Barriers to Development of Telemedicine in Developing Countries

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1
Chapter
Barriers to Development of
Telemedicine in Developing
Countries
SuryaBali
Abstract
Affordability, accessibility, availability, and quality of healthcare services
have always been a burning issue for the mankind. The issue of health care is
always crucial for the governments and countries irrespective of their financial
status. Continuous efforts are being made by policy makers, administrators, and
researchers to provide quality health care to the people at the cost that they can
afford. Developed countries have adopted many alternative tools and technologies
to leverage the supply of good health care but quality and cost of health care are
still big issues in these countries. Developing countries are far behind in adopting
technology to reduce the cost and improve the quality of health care. Telemedicine
has emerged as a new hope to remove the bottlenecks in the healthcare seeking.
Developing countries have adopted telemedicine technology in a hurry without
proper planning and strategy. Despite more than two decades of adapting telemedi-
cine, developing countries have not achieved any significant success in reducing the
cost of care or improving the access of care. This chapter has tried to explore the
various barriers to the development of telemedicine in developing countries. Proper
enlisting and detailing of these barriers will definitely help governments to under-
stand the loopholes and bottlenecks in the implementation of telemedicine and help
them to develop appropriate solution.
Keywords: telehealth, telemedicine, barriers, developing countries, health care
1. Introduction
Increasing population in the developing countries has created more demand of
health care. Demand of affordable and quality health care is increasing day by day.
Rapid demand at the global level for healthcare management is increasing over the
past few decades, increasing emphasis on healthcare quality [1]. People in poor
countries have less access of health care and poor have even less access of healthcare
services within the country [2]. Assessing the appropriate health care and improv-
ing the quality of care have been a serious issue in developing countries [3]. Many
times, quality of public health care in developing countries has been neglected and
attention is only given to technical aspects than the interpersonal components [4].
The cost of health care in developing countries has always been a crucial issue. Out
of pocket expenditure on health care has increased many folds. Catastrophic health
expenditure is posing a threat toward a household’s financial ability to maintain its
basic needs [5].

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There are many barriers like geographical access, availability, affordability, and
acceptability to access the health care in developing countries [6]. These barriers
become more problematic to women, children, old, and physically handicapped
population. Even though the health service provision and the geographical access
have improved, local women may not use the services unless the provided services
meet their demands in quality and cultural manners [7].
To overcome the barriers, healthcare sector is now using telemedicine solutions
to increase the reach of its services to population. The mindboggling developments
in Information and Communication Technologies (ICT), particularly, the web-
based technologies have opened up new possibilities in providing better health care
to population. Telemedicine is gradually coming up as a viable policy option for the
governments in developing countries [8].
Telemedicine is the use of electronic communications and information technolo-
gies to provide clinical services when participants are at different locations [9].
Telehealth is used to encompass a broader application of technologies to distance
education, health promotion, preventive services, consumer outreach, and other
applications wherein electronic communications and information technologies are
used to support healthcare services. According to WHO, “Telehealth involves the
use of telecommunications and virtual technology to deliver health care outside of
traditional healthcare facilities” [10].
In a broader and detailed way, World Health Organization (WHO) defines
telehealth as: “The delivery of healthcare services, where distance is a critical factor,
by all healthcare professionals using information and communication technologies
for the exchange of valid information for diagnosis, treatment, and prevention of
disease and injuries, research and evaluation, and for the continuing education of
healthcare providers, all in the interests of advancing the health of individuals and
their communities” [11].
Telemedicine is restricted to the use of IT for treatment and medical care whereas
telehealth cover a broader area, where IT is used to enable the environment where
people can enjoy their life at fullest. Although both these terms carry a different mean-
ing altogether but in developing countries, both these terms are used interchangeably.
Mobile Health (mHealth) helps in patient education, health promotion, disease
self-management, decrease in healthcare costs, and remote monitoring of patients
and can improve healthcare delivery for developing countries [12, 13].
Lots of efforts are being made by governments (policy makers, researchers,
and administrators) to develop the telemedicine network across their geographi-
cal boundaries but pace of development is slow and acceptance of technology to
population is not picking up. Unfortunately, the technology that has been developed
to remove or minimize the barriers to the healthcare seeking currently faces lots of
barriers itself and its development has not been happening as it was expected by
policy makers and researchers.
It was expected that telemedicine will reduce the burden of hospitals, suffering of
patients, out of pocket expenditure, need of transport, hospital fear, and save the time
and money of general public. It was also expected that it will increase the quality of care
and will develop the trust among patients toward telehealthcare system. We cannot
deny the partial development of telemedicine and few success stories in many parts of
the world but the leverage, which we have expected from telemedicine is still lacking.
Then question arises where is the problem? Why telemedicine is not picking the pace
and why it is not becoming popular among service providers as well among the patients.
Many telemedicine pilot programs have been launched in developing countries
in last three decades. Many evaluation studies [14, 15] have been conducted to know
the success and failure of telemedicine networks and programs across the globe.
Whatever success we see mostly happened in the developed countries but in most of

