INTRODUCTION:
Ghana’s National Health Insurance Scheme (NHIS) is under increasing fiscal strain, with GH₵1.5-2.2 billion approximately 20-30% of the GH₵7.5 billion outpatient budget spent on routine hypertension and type 2 diabetes reviews in 2023. These visits also impose travel, time, and infection burdens on rural patients, intensifying structural inequities common in low- and middle-income country settings.

METHODS:
The Telehealth Outpatient Review System (TORS) is a clinician-led digital platform combining physician-authored questionnaires with automated red-flag triggers (e.g., blood pressure ≥180/110 mmHg), dual-path vital-sign capture (via app/SMS or Bluetooth devices at Community-Based Health Planning and Services [CHPS] compounds and pharmacies), and an NHIS- and DHIS2-integrated portal for medication adjustments, documentation, and pharmacovigilance. The model incorporates a tele-review tariff (GH₵8–10, equivalent to 40–50% of in-person rates) to incentivize provider participation. Phase 1 pilots in the Savannah and Greater Accra Regions will engage 500 CHPS compounds, 200 pharmacies, and 10 hospitals, focusing on uncomplicated cases that constitute ~70% of chronic disease reviews. Evaluation metrics include task shifting, cost trajectories, safety events, user satisfaction, and equity impacts.

RESULTS:
Modeling suggests 20-35% NHIS savings (GH₵150-250 million annually) and a breakeven point within ≤12 months. Additional projected benefits include reduced transport emissions, shorter waiting times, and improved rural access. TORS builds on African precedents such as Rwanda’s SMS-based chronic care model (25–35% reductions in facility visits) and Ghana’s DHIS2 telemedicine pilot (80% uptake).

CONCLUSIONS:
TORS represents a scalable pathway for sustainable digital primary health care, improving continuity for marginalized populations including youth in informal economies and informing NHIS financing reforms aligned with Sustainable Development Goals 3 and 13.