Making telehealth services accessible to all: Global standards and the Implementation Kit by WHO and ITU

The World Health Organization and the International Telecommunication Union (ITU) to ensure that each person with the right to equitable access and use of digital health services for the effective implementation of telehealth services developed an Implementation toolkit The kit provides a stepwise approach to the implementation and the practical guidance on the Global standards for making telehealth services accessible to all. The menace of COVID-19 brought forward the need for telehealth services outside of the established healthcare services. With the world striving for SDGs and for the achievement of Universal health coverage, the integration of telehealth into the health system becomes essential for achieving a sustainable approach to health care delivery. With the potential of telehealth to advance equitable delivery of healthcare, several populations such as the disabled, older people, low literacy groups, and Indigenous communities experience numerous barriers in accessing and hence utilizing these services.

A significant proportion of the world’s population is of these groups and hence there is a need to make telehealth accessible to them. There is significant evidence that in low and middle-income countries, the utilization of these services is limited to these groups especially due to inaccessible formats of delivery. The platforms are incompatible for visually impaired or deaf/hard of hearing populations due to a lack of screen readers, captioning, or volume control in video conferencing. This is due to the lack of a universal design in telehealth platforms and so the focus should be on building accessible digital systems aligning with universal design principles. There is also a need for National regulatory standards in respective countries. WHO and ITU laid upon global standards for the accessibility of telehealth services in 2022. The design of these platforms should be based on 7 principles -equitable use, flexibility in use, simple and intuitive use, perceptible information, tolerance of error, low physical effort, and size and space for approach and use.

The global standards include requirements for:

• Persons with vision impairment and blindness –Compatibility with assistive devices like screen readers or Braille keyboards, Color contrast and screen magnification, Services using telephone, Avoidance of “Telehealth apps” that involves complicated processes, no background music in the videos included, avoidance of Ambiguous wording and inaccurate descriptions in videos
• Deaf and hard-of-hearing persons -Captioning and monitored chat box with volume control, integrating text messaging, to and from patients, remote sign language interpretation or a video remote interpretation (VRI) system, clear subtitles in the video with no background music, large screen for lip reading
• Persons with speech difficulties – voice synthesizers and/or text-to-speech generators
• Persons with mobility impairments-Should not require fine motor coordination eg. double-clicking, or avoidance of scrolling instead of having menu options for easy access
• Persons with mental health conditions and psychosocial disabilities-Unexpected, irrelevant, and inappropriate content that can trigger reactions in such people, clear explanation to the users for data safety and privacy, must not have complicated user interfaces, should have high-quality information in order to maintain trust among the users as information quality affects the trust level.
• Persons with developmental and intellectual disabilities-Accessible and easy-to-read format of documents provided by a healthcare provider should allow two people to participate simultaneously i.e. a person with a disability and their caregiver, A simple user manual on how to use telehealth service to be provided
• Persons with learning disabilities: Easy and accessible layout of the text, documents, worksheets, and instructions, the text should be readable and understandable and should be given sufficient time to read.

This toolkit on implementation provides a stepwise approach for implementation by four main stakeholders:

• Governments
• Industry
• Health service providers
• Civil society

Reference:

WHO – Implementation toolkit for accessible telehealth services