A Telemedicine Story

For years, 23-year-old Ahmad Shukaib from Badakhshan lived in uncertainty. Persistent seizures, severe headaches, and difficulty walking disrupted his daily life and forced him to leave university. Despite consulting multiple doctors and trying different treatments, the cause of his worsening condition, and a path to recovery, remained unclear.

When Ahmad visited Faizabad Provincial Hospital on May 21, 2025, his case was referred to the hospital’s telemedicine service, connecting him directly to specialists at the French Medical Institute for Mothers and Children (FMIC) in Kabul. Through virtual consultations and specialized review of his symptoms, Ahmad was finally diagnosed with epilepsy, a turning point after years of unanswered questions.

With the right treatment initiated by FMIC physicians and closely monitored through follow-up teleconsultations, Ahmad’s seizures are now under control. He has regained confidence, resumed his daily routine, and most importantly, returned to university to continue his studies.

“After so many hospital visits, telemedicine was the first time I received real answers,” he shared with relief and gratitude.”

Ahmad’s experience highlights the critical role telehealth services are playing in Afghanistan, especially for people in remote and underserved areas. By bridging the distance between patients and highly skilled specialists, digital healthcare is transforming outcomes and ensuring that no one is left without access to the care they need.

Today, Ahmad is healthier, hopeful, and building the future he once feared he had lost, all gratitude to timely diagnosis and continuous support made possible through telemedicine.

A Success Story from the Foundations for Health and Empowerment (F4HE) Programme

In Kyrgyzstan, where more than 90% of the landscape is mountainous, reaching specialized healthcare can require hours of difficult travel, a challenge that puts timely medical care out of reach for many women, girls, and families living in remote regions. To bridge this gap, the Aga Khan Foundation’s Mountains Societies Development Support Programme (MSDSP), through the Foundations for Health and Empowerment (F4HE) initiative, is transforming access to essential health services using digital innovation.

Since 2020, F4HE has been equipping primary healthcare facilities with the tools and skills needed to bring expert care closer to home. Facility refurbishments ensured that the new systems could operate effectively and sustainably. Capacity building has been key to this progress. Through targeted technical training, local healthcare providers have gained the confidence and expertise to deliver telemedicine services efficiently, connecting patients in rural communities to specialists based in Bishkek and other urban centers.

“Thanks to the training and the new equipment from the Aga Khan Foundation, we can now connect directly with specialists in Bishkek. Our patients save money, they save time, and they get the high-quality advice they need quickly. It has completely changed how we provide care here.”
— Healthcare Provider, Naryn Oblast

Teleconsultations are now enabling accurate diagnosis and treatment planning for long-term and complex conditions, while patients remain close to their families and support networks. The initiative is also creating stronger integration of health systems through the inclusion of digital records in the national Tunduk state platform, enhancing data management and coordination across levels of care.

Public awareness of telemedicine has begun to grow as local media highlights success stories, including features on regional TV in Naryn Oblast, showcasing improved healthcare access in hard-to-reach communities. This digital shift marks an important milestone: healthcare that once depended on geography is now accessible through a screen, making it an efficient, cost-effective, and equitable solution.

Hazrat Gul, a 51-year-old woman, had always faced life with resilience and dignity. However, following spinal surgery in Peshawar, her life took an unexpected and painful turn. What was meant to bring relief instead resulted in an unforeseen complication, urinary retention. By October 2024, she became dependent on a urinary catheter, a condition that would persist for months.

She travelled from one doctor to another, carrying hope with her at every visit, hoping that this would finally be the moment she could live without the catheter. Yet each attempt ended in disappointment. The catheter remained, along with persistent pain, discomfort, embarrassment, and the quiet emotional suffering that only she could understand. Gradually, her condition significantly affected her daily functioning, mobility, and quality of life.

In September 2025, on the sincere advice of a fellow health worker and social activist, Hazrat Gul visited Aga Khan Diagnostic Centre (AKDC) Chitral for an online consultation. As she watched the reassuring and informative video clips of Dr. Bushra Ahmed, Neurosurgeon, on the AKDC Facebook page, she felt something she had not experienced in a long time, trust. Following a careful assessment, she was guided toward a structured and non-surgical treatment plan. She was taught Kegel exercises, counselled on catheter clamping and de-clamping techniques, and prescribed medications to manage bladder overactivity. With patience, Hazrat Gul followed every instruction. Within one month, she was able to pass urine on her own, and the catheter was finally removed. An ultrasound confirmed adequate bladder emptying, marking not only a medical success.

