DIGITAL HEALTH INTERVENTIONS AND ACCESS TO CARE: A CASE STUDY OF TELEMEDICINE SERVICES AT EHA CLINICS ABUJA

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Digital health interventions, including telemedicine, mobile health (mHealth) applications, and electronic health records, are increasingly recognised as transformative tools for expanding access to healthcare services in resource-limited settings. In Nigeria, where the health system faces severe challenges including a critical shortage of healthcare workers, geographical disparities in service availability, inadequate infrastructure, and escalating costs, telemedicine offers a promising pathway for bridging the access gap (Akintunde et al., 2021). The Nigerian healthcare workforce crisis is stark: Nigeria needs an estimated 100,000 family physicians but has only approximately 1,200 available (Adeloye et al., 2017), a gap that digital health platforms can partially address.

The rapid trajectory of digital health adoption in Nigeria is reflected in market data: the Nigerian digital health market was projected to reach USD 770.30 million in revenue in 2024, driven by growing investment in telemedicine platforms, mHealth applications, and health information systems (Brieflands, 2024). A scoping review of 230 studies on digital health in Nigeria conducted between 2010 and 2024 found a dramatic increase in digital health research activity, with telemedicine, mHealth, and eHealth emerging as the dominant areas of investigation (Oke et al., 2025). However, researchers caution that research growth has outpaced practical implementation, with infrastructure gaps continuing to constrain the translation of digital health evidence into routine service delivery.

Eha Clinics, Abuja, is one of a growing number of private health facilities in Nigeria leveraging digital health infrastructure to deliver telemedicine services, including teleconsultations, remote patient monitoring, and digital prescription management. The emergence of such clinics within the Abuja FCT provides a relevant case study for examining how telemedicine services are operationalised in a Nigerian urban context and what access-related outcomes they generate. Studies have shown that telemedicine enables access to specialist care for rural and underserved populations that would otherwise face significant barriers to quality healthcare services (James et al., 2021; Mustafa et al., 2022).

The COVID-19 pandemic accelerated telemedicine adoption globally, including in Nigeria, where lockdown measures drove both providers and patients toward virtual care platforms (Salako et al., 2023). A systematic review of telemedicine adoption in sub-Saharan Africa, with a focus on Nigeria, Kenya, and South Africa, confirmed that telemedicine is emerging as a transformative solution to healthcare access challenges, with Nigeria among the regional leaders in digital health innovation (Mdlalose et al., 2025). Integrating digital health technologies into Nigeria's healthcare system has been found to improve treatment adherence, recovery rates, and access to postnatal and HIV care, while also expanding healthcare reach in remote areas (Oke et al., 2025). Nevertheless, barriers and facilitators of telemedicine provision in Nigeria have been systematically documented, with connectivity, trust, training, and regulatory frameworks identified as pivotal determinants of adoption and effectiveness (PLOS Digital Health, 2025).

1.2 Statement of the Problem

Despite the increasing deployment of telemedicine services in Nigeria and a projected digital health market exceeding USD 770 million, evidence on the access-related outcomes of specific telemedicine platforms in urban private settings such as Eha Clinics Abuja is limited (Brieflands, 2024). Existing research tends to examine telemedicine adoption at the system level or in public tertiary hospitals (Olufunlayo et al., 2023; Akwaowo et al., 2022), leaving a gap in understanding the patient-level access impacts of private telemedicine services. The question of whether telemedicine genuinely improves access in terms of reducing travel time, cost, and waiting time while maintaining quality of care for the populations served by Eha Clinics Abuja has not been empirically examined.

Furthermore, telemedicine services in Nigeria face infrastructural barriers including unreliable power supply, limited broadband penetration, digital literacy deficits, and regulatory gaps (Mbunge et al., 2022). A systematic review of barriers and facilitators of telemedicine provision specifically in Nigeria identified poor internet access, low digital literacy, inadequate regulatory frameworks, and limited trust in virtual healthcare as the most significant constraints (PLOS Digital Health, 2025). A scoping review on the adoption of telemedicine for dementia care in Nigeria similarly identified limited digital literacy, poor internet connectivity, and the absence of a coherent national telemedicine policy as central obstacles (Adedeji et al., 2025). The extent to which these barriers are operative in the specific context of Eha Clinics Abuja and how the clinic has developed strategies to mitigate them represents an important evidence gap.

1.3 Objectives of the Study

The main objective is to examine digital health interventions and their impact on access to care for patients utilising telemedicine services at Eha Clinics Abuja.

The specific objectives are to:

1. assess the types of digital health interventions available at Eha Clinics Abuja and their patterns of utilisation;
2. evaluate patient-reported access outcomes associated with telemedicine service use at Eha Clinics;
3. identify the barriers and facilitators of telemedicine adoption among patients and providers at Eha Clinics
4. assess patient satisfaction with telemedicine services at Eha Clinics; and

1.4 Research Questions

1. What types of digital health interventions are available at Eha Clinics Abuja and how are they utilised?
2. What access outcomes do patients associate with the use of telemedicine services at Eha Clinics?
3. What are the barriers and facilitators of telemedicine adoption at Eha Clinics?
4. How satisfied are patients with telemedicine services at Eha Clinics?

1.5 Research Hypotheses

H01: Telemedicine services at Eha Clinics Abuja do not significantly reduce patient-reported barriers to accessing healthcare.

