“In critical cases, we use our phones to call the doctor. Even at that, we may have to change SIM cards for strong network coverage,” she said.

The Anambra State Government launched its telemedicine initiative in November 2024 to bridge gaps in healthcare access, particularly in rural areas, and to support maternal and child health services across 329 primary healthcare centres funded under the Basic Health Care Provision Fund (BHCPF).

According to the Commissioner for Health, Afam Obidike, the programme was designed to address human resource shortages at primary healthcare facilities. Under the model, telemedicine hubs were established across the  21 local government areas, with doctors available to provide real-time consultations to frontline health workers.

Initially hailed as a breakthrough, the programme promised to ease pressure on overstretched facilities and extend specialist support to remote communities. One year later, however, findings from visits to several rural PHCs suggest a more complex reality, shaped by weak network coverage, power supply challenges and community perception.

When the network fails, the system falters

Unstable mobile networks remain the most significant obstacle to effective telemedicine use. Eunice Obi, Officer-in-Charge of Amansea PHC in Awka North LGA, said dropped calls during consultations are common.

“Sometimes, you are on call with the doctor for a critical case, the network drops and the call is aborted. It wastes patients’ time, and I see it on their faces.”

Similar experiences were reported in Umueze-Anam and other parts of Anambra West. Emmanuella Anyanwu, of Umueze-Anam 1 PHC, said she often monitors network strength on her personal phone before attempting to call.

“When the signal improves, that’s when I try to reach the doctor,” she explained.

In Ogbaru LGA, the consequences of these disruptions proved fatal. Ifeoma Ndu, who is in charge of Ogbakuba PHC, recalled a case involving a patient with a heart condition.

“I tried repeatedly to reach the telemedicine doctor but couldn’t,” she said, adding: “When I eventually got through, I was advised to refer him. But the family refused to travel at night because of insecurity. He died early the next morning.”

Such incidents, experts say, show how unreliable connectivity can undermine the promise of digital health solutions.

Despite the challenge, OICs alleged that ₦20,000 is deducted monthly from their facilities’ quarterly BHCPF disbursements for data subscriptions dedicated to telemedicine. They claim the data often expires unused due to poor network access and that they are warned against using it for other purposes.

A Ward Development Committee Chairperson, Ogoamaka Atuenyi, shared this concern, saying: “That N20,000 they are collecting is reducing the value of basic money. The quarterly disbursement is not even enough.”

To cope, some health workers rely on personal data from alternative networks. Joy Enweremadu, the OIC of a Primary Healthcare facility in Awka North, said the programme’s data works only when she leaves her community.

“I hotspot my personal data from another network. Sometimes the telemedicine device only connects when I move to where the signal is better,” she said.

Trust and perception

Beyond technical challenges, community perception is quietly shaping acceptance of the programme. Some patients interpret phone consultations as incompetence rather than collaboration.

“If they know you, they wonder why you have to call someone before treating them,” Eunice Obi said.

This view was echoed by Roseline Nwoye, from Amansea, Awka North LGA, who said her initial reaction was sceptical.

“When I saw her calling a doctor, I thought she didn’t know what she was doing,” she said.

At Akili-Ozizor PHC, a patient Chioma Ajie admitted she was uncomfortable when her case was discussed over the phone.

“I needed urgent treatment and didn’t understand why she had to call someone else,” she said, adding: “She had to explain it to me.”

Health managers acknowledge the perception problem. Mary Onwuegbuka, Director of Primary Healthcare in Ogbaru LGA, said patients often expect instant treatment like they get at chemist shops.

“They don’t understand why lab tests or consultations are needed. So, when they see you calling a doctor, they doubt your competence, she said.”

To maintain trust, some OICs have adopted coping strategies. Enweremadu said she often administers basic first aid before consulting a doctor. “That way, patients don’t feel abandoned,” she said.

Doctors often don’t respond promptly

Another challenge is delayed response from telemedicine doctors. Lauretta Nwoye, OIC of Ugbenu PHC, described the anxiety of calling repeatedly without response.

“They are human, they have other responsibilities. But it makes things difficult in emergencies.”

