The Telehealth Programme of the Commission on Science and Technology for Sustainable Development in the South (COMSATS)

Striving for sustainable healthcare delivery

The advent of modern-day information and communication technologies (ICTs) created the means to develop new forms of healthcare delivery, to fill in the gaps and strengthen the existing healthcare systems. One innovative model that emerged over time is Telehealth, which promotes the use of telecommunications and virtual technology to deliver healthcare outside or in adjunct to traditional healthcare facilities. COMSATS has been a pioneer in implementing synchronous telehealth in Pakistan using latest ICTs, showcasing how the challenge of equitable provision of healthcare can be met and sustained while operating in marginalized communities and in hard-to-reach and remote areas. Its objective is to help address the challenge of equitable healthcare delivery in a cost-effective manner to underprivileged communities there. 

COMSATS initiated telehealth in Gujjar Khan, Pakistan as an indigenous pilot activity in 2001. The objective was to implement telehealth and provide medical consultations to patients at a remote site which had no or few doctors. The activity was upscaled in size and scope in 2004 when COMSATS signed a joint agreement with the International Development Research Centre (IDRC) of Canada, and a community-based organization (CBO) based in Skardu, the Baltistan Health and Education Foundation (BHEF). IDRC funded the project activity with a view to promote growth, reduce poverty, and drive large-scale positive change in terms of healthcare delivery. 

The project’s broad objective was to undertake action-based research in order to provide healthcare services to underprivileged and marginalized communities in the northern areas of Pakistan and assess the efficacy of telehealth as a means and model of cost-effective and highly accessible healthcare system. Under this project activity, COMSATS established a Resource Centre at its premises in Islamabad (capital of Pakistan) and a distant Telehealth Centre in the premises of a community hospital in Skardu (capital city of the region of Gilgit-Baltistan) under the administrative control of BHEF. Skardu is located in a mountainous range with a desert terrain and extreme weather. For this phase of telehealth activity, COMSATS used a satellite link to connect the two telehealth nodes, i.e. the Telehealth Resource Centre and the Telehealth Centre. Patients from marginalized and remote communities of Gilgit-Baltistan, received medical care from specialist doctors visiting the Telehealth Resource Centre (in Islamabad). Medical consultations were initially provided in the areas of cardiology, gastroenterology, dermatology, paediatrics as well as gynaecology. COMSATS acquired a great deal of knowledge through the project activity, in particular in terms of setting up technical infrastructure, and operating in diverse cultural settings. Due to the knowledge acquired, COMSATS was then able to also intervene in other parts of the country. The Telehealth Service was subsequently scaled up further, and over a dozen basic health units (BHU) in different cities and surrounding communities were connected as telehealth centres to the Telehealth Resource Centre in Islamabad, including the BHUs in: Zhob (2011); Islamabad  –  Gokina (2013); Sawabi  –   Dagai (2013); Islamabad D-10 (2014); Quetta – Wahdat Colony (2014); Multan – Muzaffarabad (2015); Peshawar – Sangu (2015); Lahore (2015); Khairpur –  Ubhri (2015); Gawadar –  Shadoband (2015); Multan –  Panjfaiz (2015); Mansehra –  Behali (2017); Mardan –  Dera Lakhpani (2018); Sawabi –  Tarakai (2018); and Jhelum –  Swika (2019). With time, medical services were included to provide general outpatient care and to fight chronic diseases. 

COMSATS’s Telehealth programme has proved its worth as one of the most cost-effective solutions to increase outreach and provide equitable healthcare across different remote, hard-to-reach regions, areas and communities. More than 65,000 medical consultations were given to patients from marginalized and unprivileged areas and communities. 

In terms of the innovative aspect of the programme, when COMSATS initiated its Telehealth Programme, it based its services on using a satellite link for Internet connectivity and carried out videoconferencing to enable medical consultations between patients and medical specialists. Understanding the growing need for basic health services, COMSATS developed a patient information system and an e-portal for sharing patient data, which is maintained using servers. This innovative mechanism enables patients to present their problems directly to the doctor, be examined and diagnosed, and eventually treated. The e-portal has features for patient registration, the updating and maintenance of patients' medical history and basic examination, patient documents (pictures, previous tests and reports), scheduling of appointments with specialist doctors, doctor’s prescriptions, as well as secure data transfer. 

The Programme is sustainable because COMSATS is supporting the running expenses for Telehealth Resource Centre (using medical resources from tertiary care facilities), while the running expenses of Telehealth Centre(s) are being borne by local health organizations or authorities of the area benefiting from the service. Telehealth Resource Centre, which is well-established in Islamabad, combined with the Patient Information System and e-portal in place, make it possible to replicate these services with the support of local health organizations and partners. Partners provide funds, share resources and jointly organize capacity-building events.  

Potential collaboration areas with partners include: resource and expertise sharing among the organizations already working in Telehealth; the establishment of a Telehealth system for a selected region; sharing and provision of healthcare opinions through Telehealth across the regions and borders; and courses and capacity-building programmes arranged for health professionals through Telehealth.  

As an intergovernmental organization, COMSATS intends to take this learning and experience to other interested Member States in Asia, Africa and Latin America, in the spirit of South-South cooperation.