MotoMeds: Pilot Implementation of a Nighttime Telemedicine and Medication Delivery Service to Increase Access to Pre-emergency Pediatric Care in Ghana


Globally, leading causes of pediatric mortality include respiratory infections, diarrheal disease, and malaria.
These common illnesses are treatable with basic medications and fluids early in the disease course yet
frequently progress to emergent, life-threating conditions in low-resource settings. In response, our team has
designed a telemedicine and medication delivery service (TMDS) called MotoMeds to overcome barriers to
seeking care. We target pediatric patients during the nighttime period when barriers to accessing care are the
highest. The TMDS was initially deployed in Haiti and has been active in Ghana since 2022. The pilot
implementation took place in the urban communities of Jamestown and Usshertown. We anticipate that
MotoMeds will go live in Nima and Mamobi in July of 2024.


The workflow consists of parents/guardians calling the TMDS on their child’s behalf, Emergency Medical
Technicians (EMTs) referring severe cases to emergency services, EMTs performing phone assessments for
non-severe cases, and EMTs travelling to households to perform exams/tests and deliver protocoled
medications for cases within the delivery zone. The TMDS will operate from 8PM-7AM and serve patients
aged 10 and younger. Participants will be contacted at 24 hours and/or 10 days to ascertain disposition, if
additional care was sought, and qualitative feedback about the service.

Clinical Approach

The clinical scope of the TMDS is defined by the clinical guidelines to include pre-emergency cases of fever,
cough/respiratory illness, diarrhea/vomiting/dehydration, skin lesions, ear pain, and urinary/flank pain. The
clinical guidelines were developed by US-based and Ghanian physicians to adhere to Ghanaian and WHO
standards of care. The clinical guidelines are supported by standing orders for malaria rapid diagnostic testing
and medications/fluids including antibiotics, antimalarials, antifungals, antihistamines, oral rehydration
solution, and other pain and dermatologic medications. Neither the ability to receive care nor the type of care
will be affected by the decision to participate in the research component of the project.


The TMDS is staffed by Ghanaian medical professionals including National Ambulance Service Advanced
EMTs and KBTH physicians specializing in pediatrics. Advanced EMTs act within the scope of the pre-
defined clinical guidelines and consult on-call physicians.


The project is funded by the United States Agency for International Development and the Society for
Academic Emergency Medicine.