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

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.