Evaluating the Operational Outcomes of a Telehealth Intervention for Post-Abortion Care Counselling in Rural Sierra Leone: An Intervention Study

Restrictive abortion laws and a high incidence of unsafe abortion contribute to significant maternal morbidity and mortality in Sierra Leone. Rural areas, in particular, face acute shortages of trained counsellors for post-abortion care (PAC), limiting access to essential psychosocial support and contraceptive guidance. This study aimed to evaluate the operational outcomes of a newly introduced telehealth service designed to provide remote PAC counselling to clients at primary health units (PHUs) in the rural Eastern Province. An intervention study was conducted across 12 PHUs. A telehealth model using tablet-based video calls with a specialist counsellor was implemented for PAC clients. Operational data were collected over a multi-month period, focusing on service uptake, technical feasibility, and user and provider acceptability via structured interviews. Service uptake was high, with 94% of eligible clients accepting telehealth counselling. Technical challenges, notably unstable internet connectivity, disrupted 22% of scheduled sessions. Clients appreciated the privacy and specialist access. Healthcare workers reported the service enhanced their role but noted increased initial consultation time. Telehealth is a feasible and highly acceptable method to deliver specialist PAC counselling in rural, resource-limited settings. It can bridge human resource gaps, though sustained success depends on reliable digital infrastructure. Investment in robust internet connectivity at PHUs is critical. Scaling up should include streamlined referral protocols and ongoing training for PHU staff to act as effective telehealth facilitators. telehealth, post-abortion care, counselling, Sierra Leone, maternal health, digital health, operational research This study provides evidence on the implementation of a PAC telehealth service in rural Africa, highlighting its potential to improve service access and the practical barriers to its delivery.