Some PHC officers said they rely on specific doctors who are more responsive, bypassing others assigned to their LGAs.

Onwuegbuka urged frontline workers to remain flexible. “If one doctor doesn’t respond, call another,” she advised.

Lifestyle patterns in rural communities also limit effectiveness. Enweremadu explained that many patients visit farms during the day and only come to PHCs in the evening, when doctors may no longer be online.

She and others believe periodic physical visits by doctors could improve trust.

“When communities know a doctor will visit occasionally, they are more comfortable using telemedicine on other days,” she said.

No ambulance for referral

Telemedicine depends on functional referral systems, but these are often absent. Ndu recalled that the patient who died could not be referred because there were no ambulance and drivers refused to travel at night.

“We had no means to move him,” she said.

The lack of ambulances and coordinated referral pathways means decisions made via telemedicine cannot always be implemented.

‘Telemedicine helps but not enough’

Oluebube Agba, a telemedicine doctor supporting PHCs in Anaocha LGA, said the initiative has helped manage complex cases remotely.

“I have helped PHC workers to manage many complex cases without casualty. I remotely guided the OICs or their staff.”

However, Gideon Obiasor, an Anambra-based medical practitioner, cautioned that telemedicine cannot replace physical care.

“It’s a welcome development but it can never replace physical medical care. We should accept it despite the challenges.”

He remarked that telemedicine cannot work if devices, connectivity and infrastructure are constantly down due to lack of electricity, stressing that government must provide alternative power sources such as solar power.

“With political will, government can deploy these technologies,” he said.

Government reactions and ground reality

Responding to concerns, commissioner for health, Afam Obidike, said connectivity issues were being addressed.

“There is nowhere in Anambra where you cannot browse though you may have to switch between networks. Telemedicine works with internet and Wi-Fi. Any network that is stronger in a particular area can be used,” he said.

Obidike added that using personal phones for consultations still qualifies as telemedicine and accused some workers of bypassing the system for personal gain.

“I sincerely acknowledge most health workers for helping us at the primary healthcare level, but some of them bypass telemedicine and refer patients to private doctors for personal benefits.”

On emergency response, he said ambulances were available at Umueri and Anaku General Hospitals, with more to be deployed. He also cited partnerships with 29 private hospitals under the Emergency Medical Service and Ambulance System.

“Dial 5111 and request an ambulance. There’s nowhere you cannot drive to in Anambra, he said.

Poor infrastructure, ICT gaps persist

However, findings from this investigation show that communities such as Umudora-Anam, Oramaetiti-Anam and Ukwuala still struggle with poor access roads, limiting emergency response.

On manpower, Obidike acknowledged that shortages were a national problem but said nearly 1,000 health workers have been recruited, with plans for more.

“We are planning staff verification next year to weed out those beneficiaries of improper recruitment in the past who are dragging us back,” he said.

When contacted over complaints of poor internet connectivity, the Managing Director of the Anambra State ICT Agency, Chukwuemeka Fred Agbata, on Sunday, December 14, 2025, requested that the questions be sent to him via WhatsApp. The questions were subsequently sent, seeking clarification on the ICT Agency’s role in supporting the telemedicine programme.

As at December 16, 2025, no response had been received. A follow-up call placed to him was not answered. His agency’s Communications Desk later indicated that responses were still being prepared, but none was provided as of the time of filing this report.

However, findings show the agency plays a supporting role in training and infrastructure.

To improve internet access across the state, the government abolished Right of Way (RoW) charges, which previously required telecom companies to pay fees for every metre of fibre cable laid. With the waiver, telecom operators can now extend broadband infrastructure more easily and at lower cost.

In previous interviews, the ICT Agency said the waiver is already helping to expand broadband coverage, strengthen digital capacity and lay the foundation for improved connectivity across the state. However, officers-in-charge (OICs) and patients still struggling with dropped calls during telemedicine consultations, the promise of that expansion remains a hope yet to be fully realised.

This report was made possible with support from the International Centre for Investigative Reporting (ICIR) under its Strengthening Public Accountability For Results and Knowledge (SPARK 2.2) project.