Tele-Medicine - An Idea Whose Time Has Come

Conventional health care delivery requires a sick patient to move from the house to a hospital or clinic to meet a Health Professional, a Doctor, Physician Assistant (PA)or a Nurse Practitioner (NP) as the case may be or visit a Pharmacy or Chemist where the individual relates how he or she feels. In the case of the Doctor, PA or NP, they may proceed to examine the patient which requires physically touching the patients, doing certain manoeuvres and using a stethoscope on the chest front and back and may be on the abdomen. They may request certain laboratory tests and or X-rays and provide treatment in the form of drugs. In the case of the Pharmacist and Chemist, they will provide first aid or syndromic treatment and request that if patient does not get better then he or she must go to the hospital or clinic.

The hospital or clinic requires considerable investment in infrastructure, equipment and personnel and siting in areas of human density. The further one is from the centre, the greater the difficulty in access. The distribution of equipment and personnel has always presented great challenges, the latter being worse because of the shortages of the various categories of staff particularly, Doctors, Nurses and Midwives of all categories, Pharmacists, Laboratory Scientists, Radiographers and Physiotherapist.

In Ghana, the CHPS (Community based Health Planning and Services) concept, a close to client service was pioneered in Ghana as a means of increasing access. It was meant to ensure that nobody was more than a few metres away from health care. It was however to provide basic health care and to refer to the health centre if necessary where a Medical Assistant or Physician Assistant will treat appropriately and refer to the corresponding District Hospital to see a Doctor depending on the circumstances.

Ghana as a country has survived under this elaborate health care delivery system but has always thought about the concept of Tele-medicine (the use of audio and or video for health care) primarily as an add on to Doctors in the District Hospitals requiring added expertise such as interpretation of an X-ray or even laboratory test or a second opinion on a difficult case. It has required internet services that we all know has not always been strong or consistent. There have been many offers to the Ghana Health Service and Teaching Hospitals but at cost that has for the moment not been acceptable and therefore of limited application if any.

In the advanced countries particularly the UK where I am quite conversant with the system, the National Health Service introduced a telephone system called NHS Direct, in which anyone out of hours to start with could place a call to the telephony service which will have a nurse practitioner at the other end who will listen to the complaints and advice if that is all that is required or pass on the call to a doctor who will ask relevant questions and if necessary prescribe a remedy. It was a means of making sure that many persons did not get out of the house and move to the hospital emergency when their situation could be sorted out reasonably. Such patients invariably received a call the following morning to find out how they were fairing and for further advice if desired. It has worked tremendously and has been expanded as an additional service.

It must be remembered that many persons only need advice and a little direction and so do not need to go all the way to the hospital and many others, with the right questions from well trained practitioners, can get to the bottom of many of the complaints we take to the hospitals and clinics, so is it not possible to use a system such as the NHS Direct and drive a certain health traffic through a telephony system that can meet the needs of the people at their point of need? It only requires a telephone and we all know that mobile phone penetration in Ghana is considerable and more than the adult population because many of us carry two or one phone with two SIM cards. If phones are everywhere then what is required is a service of trained staff, in health knowledge, telephone etiquette and customer service to provide such a service to augment all our attempts to provide universal health coverage for all the peoples of the country.

Interestingly there is such a service in Ghana today that is linked to an insurance system and that got me very fascinated. It is called the BIMA Doctor Service. It is a subscription based teledoctor service which allows 60,000 subscribers to reach the call-centre staffed with fully licensed medical doctors, physician assistants and nurses. The patients receive medical advice , education and doctor consultation. They also provide preventive healthcare with a choice of coaching programmes ( e.g Diabetes and Hypertension, women and Childcare etc) sent weekly by SMS, recorded messages or via their mobile app. They have partnered Laboratories which must also be registered with their Professional Regulatory Bodies, that they work with. Admissions to hospitals if it becomes necessary are covered under their insurance scheme.

They receive 15,000 calls monthly with 8,000 doctor consultations on average per month and operate 24 hours everyday of the week. Subscribed customers make calls on a toll free number, from any part of the country. Consultations can be conducted in Twi, Ga and Ewe in addition to English.

Their healthcare consultation service for which you do not have to move either from your home or office, is conducted by very well trained health professionals and where necessary you may be directed to registered laboratories or pharmacies. You will get a follow up call subsequently to find out how you are. You can register your family, spouse and 6 children, parents as well as in-laws. All they require is a free phone call and their health needs are sorted.

COVID-19 has made the hospital environment dangerous. Many are those outside Ghana who acquired the infection from the hospital environment and there was therefore a need to advice sick patients to only go to a hospital if it was absolutely necessary. This instruction was passed on to Ghanaians also. It must be realised that the COVID-19 pandemic does not take away other ailments and diseases far from it and to realise that there is a toll free number that can help provide a service is helpful. The company made the service free during the length of the pandemic for mobile money customers who dial *789*96#.

Nothing will be the same again after COVID-19. Tele-medicine has come to stay. It is useful and convenient.