Implementation of telemedicine project in Bhutanese refugee camp in Nepal

Abstract While working with UNHCR (UN Refugee Agency) in Nepal, I faced the challenge of managing Bhutanese refugee health care programme with limited resources. Since 1993, UNHCR was providing health services to Bhutanese refugees living in seven camps. UNHCR Nepal had received limited budget due to emerging refugee crisis in other parts of the world in 2016. As a health focal person, I was assigned to look for new approaches to provide health services to refugees. After exploring several possibilities, telemedicine project was introduced in the camp in 2016 with the collaboration of tertiary hospital, B. P. Koirala Institute of Health Sciences. The main objective of the project was to reduce medical referral, which consumed most of the resources. From testing and prototyping, videoconference was considered as the most appropriate method to perform telemedicine in the camp. Telemedicine helped camp clinical staff to directly communicate with consultants in the tertiary hospital at distant and address the refugee health issue at camp level. After implementation of telemedicine, medical referral from camp clinic to hospitals in 2016 was reduced by 54.8 % in comparison to previous year 2015. Telemedicine project also enhanced the coordination and linkage of refugee and UNHCR with tertiary referral hospital. Regular monitoring visit from the expert helped to improve the telemedicine project significantly. The most important lesson learnt was that beneficiaries and camp health staff should be involved from beginning. Camp health workers must be trained on using telecommunications equipment. Telemedicine is cost-effective in refugee setting where internet access is strong. Regular monitoring and technical support from the expert, learning attitude of camp health workers and acceptance from refugee are vital for the success of the project. Telemedicine increased access of essential healthcare to the most disadvantaged communities and ultimately facilitated universal health coverage. Key messages Telemedicine is cost-effective way of providing health services to refugee at remote area where access to hospitals is challenging due to certain limitation such as distance, budget, transportation. Telemedicine not only save the cost of medical referral but also save opportunity cost, time and energy of refugees, which are invested while visiting hospital.