Tapping into telemedicine to reach people in Central African Republic

Providing remote care in a remote hospital

Access to medical care is a challenge in CAR, where there were only seven medical doctors per 100,000 people in 2023 — a figure that includes generalist physicians as well as specialist practitioners — according to the World Bank. In comparison, the EU has an average of 415 medical doctors per 100,000 people. 

At Carnot Hospital, which is run by the Central African Ministry of Health, medical activity is intense: In 2025, MSF teams recorded more than 8,000 visits to the pediatric emergency room and nearly 6,300 admissions. Faced with this heavy workload and limited staff, doctors who are on call sometimes find themselves making life-or-death decisions alone, especially at night or when some departments may be closed.

That’s where telemedicine comes in. Using a secure mobile app designed to work even with a slow internet connection, health care workers can send X-rays or test results directly to MSF’s telemedicine platform to consult with experts from around the world. The specialists are mostly doctors, but also include nurses, midwives, physical therapists, and psychologists. Their specialties are wide-ranging, including paramedical services, emergency medicine, internal medicine, infectious disease, pediatrics, reproductive health, surgery, mental health, and radiology.

“Most of the specialists on the other end of the line are MSF health care workers, including volunteer specialists from the MSF telemedicine network and MSF medical advisors,” says Clara Mazon, director of MSF’s telemedicine program. “But if we don’t have the specialist in our network, we’ll seek one out among other experts. Sometimes, even after MSF has stopped supporting a health facility, we continue to support the teams from the Ministry of Health through this tool.”

The system’s comprehensive features consist of an online case management platform, a secure instant messaging app that facilitates the exchange of patient information and documents among MSF teams, and a videoconferencing service that enables real-time discussion. 

“Sometimes I find myself alone, having to make a decision in a complex medical situation with limited resources,” says Dr. Kana Yamada, a general practitioner and specialist in antibiotic resistance. “Advice from telemedicine experts has helped me determine the best possible care for the patient.”

Expert assessments to avoid costly and risky transfers

Access to remote medical consultation via telemedicine is profoundly changing the management of complex conditions. In a setting where human and material resources remain limited for a hospital of 121 beds, the ability to seek a second opinion becomes crucial.

“When a patient’s condition does not improve despite treatment, we [seek to] benefit from the perspective of more experienced specialists,” says Dr. Anaïs Kale-Mea-Kale, a Central African general practitioner working in Carnot Hospital.

Beyond medical accuracy, telemedicine helps providers make particularly difficult decisions, like whether to transfer a patient to Bangui. Transferring a patient requires using an MSF airliner or chartering an emergency flight, which costs more than $9,000. Obtaining a second medical opinion helps confirm whether this grueling and costly journey is medically necessary.

The responsiveness of this global network is also a major asset in emergency situations: 75 percent of cases submitted receive an initial response within 24 hours, and nearly half within eight hours.

A technology adopted by teams around the world

Facilities that MSF supports are increasingly using telemedicine. Globally, more than 5,300 cases were shared with experts in 2025 across 212 MSF-led projects in 58 countries. That same year, more than 1,200 MSF staff members were trained in telemedicine.

Far from a mere technological tool, this system strengthens the skills of health care workers in places with limited resources. According to internal surveys, 96 percent of MSF medical staff believe that working with telemedicine enriches their clinical knowledge and directly improves the quality of care. At Carnot Hospital, this overall strengthening of clinical skills helped stabilize the hospital’s occupancy rate at around 77 percent and reduce in-hospital mortality to 2 percent in 2025.

The evolution of MSF activities in Carnot

MSF began working in Carnot in 2009 to respond to a nutritional crisis. Since then, we have gradually expanded health care services to meet wider health needs, including internal medicine and treatment for HIV, tuberculosis, non-communicable diseases, infectious disease outbreak response, and support for survivors of sexual violence. 

We are also working to decentralize care by bringing medical care closer to patients: More than 1,100 people living with HIV are now treated directly at peripheral health centers rather than at the hospital.

MSF hopes to continue developing telemedicine in the health facilities where we operate, in support of the Ministry of Health. While telemedicine does not replace direct surgical procedures or clinical examinations, it helps break the isolation of patients living far from medical facilities in the country’s most remote areas and also improves their access to care.