Telemedicine use in Sub-Saharan Africa: Barriers and policy recommendations for Covid-19 and beyond

Joana Eva Dodoo, Hosam Al-Samarraie, Ahmed Ibrahim Alzahrani

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)
535 Downloads (Pure)


Background: Telemedicine has been a useful healthcare alternative in the fight to contain the recent Covid-19 global pandemic. Yet the extent of its application and efficacy as an alternative route for healthcare provision remains a major concern for clinicians and patients. Objective: This study sought to identify barriers to the successful implementation of telemedicine in Sub-Saharan African (SSA) countries. Method: A systematic review of the literature was conducted by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for identifying, selecting, evaluating and interpreting findings. Results: Our results from 66 empirical studies revealed a wide usage of telemedicine technology across SSA countries but also showed insufficient evidence of usage for fighting Covid-19 infection. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the successful implementation of telemedicine in SSA. A list of recommendations was produced for each telemedicine barrier. Conclusion: Our review shows current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. This review offers a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA.

Original languageEnglish
Article number104467
JournalInternational Journal of Medical Informatics
Early online date24 Apr 2021
Publication statusPublished - Jul 2021

Bibliographical note

NOTICE: this is the author’s version of a work that was accepted for publication in International Journal of Medical Informatics. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Medical Informatics, 151, (2021) DOI: 10.1016/j.ijmedinf.2021.104467

© 2021, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International


Funding Information:
Quality healthcare delivery is intricately linked with reliable financial support. In the case of Ethiopia, the literature suggests that the healthcare sector relied mostly on government for financial support. We found four key financial barriers to the success of telemedicine adoption: limited medical budget, high cost of telemedicine and ICT infrastructure, high tariffs on telecommunication and import duties, and high cost of electricity supply. It emerged from our study that budget allocated to support telemedicine implementation was often limited [ 58 ]. In addition, literature reports of high tariffs on telecommunication and import duties on ICT equipment [ 16 ].


  • Covid-19
  • Healthcare readiness
  • Sub-Saharan Africa
  • Telemedicine

ASJC Scopus subject areas

  • Health Informatics


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