The Limits of Telemedicine in the Developing World

Communications infrastructure in the developing world remains a challenge for effective telemedicine.

Communications infrastructure in the developing world remains a challenge for effective telemedicine. (Image Courtesy of Novartis Foundation)

Scholars and health professionals alike have promoted telemedicine as a cost-effective way for patients in developing countries to gain access to basic medical care and the expertise of professionals abroad, which would not be otherwise available. Telemedicine as defined by the World Health Organization is the delivery of health care services at a distance aimed at the diagnosis, treatment, and prevention of disease and injury by using information and communication technologies (WHO 2007).  It has been touted as a way for patients to gain access to the knowledge of pediatric infectious disease specialists, dermatologists capable of diagnosing and treating skin lesions of people living with HIV/AIDS, and orthopedics that are able to examine x-rays from areas where medical infrastructure is lacking. Low-income countries are able to use telemedicine to overcome limited infrastructure such as inadequate medical facilities and road development in order to link health-care providers with specialists, referral hospitals, and tertiary care centers (Telemedicine Opportunities and Developments in Member States, WHO, V.2, at 12).

Although telemedicine has the potential to greatly improve health care in developing nations, infrastructure also remains a frustrating obstacle that may eliminate telemedicine as a viable option in many areas.  Beginning in 2010, the World Health Organization Global Observatory of eHealth began publishing a series of six reports focusing on the recent trends and developments in telemedicine based on a survey of 114  WHO Member States. Developing countries in Africa, the Americas, and South-East Asia cited infrastructure as one of the greatest barriers to telemedicine (Telemedicine Opportunities and Developments in Member States, WHO, V.2, at 70). In Africa alone, fifty percent of the responding nations believed infrastructure to be a barrier to telemedicine, which was over ten percent higher than the overall global statistic (Telemedicine Opportunities and Developments in Member States, WHO, V.2, at 70).

Many developing countries have unstable electric supplies, communication networks, and internet connections outside of urban areas, which makes it difficult to transmit data for the purpose of telemedicine consultations and treatment. Even if sufficient technology and communication infrastructure exists to support these programs, patients still need access to actual medical facilities where personnel can transmit patient histories, photographs, and x-rays to physicians abroad. Developing countries must also take into account other forms of supporting infrastructure that are essential to the administration of treatment. Hospitals and medical facilities will need electricity and clean water to conduct the prescribed medical procedures, doctors will need developed roadways to travel to patients at home and administer medication, and patients will need safe and stable housing if they are being treated for diseases and conditions exacerbated by lack of clean water, plumbing, or the presence of mold. The diagnoses and recommendations secured from experts abroad will do little good if developing nations do not address the underlying infrastructure deficiencies prohibiting effective treatment. Thus, for many countries, the desire for telemedicine may be premature. Even though telemedicine is aimed at overcoming the lack of medical infrastructure in underdeveloped areas, the reality remains that without supporting infrastructure, telemedicine solutions will likely be unsuccessful.

-Nora Ciancio; Research Officer

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