Opportunity to transform public healthcare service delivery in Ghana

A private foundation has been working with African leaders to build open, inclusive and prosperous societies in a globalised world.

They seek to help make globalisation work for the majority of the population, targeting the majority rather than the privileged few, and have embarked on a “Tech4Dev” national technical transformation programme of work. The office of the President in Ghana identified telemedicine as an area that could bring about meaningful change in a digital world.

Against this backdrop, Genesis Analytics partnered with the foundation, and key stakeholders in the public, private and NGO sectors in Ghana to develop a transformational vision for the use of digital technologies, especially in the north of the country, which suffers serious backlogs in terms of healthcare services and health indicators.

A desktop review was complemented with key informant interviews, to develop a range of options for the foundation to explore. This revealed that there have been a number of “siloed” telemedicine pilots in Ghana, but none to date have managed to scale nationally. This is largely because they have been reliant on external donor funding and because they have not been embedded in the Ghana Health Service (GHS) from the outset.

Three telemedicine uses cases were defined, each with significant potential for improving public primary healthcare in Ghana. 

1. Chatbot messaging platform to deliver behaviourally informed healthcare information: Automated messaging platform provides pregnant women (who can access a basic smartphone with a messaging app like WhatsApp) with first-line health support in the form of personalised healthcare information, behavioural nudges to address the social determinants of health, reminders of when to visit primary health centres for ANC appointments and infant vaccinations, and the option of being connected to a live agent in a telehealth contact centre if required. The messaging platform is driven by a chatbot that can be hosted in the cloud or in GHS central servers, and a segmentation algorithm that segments pregnant mothers into different milestone stages and feeds information to them based on which stage they are in and the likely challenges they will face.
2. Patient support from a telehealth contact centre: In cases of emergency or where the chatbot support is not sufficient, patients can engage with a live agent in one of the regional telehealth contact centres. The contact centres can connect patients to medical professionals through multiple channels (voice, text and video) supported by a contact centre software platform. Contact centre medical staff can assist patients with triaging their symptoms and advise them on what kind of treatment to seek, and from which institutions.
3. Specialist support to primary healthcare workers: Nurses and doctors at primary care centres and district hospitals can contact medical specialists through the regional telehealth contact centres through multiple channels (voice, text and video) including low-broadband video streaming so that the medical specialists can access a wider range of data on the patient when providing assistance.

Collectively they address the three main determinants of high maternal and infant mortality in Ghana:

• Delays at home (where patients do not seek primary healthcare until it is too late),
• delays on the road (where patients cannot access specialist services because they are located in facilities far away) and
• delays at the facility (where patients are not seen because of over-stretched staff and inappropriate referrals).

Our recommendations were that for any telemedicine solution in Ghana to scale nationally in the public healthcare sector it will be critical that the solution is owned by GHS, that is does not place an additional burden on healthcare workers, and that it fits into the existing hub and spoke model that GHS is already employing.

In addition to building a clear business case for GHS that illustrates how telemedicine can reduce service delivery costs and improve patient-level outcomes, it may also be necessary to leverage government healthcare funding in the form of the National Health Insurance Scheme (NHIS). These recommendations were taken by the Foundation back to the Presidency and the Ministry of Health for consideration.