan.
OBJECTIVES: To understand the role of telemedicine in addressing health system challenges in Pakistan • To carry out stakeholder mapping and assess the role and effectiveness of stakeholder engagement in telemedicine policy process in Pakistan. • To identify and assess barriers and facilitators of telemedicine policy implementation in Pakistan. • To conduct a desk review of telemedicine policies in neighboring LMICs India, Bangladesh, Nepal and propose recommendations for improved implementation in Pakistan.
METHODOLOGY: The study utilized a qualitative case study approach, centered on Walt and Gilson's policy triangle, to evaluate Pakistan's draft telemedicine policy. From July to October 2023, in[1]depth interviews with 28 diverse stakeholders and a review of policy drafts provided comprehensive data. Purposive and snowball sampling ensured varied insights until saturation. Data collection included interviews and document analysis, underpinned by rigorous trustworthiness measures and ethical standards, following AKU's protocols. Inductive analysis highlighted emerging themes, aligned with the study's framework and goals.
RESULTS Pakistan's healthcare system faced significant challenges due to a deficit in skilled professionals, inadequate infrastructure, and limited government support, leading to a pronounced disparity in healthcare services, particularly in rural areas. Telemedicine was identified as a promising solution to bridge these gaps. A stakeholder analysis highlighted the Policy Makers as key agents with strong support and influence, crucial for policy implementation. Telemedicine service providers and healthcare providers also showed high support levels, playing essential roles in advocacy and operational assistance, respectively, although their influence varied. The implementation of telemedicine policies was hindered by financial uncertainties, technological and infrastructural inadequacies, and a lack of consistent regulation. Operational challenges and socio-cultural barriers further impeded widespread adoption of telemedicine. Despite these barriers, strategic financial planning, public-private partnerships, and standardization of practices were recognized as facilitators that could drive policy implementation forward. compared with neighboring countries like India, Bangladesh, and Nepal, Pakistan's telemedicine policies were deficient in detailed accreditation processes and data security standards. Improving these areas is crucial for the success of telemedicine in Pakistan, aligning the policies with regional benchmarks.
CONCLUSION The study highlights Pakistan's healthcare challenges and the potential of telemedicine to address them, offering insights for LMICs. Strategic policy refinements and addressing key obstacles could unlock telemedicine's full potential, revolutionizing healthcare in Pakistan and providing a model for other LMICs.

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