Highlights

The feasibility study demonstrated that a system can be created with relatively little technical effort that enables nurses and midwives to contact doctors of all specialties around the clock.

Project goal

Overview

Partner

• Ministry of Health (MOH), Accra
• SWHAT Sewfi Wiawso Health Assistant School
• Community Health Nurses Training College in Esiama.
• Sekondi Nurses and Midwifery Training College in Sekondi
• Health Assistant Training School in Asankragua

HITA

Tasks:

1. holding workshops with representatives of the MOH and the GHS
2. Development of a test environment
3. Provision and, if necessary, adaptation of software
4. System and server connection and adaptation to the users’ mobile devices
5. Identification of Ghanaian doctors in Germany and the USA. Determining the willingness of this target group to participate in such an approach
6. Practical testing of the test environment
7. Conducting workshops with nurses and midwives on cultural issues
8. Project and process support, including monitoring, evaluation of the test applications and various consulting services
9. Presentation of the discussed solution, including financing and marketing options, to representatives of the MOH and the GHS.

Employees:

• Prof. Christian Johner
• Fabian Berger
• Thomas Erkert
• Mirco Heise
• Jörg Lesch

Ghana

Regions:

• Western
• Brong-Ahafo
• Ashanti

Places:

• Sewfi Wiawso
• Esemia
• Sekondi
• Asankragua

Short Facts

Project Type:

• Feasibility study
• Piloting
• Implementation project
• Knowledge transfer
• Continuous maintenance + further development
• other

Project volume:

• Less than €10.000,00
• €10.000,00 – €50.000,00
• €50.000,00 – €100.00,00
• €100.000,00 – €250.00,00
• more than €250,000.00
  (*) = The project volume includes all costs of HITA e.V. plus the expenses of the project partners. Private expenses and or ongoing operating and personnel costs are not included.

Period:

• 2012-2013

Status:

• Idea
• Exploration
• Implementation
• Evaluation
• Sustainably implemented (in regular use)
• completed

Report

Problem / Initial Situation:

There is a shortage of doctors in Ghana. In some areas – especially in northern Ghana – one doctor serves a population of about 180,000. Consequently, a large part of the medical services must be provided by nurses and midwives or even health care assistants*. Serious medical problems often occur when caregivers need further help and don’t get it.

Some of the nurses know people they can call if needed – others do not. However, knowing a doctor’s number is not enough if the doctor cannot take the call. The goal of this feasibility study is to figure out how to make it possible for any nurse to call a physician of the required medical school at any time. It will also clarify whether such an approach can be implemented in a sustainable manner. The task is to find out whether and how such telemedicine services can be offered in different regions and countries around the world.

The project:

The shortage of doctors in the Ghanaian healthcare system – particularly in rural areas in the north – is reaching dramatic proportions. Up to 180,000 residents in one area need to be looked after by a doctor.
Against this background, HITA has launched a feasibility study together with representatives of the Ghanaian Ministry of Health (MOH) and the Ghana Health Service (GHS) to find out how this shortage can be addressed. The idea is for a virtual telemedicine center to connect nurses and midwives seeking advice (e.g. on medical problems) with consulting doctors. In order to be sustainable and, above all, to keep investment costs low, doctors living in Ghana or elsewhere can donate consultation time for a specific date and a specific medical faculty. Once a nurse calls an emergency number specific to a medical area, their call is routed to a doctor “on duty”. Ideally, the software is directly linked to an electronic patient record and medical history.
The virtual telemedicine center could easily be expanded into a “real” telemedicine center where doctors physically sit together in one place – for example, in a hospital or a teleconsultation center. In both cases, the only technical requirement for the nursing staff is a telephone, ideally with a camera, to send images (e.g. of wounds) to the doctor as an MMS. Doctors need a PC for time bookings and a telephone for teleconsultations.
The web server runs an application that manages the time slots. Doctors donate “their” time via this application. In the case of a worldwide deployment, the different time zones – according to the considerations – could easily guarantee a 24/7 on-call time. The application “programs” the switchboard so that every call from a nurse is forwarded to a “suitable” doctor on duty. The technical feasibility of such a telephone server was successfully tested.
As part of the study, it was important to identify usage requirements. These included the following:
– A doctor can choose when and how much time they want to donate to consult nurses (also recurring).
– A doctor can choose the type of medical problems for which they want to offer help
– A doctor can recognize when his help is most urgently needed (SMS service?)
– A nurse can recognize whether a doctor is available and responsible for help/advice
– A nurse can contact the same doctor to ask further questions
– Optional: A nurse can send images of a medical problem to a doctor
– Optional: A doctor can recognize a patient’s medical history
– Optional: A doctor can forward a call to another expert if he cannot help (or make a callback à SMS with unique token?)
During the study, it quickly became clear how enormous the challenges were that the project team would have to face if the feasibility study was to be successfully completed:
– First and foremost, a sufficient number of physicians who are willing, competent and available to cover 24/7 teleconsultation for several medical faculties must be identified and recruited for such an approach
– The availability of the Internet in Ghana must be clarified and secured.
– An operator for the telephone exchange must be found
– The service must be wanted and implemented throughout Ghana
– The technical infrastructure can only be implemented with the help of a nationwide mobile phone provider
Last but not least, a decisive factor for this project is the marketing of the approach, i.e. the dissemination of information about this new service to nurses and midwives in Ghana as well as to doctors in Ghana and around the world.
Another important question for the MOH and the GHS was to what extent the offer could be internationalized and whether this could be a business opportunity for the Ghanaian health system.

Résumé and outlook:

The project was able to show in principle how a web server-based system can support nurses and midwives in being able to reach a doctor at any time. The support for teachers is not only limited to the simplified control of learning outcomes but also to other – more regular – methods of knowledge control.

It will be important to consider login issues in the future. It will be crucial to guarantee that only those who are authorized to do so can access the learning content. Solutions using access codes and/or vouchers for login must be prepared and implemented.

A basic prerequisite for the future and sustainable application of such an approach is that all those involved actually pursue this goal. Cultural concerns must also be overcome. For example, it is essential that a doctor can be called despite and precisely because of their reputation – even by a midwife or nurse. The approach could not be implemented without additional sponsorship. Due to the call costs involved, it is very unlikely that nurses or midwives would make such a chargeable call if necessary. This means that when selecting such an application, consideration must be given to the fact that the costs for a cell phone and the calls made with it must be covered in full by the employer. Higher-level institutions, such as the Ministry of Health (MOH) and/or the Ghanaian Health Service and others, must guarantee this cost coverage – otherwise a virtual telemedicine center will remain a dream.

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