H02: There is no significant difference in patient satisfaction between telemedicine and in-person consultations at Eha Clinics.

H03: Digital literacy level does not significantly predict the adoption and sustained utilisation of telemedicine services at Eha Clinics.

1.6 Significance of the Study

The findings of this study will contribute to the growing evidence base on digital health in Nigeria, with practical implications for the Federal Ministry of Health's digital health strategy, private healthcare operators, and investors in health technology. The Eha Clinics case study provides a private-sector model that can be evaluated for broader applicability across Nigeria's urban healthcare sector, at a time when the Nigerian National Broadband Plan has set a target of effective internet coverage for at least 90% of the population by 2025 (Medium, 2025). Academically, the study contributes original empirical data from a private-sector digital health context that is underrepresented in the literature, which has been dominated by public hospital-focused and system-level analyses (Olufunlayo et al., 2023). The study also advances patient-centred evaluation of telemedicine, which has been identified as a methodological priority in recent systematic reviews of telemedicine in sub-Saharan Africa (Mdlalose et al., 2025; PLOS Digital Health, 2025).

1.7 Scope and Limitations of the Study

The study focuses on patients and healthcare providers at Eha Clinics Abuja who have utilised telemedicine services within the defined study period. Data collection includes patient surveys, provider interviews, and review of telemedicine utilisation records. Limitations include: the single-site nature of the study limits generalisability; patients who exclusively use in-person services are less accessible for comparison; social desirability bias may influence patient satisfaction responses; and the rapidly evolving nature of digital health technologies may affect the currency of findings.

1.8 Definition of Terms

Telemedicine: The use of electronic information and communication technologies to provide and support healthcare when distance separates the participants, encompassing video consultations, remote patient monitoring, and digital prescription services.

Digital Health Intervention: Any health service or function that is delivered through digital and electronic technologies, including mobile health applications, telemedicine platforms, electronic health records, and health information systems.

mHealth (Mobile Health): The use of mobile devices and applications to support medical and public health practice, including health information delivery, patient monitoring, and appointment management.

Access to Care: The ability of individuals to obtain needed healthcare services in a timely, affordable, and geographically convenient manner without facing undue barriers.

Electronic Health Record (EHR): A digital version of a patient's medical history maintained by the healthcare provider over time, designed to be accessible by authorised healthcare professionals across different care settings.

Teleconsultation: A healthcare consultation conducted via telecommunication technologies such as video conferencing or telephone calls between a patient and a healthcare provider in different locations.

Digital Literacy: The ability to access, manage, understand, integrate, communicate, evaluate, and create information safely and appropriately through digital technologies.

Broadband Penetration: The proportion of a population or geographic area with access to high-speed internet connectivity sufficient to support video-based telemedicine consultations.

References

Adeloye, D., David, R. A., Olaogun, A. A., Auta, A., Adesokan, A., Gadanya, M., et al. (2017). Health workforce and governance: The crisis in Nigeria. Human Resources for Health, 15(1), 32. https://doi.org/10.1186/s12960-017-0205-4

Adedeji, A., Dogan, H., Adedoyin, F., & Heward, M. (2025). Adoption of telemedicine for dementia care in Nigeria: Scoping review. Interactive Journal of Medical Research, 14, e75168. https://doi.org/10.2196/75168

Akintunde, T. Y., Akintunde, O. D., Musa, T. H., Sayibu, M., Tassang, A. E., Reed, L. M., et al. (2021). Expanding telemedicine to reduce the burden on the healthcare systems and poverty in Africa for a post-COVID-19 pandemic reformation. Global Health Journal, 5(3), 128–134. https://doi.org/10.1016/j.glohj.2021.07.006

Brieflands. (2024). Role of telemedicine in increasing healthcare access in Nigeria: Challenges and effective adoption. Brieflands. https://brieflands.com/articles/chbs-153991

Mbunge, E., Muchemwa, B., & Batani, J. (2022). Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems. Sensors International, 3, 100152. https://doi.org/10.1016/j.sintl.2021.100152

Mdlalose, N., et al. (2025). Telemedicine adoption and prospects in sub-Sahara Africa: A systematic review with a focus on South Africa, Kenya, and Nigeria. Healthcare, 13(7), 762. https://doi.org/10.3390/healthcare13070762

Medium. (2025). Telemedicine in Nigeria: Evolution, current landscape, and future horizons. Medium. https://medium.com/@michealomis99

Oke, A., et al. (2025). Adoption of digital health technology in Nigeria: A scoping review of current trends and future directions. Advances in Public Health. https://doi.org/10.1155/adph/4246285

Olufunlayo, T. F., Ojo, O. O., Ozoh, O. B., Agabi, O. P., Opara, C. R., & Taiwo, F. T. (2023). Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria. Digital Health, 9. https://doi.org/10.1177/20552076221150072

PLOS Digital Health. (2025). Barriers and facilitators of provision of telemedicine in Nigeria: A systematic review. PLOS Digital Health. https://doi.org/10.1371/journal.pdig.0000934

Salako, A., Odukoya, O., Akinwalere, O., & Aina, O. (2023). Application of telemedicine in the provision of healthcare in Nigeria: An insight from COVID-19. Journal of Health Research and Training. https://doi.org/10.34172/jhrt.2023.130916