As a result, Hazrat Gul was able to resume daily activities without catheter dependence, improving her functional independence and overall well-being. This case demonstrates the effectiveness of patient-centred, non-surgical management delivered through telehealth services, particularly for patients in remote settings.

To address the widening mental health gap among Pakistani youth, dHRC, in close collaboration with the Department of Psychiatry at the Aga Khan University and Medical College, has initiated the design and development of DOST: an innovative mHealth solution to offer accessible, confidential, and youth-friendly support to adolescents aged 16–19 years in Karachi. Inspired by the proven Friendship Bench model, DOST reimagines digital care as a trusted “friend,” delivering guided problem-solving support, psychoeducation, mood tracking, and coping tools in a safe and culturally relevant environment.

The mobile application, deployable on Android and web, combines early screening, self-help interventions, and smart referral mechanisms to provide timely care for young people experiencing anxiety, depression, or thoughts of self-harm and suicide. A conversational chatbot as a core feature will help users identify mental health challenges, explore solutions, and take actionable steps toward improved emotional well-being. Where needed, high-risk cases will be immediately linked with specialist care.

As the technical lead, dHRC is overseeing the full digital lifecycle, from human-centered design and development of the app to secure data management and continuous monitoring, whereas the Department of Psychiatry will provide subject matter expertise and conduct pilot testing of the App. The platform will be assessed for its feasibility, usability, and engagement as part of a pilot phase, generating valuable evidence for future scale-up.

DOST represents a milestone in Pakistan’s efforts to introduce scalable, tech-enabled primary prevention for common mental disorders and suicidal behaviors among adolescents. Combining global evidence with local innovation, both departments intend to achieve improved mental health outcomes among young people.

Pehli Ghiza is a mHealth initiative advancing maternal and child health through accessible digital guidance on Infant and Young Child Feeding Practices (IYCFPs). Led by Dr Rehma of Community Health Services Department at the Aga Khan University in close collaboration with the AKU Digital Health Resource Centre (dHRC), the project bridges a persistent gap in maternal health education by delivering credible, culturally relevant, and easy-to-understand information directly to expectant and new mothers via a mobile application.

Developed with evidence-based content from WHO, UNICEF, and the Government of Pakistan, the Pehli Ghiza app provides a comprehensive suite of features, including visual learning modules, reminders for checkups and breastfeeding initiation, and milestone tracking, all presented in Urdu to enhance usability for mothers with varying literacy levels. The system also includes dedicated dashboards for research and administration teams, offering real-time analytics and secure data management to inform ongoing improvements in care delivery.

Designed to strengthen the continuum of maternal and newborn care at AKU Secondary Care Hospitals in Karachi (Kharadar, Karimabad, and Garden East), Pehli Ghiza is pioneering a new model of digital engagement that supports healthier feeding practices, enhances maternal confidence, and contributes to improved early childhood outcomes.

Implementation and Impact:

• Deployed across 189 government health facilities in Bamyan and Badakhshan provinces, aligned with BPHS/EPHS frameworks.
• Enhanced real-time performance monitoring, improved accountability, and streamlined facility reporting.
• Supported the Ministry of Health (MoH) Pay-for-Performance model, enabling transparent tracking of targets and linking facility performance to incentive payments.
• The system’s dashboard and mobile interface provide graphical progress reports, supervisory modules for data quality verification, and trend analysis for informed decision-making.

Evaluation and Key Findings:

A qualitative sustainability study conducted post-implementation revealed:

• Significant improvements in timely reporting, data accuracy, and evidence-based decision-making.
• Offline capability was a critical enabler in connectivity-poor settings.
• Barriers to scale-up included infrastructure gaps, lack of capacity building, equipment maintenance and continuous operational support, limited monitoring and supportive supervision, high staff turnover, and limited structured training.

Evaluation underscores a vital lesson, i.e., digital health solutions require sustained investments beyond project-based funding to achieve long-term institutionalization.

Strategic Insights:

We conducted a dissemination seminar to share lessons learned and explore opportunities for refinement and expansion of Sehatmandi, reinforcing its role as a sustainable digital solution that empowers healthcare providers and improves patient outcomes. The successful completion of Sehatmandi sets a benchmark for digital performance monitoring in fragile contexts. Moving forward, we aim to leverage these insights to scale such innovations that strengthen global health systems.