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Barriers to Development of Telemedicine in Developing Countries
DOI: http://dx.doi.org/10.5772/intechopen.81723
the developing countries, success of telemedicine program is limited. This chapter
will explore the various hurdles in the development of telemedicine and its opera-
tions in developing countries. Despite many benefits offered by the telemedicine, it
has not been utilized fully to serve humanity and is underused [6, 7, 16–18].
There are many barriers in the adoption of telemedicine and adoption failure
is serious issue, which needs to be discussed and explored. According to a study,
about 75% of the telemedicine projects are abandoned or failed outright and called
as failed projects and this percentage goes up to 90% in developing countries [19].
Until we are not able to find out, enlist, analyze, and understand the barriers in the
deployment and development of telemedicine, we cannot ensure success of tele-
medicine program. Following crucial barriers are currently working in the field of
telemedicine implantation and operation.
1.1 Barriers to telemedicine programs
.. Policy barriers
For smooth functioning and development of any system, we need to have
definite policies and procedures at State and National level. These defined rules,
regulations, procedures, and protocols are necessary to help a telemedicine system
to run smoothly and safely and ensure that population receive a quality healthcare
services. In many developing countries, there are no uniform and standard tele-
medicine policy, which leads confusion for designing telemedicine-related services,
program, and its smooth implementation.
Many practitioners have fear of malpractice-related legal issues and which
prevents them to actively participate and develop telemedicine program.
Malpractice liability is an important barrier in the practice of telemedicine services.
Certification and credential barriers also de-motivate practitioners. There is no
public policy related to telemedicine for the end users, which can ensure privacy,
confidentiality, and security of patient’s health information during teleconsultation
[8]. There are weak regulatory frameworks related to reimbursement in government
as well as in private sectors against the teleconsultation services.
Because health is a state matter, state government should frame policies, pro-
grams, guidelines, and regulations regarding telemedicine practices and also allo-
cate sufficient financial resources for telemedicine development. In few developing
countries, telemedicine policy exists but implantation framework is absent [8].
There is lack of established international framework on telemedicine and also
there is little consensus or understanding on uniform international standards for
telemedicine practices. Telemedicine provides services across the state, country, and
international borders, so there should be, at least, common international under-
standing on this issue.
Standardization of both hardware and software, as well as guidelines for prac-
tice, would help program managers to overcome interoperability, portability, and
security issues [11].
.. Organizational structure
Lack of formal organizational structure to deliver telemedicine services is the
biggest barrier for the development of telemedicine services in any country. Because
being a hybrid discipline, it needs collaboration with all possible stakeholders at
each level of the healthcare delivery system. Lack of collaboration between the
stakeholders in the absence of specific policy becomes bottleneck in the develop-
ment of telemedicine.

