E-Health Case Study: Roshan Telemedicine


According to Roshan, one of Afghanistan’s top three operators, 25 per cent of children in the country die before their fifth birthday, due to illnesses such as pneumonia, poor nutrition and diarrhoea. Appropriate healthcare is extremely limited with only one doctor for every 100,000 people, so there is a strong need for telemedicine in Afghanistan in order to allow for more efficient medical services in the rural communities.

Market leadership is a close fought thing —Roshan, Afghan Wireless and MTN Afghanistan all have similar market share in a country with a population of 29 million. The main driver behind the operator’s telemedicine service is the Aga Khan Fund for Economic Development (AKFED) which has a 51 per cent stake in Roshan and is part of the Aga Khan Development Network, a group of nine international development agencies and institutions that implement programs in rural development, education, health, culture, microfinance and business. The AKFED has partnered with the government of Afghanistan, the Aga Khan University hospital, Aga Khan Health Services, the French Medical Institute for Children and Cisco to roll out the telemedicine service in Afghanistan.

With the service being offered free of charge, Roshan is not looking to make direct profits from it but instead is looking to strengthen its brand in rural communities and improve living conditions and opportunities for the poor. The telemedicine service uses the operator’s network to transfer medical imaging such as X-Rays and CT scans  from remote areas to the large hospitals in Kabul, Iraq and Pakistan to provide specialist remote medical diagnosis. It also provides videoconferencing for medical training which is 100 per cent subsidised and gives local doctors and nurses free university training. No costs are borne by the patients at any time.

So while Roshan does not make any profits directly from the service, it does have access to a platform from which it can develop a strong sense of trust within rural communities. This can indirectly reduce its churn levels, and give the operator more opportunities for subscription growth, as subscriber acquisition in the urban areas becomes more of a challenge.

The main feature of Roshan’s telemedicine service is to provide remote rural diagnostics and medical training. However, it also provides convenience to patients and medical professionals who would otherwise have to travel to the nearest city to gain access to higher levels of medical care or medical education.

The service has not been positioned by Roshan as a value-added service but as a medical service that acts as source of knowledge for both patients and healthcare professionals through the sharing of expertise internationally and within Afghanistan. Despite all four operators in the country implementing various community projects, Roshan is currently the only operator that is providing an m-health service.

The most measurable impact of the service is in the Bamyan region which is located in a remote valley where there is limited access to infrastructure. The region has the highest level of childbirth mortality rates in the country and no qualified radiologists who can take X-rays and ultrasounds.

The number of cases treated in Bamyan’s hospitals exceeded 350 in 2009, with the majority of the teleradiology being used for CT-scans. Over the two years to end-2009, the annual number of telemedicine cases grew by approximately 300 per cent.

Roshan has not tried to use its telemedicine service as a source of additional revenues but rather as a community service project that can establish its brandname in rural communities. The success of Roshan’s telemedicine service is mainly due to the fact that its main stakeholder is part of the Aga Khan Development Network which focuses on this type of activity. In a market where it is becoming increasingly difficult to retain subscribers due to the vast amount of low price-based promotions, a service of this type can allow the operator to build a sense of community and trust, which will increase brand loyalty and brand awareness in the remote rural areas.

No drastic changes have occurred in terms of Roshan’s overall subscription base, revenues or ARPU as a result of the launch of its telemedicine service. However, the operator has managed to hold onto its market leadership despite strong competition in the mobile market due to an increased customer loyalty.

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