Hayat, an award-winning novel Android-based mHealth platform, empowers health workers by digitizing community and facility-level operations to enhance access to and coverage of RMNCH, immunization, and child growth services, thereby strengthening primary healthcare delivery systems. It comprises two integrated components:

The Hayat platform has gained strong endorsement from the health systems in Gilgit-Baltistan (GB) and Khyber Pakhtunkhwa (KPK), reflecting its success in improving health outcomes and streamlining service delivery, despite administrative and political challenges. Operating across these provinces, Hayat has supported over 1,200 frontline health workers, across 180 health centers, enabled the registration of more than 450,000 beneficiaries, and facilitated over 192,000 community awareness sessions on maternal, newborn, and child health.

1200

Health Workers Trained

180

Health Centers Targeted

450,000

Beneficiaries Reached

192,000

Awareness Sessions Conducted

Building on its positive impact, the GB Department of Health has fully funded and formally signed Memorandum of Understanding (MoU) with the Aga Khan University for adopting Hayat and scaling it across additional districts, including Astore, Diamer, Hunza, Skardu, and Nagar. This scale up also aims to integrate the Hayat platform within existing digital infrastructure, including NEIR/EPI, MIS, VLMIS, and DHIS to ensure interoperability. In KPK, Hayat has evolved into the Khyber Pakhtunkhwa Electronic Immunization Registry (KP-EIR), with the government committed to expanding it beyond Upper and Lower Chitral to other districts, integrating features such as real-time stock management, geotagging, offline capability, proactive birth and child immunization tracking, digital reporting, and live dashboard accessible at district, regional, and provincial levels. These developments signify a critical transition from pilot innovation to institutional adoption and sustainable digital transformation within provincial health systems.

Hayat has been initially implemented by the Aga Khan University in collaboration with Aga Khan Health Service, Pakistan and local government partners. It was funded by the Government of Canada, through the Grand Challenges Canada and the Aga Khan Foundation Canada.

As the technical backbone of AKDN’s mental health initiatives in Gilgit-Baltistan and Chitral, the Digital Health Resource Centre (dHRC) will drive the development of a centralized digital case management system to operationalize coordinated mental health service delivery. This system will securely connect healthcare providers, school-based teams, and community responders, enabling streamlined case identification, referral pathways, follow-up, and outcome tracking within a single integrated platform. Through strengthened data visibility and communication across institutions, the system will enhance accountability, reduce fragmentation, and ensure that individuals receive timely and continuous care aligned with program standards.

Program Strategy:

The program is designed to foster resilience, reduce stigma, and expand access to timely mental healthcare across diverse population groups through a coordinated and system-strengthening approach. A cornerstone of this strategy is the integrated Mental Health Case Management System being developed by dHRC, which will enable real-time data capture, continuity of care, and proactive follow-up across all implementing agencies. By standardizing workflows and strengthening institutional capacity, the digital platform will ensure that mental health needs are identified early, referrals are efficiently managed, and decision-making is guided by robust evidence. This digital innovation underpins a comprehensive set of interventions spanning community, education, and health services. Alongside case management system, the program also includes diverse components, such as adolescent resilience initiatives, volunteer-led awareness efforts, and suicide prevention/postvention support, maternal mental health, school-based mental health screening, scale-up of the Healthy Minds curriculum, and enhanced parent-youth engagement. Where applicable, the related data from these key interventions will be embedded in the case management system to improve timely support and clinical decision-making. Collectively, this integrated model, enabled by the case management system, will enhance access to primary and specialized mental health care delivery for improve outcomes, while building institutional knowledge, skills, and support systems for sustainable impact.

Collaborating Agencies/Workstreams for IMHP:

• Aga Khan Health Services, Pakistan (AKHS,P)
• Aga Khan Education Services, Pakistan (AKES,P)
• Aga Khan Rural Support Programme, Pakistan (AKRS,P)
• The Aga Khan Hospital and Medical College Foundation, Department of Psychiatry, AKUH
• Aga Khan University – Brain and Mind Institute (AKU-BMI)
• AKDN Digital Health Resource Centre (AKDN dHRC)
• Aga Khan University – Institute for Educational Development (AKU-IED)
• The Ismaili Council for Pakistan and National Health Board
• International Mental Health Taskforce