Telemedicine and developing countries. A report of study group 2 of the ITU Development Sector.

While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.