Various telehealth services have been implemented in Ghana since 2012 (Novartis, 2022). As telehealth services have proved their importance during the COVID-19 pandemic, the government of Ghana has scaled up their efforts to expand service coverage at the national level (Novartis, 2022). Yet, the utilization of telehealth services in developing counties, including Ghana, is challenging due to several factos including political instability, lack of access to technology, poor internet connectivity and coverage, limited infrastructure and resources, and others (Shaarani et al., 2022; Ftouni et al., 2022).
In 2016, Ghana implemented a telehealth services program across the nation connecting doctors, nurses, and midwives in the teleconsultation centers with community health workers to advise on the treatment of their patients (Novartis, 2022). Currently and after the COVID-19 pandemic, the Canadian UniDoc Health Corporation has signed an agreement to further expand the program’s activities (Baldassarre, 2021). Integrity Care Services is also a platform that provides telehealth services (including nutritional and surgical consultations, health screening, pharmaceutical services, etc.) and connects patients with healthcare providers (Integrity Care Services, 2022). However, the above-mentioned programs allow patients to have consultations with physicians and medical professional based in Ghana only and do not extend to physicians outside the country. These services are still limited in scope and coverage.
In fact, very few platforms are available in Ghana which provide transnational telehealth services with physicians outside the country, such as the United States (U.S.). An example of these platform includes My Care Ghana which provides transnational telehealth services to patients. The latter provide services in several specializations including Family Medicine, Internal Medicine, Neurology, Urology, etc. and connects patients with healthcare providers in Algeria, Libya, Bahrain, etc. (My Care Ghana, 2021). Emed Ghana is another similar platform that allows patients in Ghana to book consultations with more than 100 doctors around the world, including the U.S. The platform provides several specialized services including cardiology, dermatology, oncology, mental health, therapy, internal medicine, and more (Emed Ghana, 2022).
International telehealth services are a new global health endeavor, which can provide cost-effective, and easy access to specialists and healthcare workers located in multiple countries. These services can lead to better global health outcomes and can prepare countries for arising public health emergencies such as the COVID-19 pandemic (Ferreira and Rosales, 2020). Providing consultations and services to patients located around the globe involves synchronous and asynchronous communication tools that facilitate diagnosis, consultation, treatment, and monitoring of health outcomes (Ferreira and Rosales, 2020). This is a challenge that developing countries, including Ghana, face which hinders their ability to meet U.S. based telehealth consultation standards and best practices, especially with the interrupted power supply, and poor internet connections and coverage.
Medical practice is regulated in both the U.S. and Ghana. However, transnational telehealth activities often do not fall within the traditional laws and regulations of the medical profession (Ferreira and Rosales, 2020). As such, a framework ought to be developed to guide implementation of such services between Ghana and the U.S. This framework is needed to protect the patients and the physicians and provide clear guidelines for physicians to adhere to.
In Ghana, there has been a shift from government-controlled telecommunication to an unregulated system with the participation of the private sector (Dzando et al., 2022). This highlights the need for documented policies and regulations to govern the safe transfer of data through telecommunication and technological devices within and outside the country. In addition, the Ministry of Health (MoH) in Ghana has devised a National e-Health Strategy that aims to develop a regulatory framework for health data and information management to serve the nation in the digital transformation (MoH, 2010). However, the strategy does not include a framework for transnational telehealth services. This is imperative as unregulated use can contribute to unacceptable level of service quality.
Currently, patients in Ghana are engaging in telehealth services with U.S. based physicians without the existence of comprehensive platforms and legal frameworks. In addition, the services provided by these platforms are not specific to a certain specialty. Telehealth services should be categorized by specialty (such as cardiovascular, oncology, orthopedics, etc.). This is important as different specialties may have different requirements and regulations to govern its services (Robezniek, 2019).
From a regulatory perspective, the Ministry of Health in Ghana ought to include in the national e-Health strategy a comprehensive medicolegal framework to govern telehealth activities with U.S. based medical professionals. The framework should include specific laws or regulations regarding integrated medical services at the national and healthcare institution level between the two countries, clinical guidelines for transnational telehealth services and consultations, research on foreseen issues arising from these services, etc. (Ohannessian et al., 2020; Ferreira and Rosales, 2020). Regulations to govern the telecommunication sector to secure transfer of patient data is also needed.
Ohannessian, R., Duong, T. A., & Odone, A. (2020). Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR public health and surveillance, 6(2), e18810.
Ferreira, W. and Rosales, A. (2020). International Telemedicine: A Global Regulatory Challenge. Hogan Lovells.
Shaarani, I., Ghanem, A., Jounblat, M., Jounblat, H., Mansour, R., & Taleb, R. (2022). Utilization of telemedicine by the Lebanese Physicians during time of pandemic. Telemedicine and e-Health, 28(2), 219-226.
Ftouni, R., AlJardali, B., Hamdanieh, M., Ftouni, L., & Salem, N. (2022). Challenges of Telemedicine during the COVID-19 pandemic: a systematic review. BMC medical informatics and decision making, 22(1), 1-21.
Robezniek, A. (2019). Which medical specialties use telemedicine the most? American Medical Association.
Novartis Foundation (2022). Ghana Telemedicine. Available at: https://www.novartisfoundation.org/past-programs/digital-health/ghana-telemedicine
Integrity Care Services (2022). Quality Healthcare At Your Home. Available at: https://integritycaregh.net/about-us/
My Care Ghana (2021). Home Page. Available at: https://www.mycareghana.com/
Baldassarre, A. (2021). UniDoc Signs Definitive Agreement to Provide Telehealth Services in Ghana. Available at: https://unidoctor.com/unidoc-signs-definitive-agreement-to-provide-telehealth-services-in-ghana/
Dzando, G., Akpeke, H., Kumah, A., Agada, E., Lartey, A. A., Nortu, J., Nutakor, H. S., Donyi, A. B., & Dordunu, R. (2022). Telemedicine in Ghana: Insight into the past and present, a narrative review of literature amidst the Coronavirus pandemic. Journal of public health in Africa, 13(1), 2024. https://doi.org/10.4081/jphia.2022.2024
Ministry of Health (MoH). (2010). National e-Health Strategy. Available at: https://www.isfteh.org/files/media/ghana_national_ehealth_strategy.pdf
Emed Ghana. (2022). Emed Ghana home page. Available at: https://www.emedghana.com/doctors/grid