Can Telecommunications Bring Health Care to the Hard-to-Reach? — EHealth networks in Asia and Africa say yes

One morning in June 2016, an anxious Afghan couple left their mountain village of Sar-e-deh carrying their 8-year-old son Mashhoruddin* in their arms. For the 40-minute walk over steep slopes to the nearest health clinic in Nusai, the boy was unresponsive.

When they reached Nusai, the parents were in such despair they were starting to plan for their son’s burial. Staff at the Nusai Comprehensive Health Center documented the child’s condition with concern: He was unconscious and his life-threatening symptoms included hyperthermia and low blood pressure. So the clinic reached out to the better-equipped Fayzabad Provincial Hospital, a two-day drive away.

The boy’s condition was too unstable to make the trip, but, by internet connection, clinic doctors shared his charts. Working together with hospital staff, they narrowed the diagnosis to two possibilities: a diabetic coma or organophosphate poisoning, which could result from exposure to farm chemicals. After conferring, the clinic team treated the boy for poisoning. They suctioned the boy’s airway, prepared oxygen therapy, and provided injections and antibiotics.

After a tense eight hours, little Mashhoruddin returned to consciousness. After bed rest in the clinic, he left in stable condition with his grateful parents.

Medical staff at a hospital in Fayzabad, Afghanistan, provide diagnostic support in a teleconsultation with a clinic in rural Nusai, a six-day walk away. / Aga Khan Development Network

In remote areas, a medical disaster can have a domino effect, causing families emotional and financial disaster as well.

The life-saving connection came through USAID’s partnership, or Global Development Alliance, with the Aga Khan Development Network (AKDN) called the Integrated Development for Quality of Life in Afghanistan.

The case reflects how the larger health system in Afghanistan has made important strides as a result of telemedicine — one aspect of electronic communication in the health field, or eHealth.

When the eHealth field started over a decade ago, many health care advocates heralded it as a revolution in care. Since then, eHealth has gained traction to bring health care to marginalized communities.

With USAID support, eHealth is making an impact in some of the world’s most isolated settings, including Central Asia and West Africa. In both regions, the health care systems have linked rural clinics to better-equipped urban hospitals and have used training as well as teleconsultations to strengthen the whole system.

The technical advances behind these changes are stunning, but equally remarkable is the human network that has extended the expertise of a hospital like Fayzabad’s, expanding the reach of care.

Shafiqullah Safi is a young doctor in Kabul with the Aga Khan Health Service. After growing up in Kabul, he studied medicine and received a degree in public health in Thailand. Now back in Afghanistan, he backstops the eHealth system. He describes its hub-and-spoke framework: a central hospital in Kabul serves as the hub for teleconsultations, and training extends out to provincial hospitals like the one in Fayzabad. Those hospitals, in turn, are spokes for reaching clinics; Fayzabad now supports five clinics in its radius.

In northern Afghanistan, the rugged mountain terrain makes a visit to the nearest clinic a journey of many hours. / Jean-Luc Ray, Aga Khan Development Network


Numbers from Central Asia are impressive: In its first 10 years in Central and South Asia (2007–2017), Aga Khan’s eHealth Resource Program linked 31 sites in four countries. It trained over 10,300 health care providers and provided over 35,500 teleconsultations, according to Saleem Sayani, who leads the program. But the biggest impact of teleconsultations in the past five years, he says, is in savings to beneficiaries in terms of expense and travel time. EHealth saved patients and their families a total of $7.1 million and 180 person years of travel time (the time spent by patients and their families traveling to clinics).


And eHealth experiences are being shared across borders, changing health care for countries where USAID works and for their neighbors as well. Safi notes that Afghanistan’s system receives technical support from colleagues in Pakistan, such as trainings in new platforms, databases and workshops.

Melting the Border With Tajikistan

Across Afghanistan’s northern border with Tajikistan, telemedicine fills gaps in that boundary area, providing clinic staff with expert support and patients with cost-effective treatment. When Noziyai*, a 6-year-old Afghan girl living near the border, fell and impaled her head on a sharp rock, her prognosis was bleak. Her parents, beside themselves with grief, rushed her unconscious to the nearest clinic, in Ishkashim. Her skull was fractured.

Participants in an e-Learning class at the Khorog Oblast General Hospital in Tajikistan (foreground) interact with instructors from the French Medical Institute for Children in Kabul, Afghanistan. / Aga Khan Development Network

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