The promise of telemedicine

In developing countries, insufficient access to quality medical care undermines health outcomes and disadvantages entire generations. But as the successful implementation of a national telemedicine program in Ghana shows, well-planned digital solutions can help bring health coverage to those on the medical margins. ACCRA/BASEL – 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 revolutionizing patients’ engagement with modern medicine. In a remote corner of Ghana, one “telemedicine” program illustrates just how effective digital care can be when coverage is extended to those on the medical margins. In 2011, our organizations launched Ghana’s first telemedicine pilot program, with the goal of creating a model for national expansion. Starting in the country’s Amansie West District in the Ashanti Region, about 330 kilometers (200 miles) 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 program, designed in collaboration with global telecommunications providers, universities, and NGOs, initially covered 30 rural communities, and connected some 35,000 people to health-care professionals through a staffed call center. 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 program 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 program’s consultations were resolved by phone. Each referral that was avoided saved patients, on average, 110 Ghanaian cedis ($25), 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 program 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 center, 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 centers 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, ten years ahead of the target date. But, most exciting of all, Ghana’s program offers a blueprint for how other developing countries can expand their own health-care access. In developed countries, too, telemedicine is revolutionizing 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 program, multisector collaboration is crucial. In Ghana, our organizations partnered with entities like Columbia University, the Millennium Promise Alliance, Ericsson, and Airtel, combining local and international knowledge about health-care 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 program, and built telemedicine into the Ministry of Health’s national e-health strategy. Eventually, the new program could expand beyond basic triage support to offer consultations in disease management, mental health, and other services. Ghanaians should be proud of the telemedicine program they have built. Not only is it one of the region’s most comprehensive health-care initiatives; it is also an example of what can be accomplished through health partnerships. In any country, prosperity begins with access to quality health care, 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

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The promise of telemedicine