Integrating telemedicine into health systems: A qualitative study on availability of health workforce and infrastructure capacity at the Ashanti regional secondary level hospital, Ghana

Background Telemedicine has become a key part of health system transformation, particularly in Africa. The Millennium Promise Alliance (MPA) and Ghana Health Service launched a national telemedicine program in 2010, scaling it across six regions, starting with the Ashanti Regional hospital. It aims to improve healthcare access in remote areas and strengthen primary-to-secondary referrals. Despite telemedicine’s potential, little research exists on service availability. This study evaluates workforce density, ICT training, and infrastructure capacity at Ashanti’s regional hospital to assess the effectiveness of telemedicine integration. Methods Qualitative in-depth interviews were conducted with the management team of the Ashanti Regional Hospital's teleconsultation centre using a semi-structured interview guide. Purposive sampling identified seven key informants who participated in the interviews. The interview guide was based on the Service Availability and Readiness Assessment (SARA) framework. Data collection occurred from April to May 2023, and thematic analysis was conducted. Responses were compared with the Novartis Foundation's interactive implementation guide for telemedicine. Results The operations of the teleconsultation centre have been significantly affected due to a critical server breakdown, which has led to frequent service disruptions and limited access to virtual consultations. Additionally, the lack of funding for staff training has reduced efficiency and limited capacity to adapt to evolving telehealth technologies. These combined challenges have negatively impacted the daily call volume and strained overall service delivery. Conclusion Server malfunctions and inadequate training funds have disrupted the telemedicine centre’s operations, limiting remote healthcare delivery. Addressing these challenges requires strategic investments in technology and staff training. Resource mobilization, partnerships, and phased development plans are essential to restore services and ensure sustainable, quality care. Without these fixes, the centre cannot meet its healthcare access goals.