Project Echo & Ghana: Access

Various telemedicine projects have demonstrated potential in increasing geographic access to higher levels of care without substantial investments in workforce or infrastructure.

Project ECHO is a telemedicine initiative that was launched in the United States in 2003 and now operates in 23 countries.1 Project ECHO supports primary care providers in the treatment and management of complex conditions and is particularly beneficial in areas with limited access to specialized or tertiary care.2 The services provided through Project ECHO differ according to the burden of disease, need, and access in each location. For instance, in Namibia, Project ECHO was instituted in 2014 to improve HIV care and currently facilitates 30 weekly HIV clinics for providers at ten sites across the country. While this technology has the potential to improve access to care, the success of this initiative depends upon adequate facility infrastructure to support telecommunication, availability of primary care providers to administer care as directed, availability of specialized providers to direct care via telecommunication, and availability of drugs and equipment for treatment.

A similar use of telemedicine is utilized in Alaska where the Southcentral Foundation’s Nuka System of Care regularly sends care teams to rural areas. During these consultations, primary care providers can use telecommunication to discuss complex care treatment with specialists stationed in larger cities, as needed.3 This use of telemedicine for access to specialized care promotes continuity and coordination with a primary care provider as they are needed to connect patients with specialists and administer care.

Telehealth can also be used to support direct communication between providers and patients in homes or facilities. In Ghana, a joint provider and patient mobile health program was designed to improve the recording of antenatal and postnatal patient data while also making patients aware of appointments or pregnancy-related consideration.4 The demand-side program, called Mobile Midwife, delivered voice recorded messages to patients according to their gestational age or the age of their infant. Voice recording helped overcome limitations related to low literacy, and messages were recorded in the local language and attuned to specific local values or beliefs. As with many mobile health interventions, availability of mobile phones and connectivity were limitations in effective use of this technology.


  1. Project ECHO: Our Story [Internet]. 2017 [cited 2017 Aug 23]. Available from:
  2. Hostetter M, Klein S, Mccarthy D. Project ECHO’s Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. 2016;22. Available from:
  3. Gottlieb K. The Nuka System of Care: Improving health through ownership and relationships. Int J Circumpolar Health. 2013;72(SUPPL.1):1–6.
  4. LeFevre AE, Mohan D, Hutchful D, Jennings L, Mehl G, Labrique A, et al. Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs? BMC Med Inform Decis Mak [Internet]. 2017;17(1):27. Available from: