This worked for countries with high and reliable availability of:

1. Communications infrastructures

1. The phone and computer devices to use for care delivery

1. The data to deliver the care.

However, the availability of these three infrastructures was not widely guaranteed in sub-Saharan Africa. Countries in sub-Saharan Africa already have fragile health systems, and large-scale Coronavirus spread across the health worker population could decimate it. Professor Jackie Sturt and her team developed a way of enabling and testing the safety of remote health consultations in sub-Saharan Africa.

Identifying locations for trial

Prior to the pandemic, Professor Frances Griffiths at the University of Warwick had been leading developmental research, with which Professor Sturt collaborated, into the feasibility and desirability of remotely delivered healthcare in Tanzania, Nigeria, Kenya, Uganda, Bangladesh and Pakistan. They had developed remote healthcare training previously during an early UK NHS study, and this had been delivered in Tanzania to medical and clinical medical officer students in person with the educational expertise of Professor Senga Pemba from St Francis University College of Health and Allied Sciences in Ifakara, Tanzania.

Collectively, Professors Griffiths, Pemba and Sturt developed REaCH training and undertook a pilot evaluation with 63 health workers in Ifakara, Tanzania funded by King’s Together. With the intervention developed, the team then applied for COVID-related funding to UKRI to undertake a fully powered clinical trial. They needed a contrasting trial site with a robust research infrastructure and health systems expertise. Therefore, they decided to collaborate Professor Akinyinka Omigbodun from the University of Ibadan, Nigeria.

Results and effects of remote health care training

The team ran two independent trials with process evaluations in 35 government-funded primary healthcare facilities in Nigeria, and in 21 primary care facilities in the mixed-economy health system of Tanzania. These were on upscaling the delivery of health worker training in Remote Consultations for primary Healthcare (REaCH).

Providing training and airtime resulted in increased remote consulting. In Nigeria, remote consultation increased four-fold with no evidence of change in the rate of face-to-face consulting. There was no increase in remote consulting in Tanzania where phoning health workers was already encouraged.

Remote consulting was also found to be safe and trustworthy: in Nigeria, there was no change in prescribing and investigation rates, and trustworthiness scores were unchanged; in Tanzania, these outcomes also remained unchanged.

Health workers were also found to value remote consulting for a variety of uses, including:

• Giving patient test results

• Adjusting medication after tests and in response to side effects

• Checking how patients take their medication

• Providing advice on self-management

• Directing patients to needed urgent or specialist care

• Enabling patients to contact the right health worker when they needed advice

Patients also reported a positive response to remote consultations because they could receive help at the time they needed it. They also reported trusting their health worker and feeling cared for. One patient in Nigeria said, “it’s confidential and I trust them and also the treatment. They are very effective whenever I call them and they also call me back to check on me.”

In brief, the effects of better remote health care are that more people with long term conditions can receive safe and trustworthy healthcare, more quality care is delivered to these people, and health workers receive training which is accredited by their local health board, or university or professional registration body. This improves healthcare quality and the career development and salary of the worker.

Impact beyond the study

In February 2023, the research team undertook a policy field trip to disseminate the REaCH study findings to national policy makers.

Meetings took place in Uganda, Kenya, Malawi, Ghana and Sierra Leone. In Uganda, meetings were held with Uganda Nurses & Midwives Council, the Republic of Uganda Ministry of Education and Sports, Makerere University, in Kenya with the Republic of Kenya Ministry of Health, Amref International University and Safaricom.

A gap analysis was also sent to 150 policy makers that the research team met in person and online during and subsequent to the field trip in February 2023.

Following the field trip meetings, plans are progressing with several countries to achieve CPD accreditation and host the REaCH training locally. The gap analysis has been well received as supporting policy development priorities within several countries.

The team are currently delivering a project to accredit REaCH training on Oyo state and Kano state in Nigeria, and in Greater Accra in Ghana. In each site, they are training 150 students of nursing or medicine and 150 staff members delivering care in primary care health facilities. This project completes in January 2025.