ESPE Yearbook of Paediatric Endocrinology

J Epidemiol Glob Health. 2024 Sep;14(3):779-786. PMID: 38478166 doi: 10.1007/s44197-024-00214-8

Brief Summary: This narrative review examined the potential role of telemedicine in improving care provision in low and middle income countries (LMICs), particularly for subspecialty pediatric care. There remain significant technological and regulatory obstacles, but the authors advocate for use of these innovations to promote equity and access to high quality pediatric care.

Delivering pediatric healthcare to rural communities can be challenging, particularly subspecialty care, and can create physical, psychological and financial burdens. New healthcare models using telemedicine may overcome barriers to access in remote and rural areas. Telemedicine has been used in developed countries for some time and the COVID pandemic made it more acceptable in LMICs, potentially having a higher impact in developing countries where resources are scarce, and cost of care is a major determinant of health. While telehealth runs concurrently to traditional healthcare models in high-income countries, it might be the only alternative in LMIC.

The authors note significant issues with implementation, including inadequate digital infrastructure. Low bandwidth telemedicine has been proven effective in overcoming poor network connectivity in Cambodia, Uzbekistan, and Kosovo, as shown in previous literature. With the high penetration of smart phones in low-income countries, focusing on phone-based interventions may decrease digital disparities. Phone-based applications can provide variable platforms for telemedicine including written consultations, audio or video consults.

Identifying providers with appropriate specialty training is also a challenge. There may be insufficient local specialists to remote care and international specialists may lack appropriate cultural understanding and awareness of the variability of locally available resources. Limited reimbursement for providers is also highly variable and many current services rely on volunteerism which may not be sustainable. However, telemedicine can also provide a tool for capacity building through shared decision-making and improving medical knowledge.

Despite many obstacles, the authors support the development of telemedicine to improve provision and decrease disparities in pediatric care and in LMICs.