Central African Republic: Using telemedicine to tap into a global network of healthcare professionals
Telemedicine has become an indispensable tool as Carnot faces a severe shortage of medical specialists.
Providing Remote Care in a Remote Hospital
Accessing specialized medical care is a challenge in the Central African Republic (CAR). According to the World Bank, there were only seven medical doctors per 100,000 inhabitants in 2023 — a figure covering generalist physicians as well as specialist practitioners. For comparison, the EU average is 415 medical doctors per 100,000 people. At Carnot hospital, Doctors Without Borders/Médecins Sans Frontières (MSF) recorded more than 8,000 visits to the pediatric emergency room and nearly 6,300 admissions in 2025. Faced with this heavy workload and limited staff, doctors sometimes find themselves making life-or-death decisions alone.
That’s where telemedicine becomes invaluable. Using a secure mobile app designed to work even with slow internet connections, healthcare workers can send X-rays or test results directly to the telemedicine platform to obtain expert opinion from around the world. The experts include doctors, nurses, midwives, physical therapists and psychologists. Their specialties are wide-ranging: 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 healthcare workers, including volunteer specialists from the MSF telemedicine network and MSF medical advisors,” says Clara Mazon, Director of the MSF Telemedicine Program. “But if we don’t have the specialist in our network, we’ll seek one out from among other experts who wish to work with MSF. Sometimes, even after MSF support to a health facility has stopped, 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 discussions. “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.” The responsiveness of this global network is also a major asset in emergency situations. Seventy-five per cent of submitted cases receive a response within 24 hours, and nearly half within eight hours.
Expert assessments to avoid costly and risky transfers
Remote medical consultation via telemedicine is profoundly changing the management of complex medical conditions. In a setting where human and material resources remain limited, the ability to seek a second opinion becomes crucial.
“When a patient’s condition does not improve despite treatment, this allows us to benefit from the perspective of more experienced specialists,” says Dr Anaïs Kale-Mea-Kale, a general practitioner working in Carnot’s hospital.
Beyond medical accuracy, telemedicine helps in making decisions that can be particularly difficult, for example, whether to transfer a patient to Bangui, which is 500 kilometres away. Transferring a patient requires an MSF plane or chartering an emergency flight, which costs around 8,000 euros. Obtaining a second medical opinion can confirm whether this journey is medically necessary.
A technology adopted by field teams
The use of connected medicine is growing every year within medical facilities supported by MSF. More than 5,300 cases were shared with experts in 2025 from 212 projects led by our teams across 58 countries. That same year, more than 1,200 MSF staff members were trained in telemedicine. Telemedicine also strengthens healthcare workers’ skills in resource-limited locations. According to internal surveys, 96 per cent of MSF medical staff believe that engagement with telemedicine enriches their clinical knowledge and directly improves the quality of care. In Carnot hospital, this overall strengthening of clinical skills helped stabilise the hospital’s occupancy rate at around 77 per cent and reduce in-hospital mortality to two per cent in 2025.
The evolution of MSF’s activities in Carnot
MSF has been present in Carnot since 2009 — initially responding to a nutritional crisis. Since then, MSF has expanded its healthcare services to meet wider health needs:
• Comprehensive healthcare: internal medicine and treatment for HIV, tuberculosis and noncommunicable diseases; and assistance with responses to recent infectious disease outbreaks, particularly measles
• Support for survivors of sexual violence
• Decentralized care: to bring medical care closer to patients, more than 1,100 people living with HIV are now treated directly at peripheral health centres rather than at the hospital.
MSF hopes to continue developing telemedicine in the health facilities where it operates 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 improves the equity of their access to care. Find more information about MSF Telemedicine on telemedhub.org.
