RT Journal Article
SR Electronic
T1 Teleconsultation Support for Obstetric Emergencies During the COVID-19 Pandemic in Rural Nepal: Results and Lessons Learned From a Mixed-Methods Study
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2300423
DO 10.9745/GHSP-D-23-00423
VO 13
IS 2
A1 Maharjan, Sajana
A1 Rajbhandari, Swaraj
A1 Dhakal, Liladhar
A1 Shrestha, Bhagawati
A1 Hayes, Michaela
A1 Paudel, Punya
A1 Karki, Anjana
A1 Dangal, Binod
A1 Bhatta, Surya
YR 2025
UL http://www.ghspjournal.org/content/13/2/e2300423.abstract
AB Key MessagesA helpline program, designed and implemented during the COVID-19 pandemic, provided real-time clinical support to service providers in remote birthing centers during obstetric and neonatal emergencies via telephone consultation with hospital-based clinical experts.Quantitative and qualitative data suggest the program resulted in benefits to clinical decision-making and timely referral for obstetric emergencies while also building the confidence and skills of service providers.The program has the potential for scale up and sustainability beyond the pandemic era, especially in remote facilities with limited access to higher-level referral centers, through careful tailoring such as strengthening the pool of dedicated clinical experts and building strong linkages between primary health care facilities and referral centers.The study findings will be of interest to governments, policymakers, public health officials, and health workers around the world who can adapt and tailor the modality of remote consultations to their own contexts.In response to the 2020 COVID-19 pandemic, a nongovernmental organization in Nepal piloted a maternal and newborn health helpline program in partnership with the Government of Nepal and the Nepal Society of Obstetricians and Gynaecologists. The program connected service providers in remote areas with real-time clinical support during obstetric and neonatal emergencies via telephone consultations with clinical experts. 551 primary health care facilities across 14 districts of Nepal were included in the program and connected to a roster of 33 clinical expert volunteers from district or tertiary care hospitals. To assess the results of the program, we collected both quantitative and qualitative data, including monthly health facility record reviews from July 2020 to June 2021 and semi-structured interviews with clinical experts and service providers conducted in June 2021. Of the 551 health facilities included in the program, 160 facilities (29%) reported using the helpline during the study period, with 429 teleconsultation cases recorded. We found that 21% of these cases that otherwise would have been referred to a hospital were effectively managed by telephone on-site at rural health facilities, revealing the promising potential for impact using a low-tech solution. Of the health facilities that participated in the program, the helpline was predominantly used in remote facilities where access to higher-level referral centers for emergencies was limited. Feedback from both experts and service providers revealed that the program helped to improve clinical decision-making during emergencies, build confidence and skills of service providers, and improve referral efficiency. Implementation challenges included service providers’ underreporting of helpline utilization, a lack of essential drugs at primary health care facilities, unreliable phone signals, and a lack of financial incentives for clinical experts. The results and implementation experiences shared in this article provide a template for the design and implementation of similar support programs for service providers managing clinical emergencies in rural contexts.