Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana

Clinical Snapshot

Key Findings

• P Value: Not reported for primary outcomes

• Effect Size: 89.4% would recommend service, 78.2% would use again

• Primary Outcome: Complete abortion rate of 96.9% among EMA clients reached for follow-up

• Nnt Or Sensitivity: Post-abortion contraception uptake 24.8%, 47% reported no other way to access care

• Confidence Interval: Not reported

Clinical Application

Requires robust telemedicine infrastructure, trained providers, and appropriate regulatory framework for remote prescribing Limited direct applicability due to different regulatory environment. TGA and PBS frameworks would need adaptation. RACGP telemedicine guidelines relevant for implementation considerations Women in rural or underserved areas requiring reproductive health services, particularly where access barriers exist

Abstract

BACKGROUND: In 2021, Ghana's National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model. METHODS: A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research. RESULTS: A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks' gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care. CONCLUSIONS: Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.

References

1. 1.Owusu, E. A., Roemer, M., Monney, E., Dugbazah, P., Attah, E. N., Akanlu, G., & Fofie, C. (2026). Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana. BMJ Global Health, 11(5), e018762. https://doi.org/10.1136/bmjgh-2024-018762