Ghana offers blueprint on expanding access to healthcare

In a remote corner of Ghana ‘telemedicine’ is proving how effective digital care can be when coverage is extended to those on the medical margins, write Koku Awoonor-William and Ann Aerts

IN LOW and middle-income countries, insufficient access to medical care undermines health outcomes and disadvantages entire generations.

But, in some of the world’s hardest-to-reach communities, technology is revolutionising patients’ engagement with modern medicine. In a remote corner of Ghana, one “telemedicine” programme illustrates just how effective digital care can be when coverage is extended to those on the medical margins.

In 2011, our organisations launched Ghana’s first telemedicine pilot programme, with the goal of creating a model for national expansion. Starting in the country’s Amansie West District in the Ashanti Region, about 330km northwest of the capital, Accra, we sought to improve the quality of care in isolated areas, reduce transport times to hospitals, and lower patient costs.

The programme, designed in collaboration with global telecommunications providers, universities, and NGOs, initially covered 30 rural communities, and connected some 35,000 people to healthcare professionals through a staffed call centre.

Ghana’s programme offers a blueprint for how other developing countries can expand their own healthcare access.

By linking these communities to a communications hub, nurses, doctors, and specialists were digitally available 24 hours a day, offering immediate support to patients and community-based health workers (CHWs).

Today, we are pleased to report that the programme succeeded beyond our most optimistic expectations. Five years after launch, the number of patient referrals to clinics fell 31% in the pilot area, while more than half of the programme’s consultations were resolved by phone.

Each referral that was avoided saved patients, on average, 110 Ghanaian cedis (€20), and the high success rate of closed cases reduced waiting times in clinics.

We have heard many stories of patients whose lives were affected by this digital-health innovation; one in particular sticks with us.

Not long after the programme began, a young woman named Debora, who was under the care of a local health worker, began bleeding uncontrollably during childbirth. Unable to treat her patient, and with no access to an ambulance, the health worker faced a choice.

She could either send Debora to a distant hospital by taxi — an arduous journey over rutted roads — or she could pick up the phone. After connecting with the regional telemedicine centre, a doctor coached the caregiver through Debora’s treatment, and in the process, very likely saved her life.

Buoyed by similar stories, in 2016, the Ghana Health Service began expanding telemedicine access to other parts of the country. That work was completed last month, and today, six call centres staffed by hundreds of medical professionals are in operation, bringing affordable medical expertise to an estimated six million people.

With this commitment, Ghana is making a bold statement: telemedicine holds the key to expanding universal health coverage, a primary objective of the UN Sustainable Development Goals that Ghana hopes to meet by 2020, 10 years ahead of the target date.

But, most exciting of all, Ghana’s programme offers a blueprint for how other developing countries can expand their own healthcare access.

In developed countries, too, telemedicine is revolutionising how patients interact with medical professionals. In the United States, surgeons virtually connect to hospitals to advise on treatment.

In Europe, doctors link up with patients by phone and email to advise on immediate and long-term care. And across Africa, NGOs like Doctors Without Borders use telemedicine to connect difficult-to-treat patients to specialists in distant countries.

For any telemedicine programme, multisector collaboration is crucial. In Ghana, our organisations partnered with entities like Columbia University, the Millennium Promise Alliance, Ericsson, and Airtel, combining local and international knowledge about healthcare innovation with the ability to take on financial risk.

In turn, the Ghana Health Service, the Ministry of Health, the National Health Insurance Authority, and the Ministry of Communications expanded the pilot programme, and built telemedicine into the Ministry of Health’s national e-health strategy.

Eventually, the new programme could expand beyond basic triage support to offer consultations in disease management, mental health, and other services.

Ghanaians should be proud of the telemedicine programme they have built. Not only is it one of the region’s most comprehensive healthcare initiatives; it is also an example of what can be accomplished through health partnerships.

In any country, prosperity begins with access to quality healthcare, and Ghana now has in place a highly effective approach to providing it.

Koku Awoonor-Williams is director of the policy, planning, monitoring, and evaluation division of the Ghana Health Service. Ann Aerts is head of the Novartis Foundation. Copyright: Project Syndicate, 2018.

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