Abstract
Introduction
Remote consulting can improve healthcare access and equity. When delivered by trained health workers, it is safe, trustworthy and efficient. Alongside two independent clinical trials, we studied the implementation of a cascaded health worker training intervention (REaCH), plus airtime, on remote consulting in primary healthcare facilities in Nigeria (n=35) and Tanzania (n=21). Additionally, we assessed health service readiness for sustainable remote consulting in Ghana, Kenya, Nigeria, Malawi, Sierra Leone, Tanzania and Uganda.
Methods
We explored what worked for whom, how, and why in both health worker training in Nigeria (n=115) and Tanzania (n=136), and the implementation of remote consulting for patients with long-term conditions. We assessed REaCH training for talent, resources, alignment, implementation and nurture. We analysed system readiness with WHO’s Digital Investment Guide. We undertook 82 semi-structured interviews with health workers and patients (n=40: Nigeria, n=42: Tanzania), collected text produced, engaged with stakeholders and reviewed key policies/guidelines. Data were analysed thematically.
Results
Health workers were already doing informal remote consulting. REaCH training helped facilities to plan and implement remote consulting. It addressed concerns about delivering a safe and ethical service. Provision of airtime was critical. Health workers used remote consulting for patient follow-up and patients sought advice, test results, prescriptions, referrals and emergency help. Patients and health workers trusted and appreciated remote consulting as it saved time. Patients felt cared for, but some received calls at inconvenient times. Health workers reported reduced stress but noted off-duty calls could be burdensome. Stakeholders were aware of informal remote consulting and were concerned about quality. None of the study countries provided airtime for remote consulting or had guidance or recording systems for remote consulting.
Conclusion
There is an appetite for remote consulting in primary healthcare. However, health systems in seven countries of sub-Saharan Africa are not yet fully prepared for this.