| Challenges highlighted by the respondents |
| Inadequate mobilization for service utilization |
The community was inadequately aware of TM services. Passive efforts at information-education-communication for mobilization. |
| Inadequate administrative preparedness |
Ambiguity in medico-legal implications. Lack of standardized guidelines for operations, monitoring, and evaluation of TM centres. Inconsistent documentation practices and systems to manage health records. Not all TM centres were equally prepared when services were launched. |
| Challenges with scheduling the appointments |
Clients face difficulty in obtaining same-day or emergency appointments. Change of doctors in consecutive consultations leads to difficult follow-up. Lack of fixed time slots led to consultations beyond the allocated time (pressure on doctors). |
| Human resources (HR) issues |
Staff inadequately oriented to TM processes. Lack of dedicated TM coordination staff. High load of incoming irrelevant messages on WhatsApp etc. Excessive load of incoming calls. |
| Issues with phone and internet connectivity, and logistics |
Client-side issues: Poor phone and internet network connectivity. Lack of smartphones for video consultation and multimedia messaging. Inability to adapt to digital technology. Provider side issues: Inadequate data packages. Low internet bandwidth (TM centre). Unavailability of high-definition cameras. No proper TM software or platform was used. |
| Inadequate confidence in the quality of services provided and received |
Lack of physical interaction with patients. Risk of misdiagnosis and/or wrong assessment of disease severity. Risk of missing signs and symptoms of other comorbidities. Limited scope for intervention. Inadequate client satisfaction. Difficulty in communication and counselling. Limited consultation time. Difficulty communicating with people from rural communities. Unavailability of prescribed medicines in the local pharmacy. |
