ArticleDigital health
Making policy to bridge gaps in health care access in Sindh, Pakistan: An analysis of the Sindh telemedicine and telehealth act 2021.
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Abstract
Objective: To conduct a comprehensive health systems policy analysis of the Sindh Telemedicine and Telehealth Act 2021 by examining its contextual drivers, governance and stakeholder dynamics, implementation barriers and facilitators, and policy content, and by comparing it with telemedicine policies in neighboring low- and middle-income countries (LMICs). Methods: Our study applied Walt and Gilson's policy triangle to examine context, content, process, and actors. A desk review of relevant policy documents from Sindh and other LMICs (India, Bangladesh, and Nepal) was conducted, followed by in-depth interviews with 28 stakeholders (July-October 2023) until data saturation was reached. Participants were recruited using purposive and snowball sampling strategies. Thematic analysis was done using Qualitative Data Analysis Software (QSR NVivo v12) to identify barriers and facilitators to policy implementation. Result: The contextual drivers behind the formulation of the Act included the coronavirus disease 2019 pandemic, limited healthcare access, and the growth of telehealth providers in private sector. The Act provides a regulatory framework for healthcare providers registration and training requirements, guidelines for patient consent, emergency care, and data privacy. However, it lacks clarity on the cost of telemedicine services and measures for cross-border telemedicine. Stakeholder analysis showed government bodies hold the highest power in telemedicine policymaking. Telemedicine service providers and healthcare providers expressed support for the Act but were excluded from policymaking process. Service users also had minimal involvement in the policymaking process. Policy implementation varies, facing financial and technological barriers, while strategic financial planning and public-private partnerships, identified as facilitators in overcoming these challenges. Limitations: The study may be subject to limitations, including potential selection bias while identifying stakeholders and the constraints of desk review in capturing details. Conclusion: The Act is an important step towards addressing healthcare disparities, with its success contingent on overcoming implementation barriers through inclusive and strategic policymaking and investment in digital infrastructure.
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