The future of telehealth in a post-pandemic world

When five-year-old Afrin caught a fever, her mother Afroza immediately thought of Covid-19. After all, it was mid-2020 and the pandemic was at its peak. But Afrin's grandparents lived with her family and they could not risk getting infected. 

So, they found a clinic which provided online doctor's consultation and sent people to collect samples from home. "It was quite a relief for us, especially during that time when everyone was scared of getting Covid-19," said Afroza. 

Fast forward to 2023, now when Afrin falls sick, she is taken to her paediatrician's chamber in Dhanmondi. "The situation has become better and we obviously feel safer now," she said.

Many people went through a similar situation in 2020 when the pandemic broke out and mobility got restricted. Back then, most hospitals and clinics were offering online doctor's consultations and patients were demanding it as well. 

Given Dhaka's traffic situation and the huge number of patients who live outside cities, it seemed telehealth services were always going to be in high demand in the country. Online appointments also cost a little less than in-person ones. 

However, although hospitals including Square Hospital, Labaid Specialised Hospital and Praava Health have online options, most appointments are now in-person. 

"It is a psychological thing and also a thing of trust between the two parties (patient and doctor). Patients trust doctors more when they listen to them, put the stethoscope on their chests etc; the patients are affected by these. Even doctors are more confident in diagnosing the disease when they see the patient face to face," said Dr Be-Nazir Ahmed, former Director of Disease Control at Directorate General of Health Services.

"We have seen in studies that when doctors go on rounds in hospitals, patients feel better when the doctors touch them and inquire about their health. When they do not, patients complain that the doctors did not see them properly," he said.   

Nonetheless, platforms that exclusively cater to patients on virtual platforms are still going strong, despite the end of the pandemic.

Start-ups like Moner Bondhu (mental health care and wellbeing platform) and Dhaka Cast (online diabetes management website) shared with us that they still get huge requests for online consultations. 

According to Dr Be-Nazir, this trend may have to do with the fact that when it comes to mental health issues, patients prefer privacy or anonymity. Moreover, those who are younger and more comfortable with technology and those who cannot travel [because of health restrictions] prefer telehealth services. 

A different scenario for start-ups

Moner Bondhu began to offer online services from March 2020, almost at the same time as the lockdown. From 2019 to 2020, the platform saw a huge growth (based on number of clients, payment forms, hours of counselling etc), almost 300%. Between 2020 and 2023, there was 200% growth.  

Founder of Moner Bondhu, Tawhida Shiropa, said, "In 2021, we faced this dilemma: were people only accepting online services because of the pandemic or were they going to continue with this, whether the business was going to be viable etc."

"But once you taste something and it feels good, or has a good impact on you, it might become a habit. Such a situation did not exist before [the pandemic]," she said.

At present, because of continuous strikes and blockades, many clients are cancelling in-person sessions and choosing online ones. "Till August of this year, in-person was more than online, you could say a 55-45 ratio. But it has been the opposite in the last two months. Traffic, external issues etc could be the reasons."  

Praava said that although more clients are coming to the clinic to see the doctors, the number of online mental health consultations have remained the same since the pandemic (20 per month on average).  

Dr Fahreen Hannan, founder and CEO of Dhaka Cast, an online diabetes management website, said, "During the pandemic, clients had a different demand and now, they want something else. For example, the demand for lab tests and caregivers have increased. We have grown almost four times in the last few years."  

She said that other than diabetic counselling, clients are seeking normal physical health related services online. Most of their mental health counselling sessions are also online. 

"Online sessions and offline sessions do not vary much so why won't people prefer the former? It costs lower but has the same service quality."  

She added, "Other than these, diabetic patients also prefer Dhaka Cast because they can get medicines delivered at their doorstep, give urine and blood samples from home, get online reports etc."  

In future, Dhaka Cast wants to provide at-home ECG and ultrasonography support to their clients. 

Shastho Batayan and the dengue situation 

Shastho Batayan (helpline 16263) is the national medical call centre run by the government. A call to this number will connect you to a medical professional at the nearest government hospital. 

According to the dashboard provided on the Shastho Batayan website,16,51,360  calls were made in 2023 (till December 11) with 11,07,329 seeking doctor's consultation. The number of calls increased between May and August, the dengue season.  

The numbers were much higher in 2020 - more than one crore 9 lakh and 73 lakh respectively. The number of calls was the highest between March and July, the peak Covid-19 time. 

On this, Dr Be-Nazir said, "When there is a pandemic-like situation, people become panicked and they look for information from many sources. They look for suggestions and consultations. We saw that many people were tuning into the television when we were giving health updates in 2020." 

He emphasised on the need for telehealth in the country. "Telehealth is important, especially in remote areas in the chars (riverine islands) or Hill Tracts. Even if not as the best alternative, it can provide some support." 

He believes both online and in-person doctor's consultations will go on and only time will tell whether people will get more used to the former or not.