A study published by the Lancet Global Health shows that online consultations (telemedicine) improve access to healthcare in Nigeria and Tanzania with appropriate training and funding.
The trial called ReaCH, is a training programme for the delivery of remote healthcare which took place at Oyo state, Nigeria and Morogoro Region, Tanzania.
It found that online consultations improve health access for people with diabetes, hypertension and respiratory conditions without compromising patient safety or the trustworthiness of online consultations.
At the peak of COVID-19, high-income countries quickly responded to the pandemic by replacing physical (face-to-face) consultations with online consultations.
However, middle- and low-income countries faced barriers to implementing online consultations including network issues, shortage of phones with internet access especially in rural areas, inadequate training and lack of electronic records.
The trial showed that these challenges can be overcome, and telemedicine can be rolled out.
Research Data
40 clusters were enrolled. 20 clusters were enrolled in each of the two settings (Oyo state, Nigeria and Morogoro Region, Tanzania).
35 urban and peri-urban primary healthcare facilities in Ibadan, Oyo state and 21 rural and remote primary healthcare facilities in regions in Morogoro Region were recruited during the pandemic based on the associations with the Oyo State Health Board and the remote locations of the Morogoro region.
The primary healthcare facilities in Nigeria were publicly funded, consultations were free, and prescribed drugs were purchased at commercial pharmacy shops.
In Tanzania, primary health-care facilities were a combination of public, faith-based, and private, in which, unless they were exempted or insured, were paid for consultations.
Hypertension was the most predominant condition.
| Nigeria | Tanzania | |
| Location | Oyo State | Morogoro Region |
| Number of clusters | 20 | 20 |
| Number of patients | 8776 | 3246 |
| Females | 6377 (72.7%) | 2235 (68.9%) |
| Males | 2399 (27.3%) | 1011 (31.1%) |
| Mean age | 55.3 years | 59.2 years |
| Number of patients with conditions | |
| Hypertension | 8145 (90.9%) |
| Diabetes | 618 (6.9%) |
| COPD | 190 (2.1%) |
| Coronary Heart Disease | 5 (0.1%) |
Result
- No evidence of change in the face-to-face consulting rate was observed.
- However, the online consulting rate increased FOURFOLD.
| Nigeria | Tanzania | |
| Face-to-face consulting rate | 1.06 | 0.94 |
| Online consulting rate | 4.44 | 1.17 |
There was no evidence of a difference in prescribing rates, investigation rates or trustworthiness scores.
What Professor Akinyinka Omigbodun, UCH, the Lead Investigator Had to Say
- “Both the health care workers and patients found a lot to like about virtual consultations.”
- “The health workers felt that they were able to attend to a greater number of patients without experiencing overcrowding in the clinics.”
- “The patients who were traders or market women were happy that they did not have to leave their shops or market stalls before they would consult with their care provider, thereby boosting their earnings.”
Why It Matters
- Telemedicine (Online Consultations) should be promoted by national, standardized training which can be delivered online.
- Telemedicine (Online consultations) should be part of national strategies for achieving national health coverage and maintaining public health.
- Finding airtime and data packages needs to be addressed as part of the strategy for the implementation of online consultations.