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Department of Health and Family Welfare and Department of Information
Technology should have a national level formal collaboration to develop a national
telemedicine network. There are examples of such collaboration and presence of
telemedicine department in few developing countries like India but it is patchy,
broken, and not well established [8].
The absence of structured organization is another barrier in transforming
telemedicine-related vision and political will into policies at central level. If there
is no such policy, then framing of program related to accomplish those political
wills become impossible. Lack of specific time bound and result-oriented programs
become difficult to implement and evaluate. Systematic planning of implementa-
tion of such telemedicine programs, its concurrent monitoring, and final evaluation
demands lots of trained human resources.
1.2 Lack of accreditation or regulatory bodies
There is no specificity and standardization in the practice of telemedicine,
which poses accreditation issue. Lack of accreditation of telemedicine facilities
creates fear among the users as well as providers. Absence of accreditation councils
and regulatory bodies leaves telemedicine in isolation. Medical Councils and other
health councils should take responsibility to regulate the practice and procedures of
telemedicine.
There is lack of uniformity in telemedicine regulations across the world. In the
absence of definite regulatory policy and guidelines, physician has apprehension and
fear to practice telemedicine. Medical and health councils of different countries still
find that proposed definition of telemedicine has deficiencies. These councils do not
consider telemedicine as a new discipline or a new branch of medicine. Regulators
consider that telemedicine presents challenges and assume that it is new and unproven.
There is no clarity what to be regulated. An enabling regulatory environment is required
to ensure appropriate, adequate, and quality delivery of healthcare services [20].
.. Lack of team of champions
Once telemedicine system is deployed and is placed, then there is a need of
project champions, who will implement the telemedicine program. The three
major champions are clinical champion, IT champion, and telemedicine champion
[21]. Success of any telemedicine program depends on these champions but these
champions are very few in developing countries, so most of the deployed telemedi-
cine program die very soon after their piloting. There are also deficiencies in the
training and job orientation of these champions. In most of the cases, they are not
well oriented about their roles and responsibilities.
1.3 Lack of telemedicine champions
There is a paucity of dedicated, focused, and visionary telemedicine leaders in
developing countries. These leaders are brand ambassadors of telemedicine and
are carrying the flag of telemedicine high even in the adverse situations. Whatever
telemedicine work, we see in these developing countries, are only due to individual
efforts of these telemedicine champions.
1.4 Lack of clinical champions: physicians
Training is an import part of skill development and the organizations should
develop a training schedule to train health professionals for smooth delivery of
telemedicine services [21]. It is very important to provide training to all government

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Barriers to Development of Telemedicine in Developing Countries
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officers regularly. Without proper knowledge of IT of government officers, e-
governance project will never see the real face of the project [22].
Most of doctors are not aware about the latest information technology and
find difficulty to used modern IT gadgets. There is lack of telemedicine experts in
healthcare sectors. There is a need to include few chapters related to telemedicine in
Medical education curriculum to sensitize and orient budding doctors to learn the
technical part of this discipline. There should be separate telemedicine education
secretariat and directorate in Ministry Medical Education like in Ministry of Health
care, which will promote the development of telemedicine [8].
1.5 Lack of paraclinical champions: nurse providers
Telemedicine health services are also assisted or provided by nursing staff but their
contribution in telemedicine is not recognized and acknowledged. Role of nursing
staff in expansion of telemedicine could be very vital if proper training and guidance
is provided to them. Most of the developing countries do not have trained telenursing
officers or staff who can contribute in the development of telemedicine network.
There is also lack of proper institutional training program in the course cur-
riculum like traditional nursing courses. Until nursing students are sensitized
toward this new technology, they are not going to make carrier in telenursing.
Apprehension and fear toward telemedicine can only be removed through provid-
ing the knowledge about telemedicine. There should be basic telemedicine nurs-
ing lesson in their course curriculum. Telenursing is still a remote concept in the
developing countries, where focus is mainly on telemedicine.
1.6 Lack of IT champions: teletechnicians
Telemedicine is a hybrid system, which involves the medical as well as ICT
domain for complete understanding of the telemedicine solutions and its delivery.
There is a serious lack of such technical persons, who can run day-to-day business
of telemedicine. To run any telemedicine system properly, trained technical man-
power is required. There is lack of technical champions in the field of telemedicine
in India, especially in the field of health care and only voluntary champions here
and there are visible.
It is common fact that many provider physicians and clients cannot fix the tech-
nical problems arising from computer system and ICT network. So, for a proper and
smooth functioning of telemedicine system, we need trained and expert manpower
to establish a stable and continuous communication during teleconsultation [25].
Unfortunately, there is serious lack of such trained persons in the system in most of
the developing countries.
There are very few institutions in developing countries, which train and develop
this special group of technicians. It is very difficult to find a person who has under-
gone training in Medicine and in Information Technology.
.. Technological barriers
Technology itself is becoming a barrier in the development of telemedicine in
developing countries. High cost of replacing the older technology is not affordable
for many stakeholders.
1.7 Rapid upgradation of ICT
Due to rapid advancement of telemedicine technology, many state-of-the-art
facilities and equipment (software and hardware) become obsolete and outdated.

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6
A complex and often unwieldy technical infrastructure may yield disappointing
evaluations until it becomes more ubiquitous and user-friendly [23]. People work-
ing with these outdated technologies become demotivated and frustrated and lose
interest in providing services through old technology system. Government also
finds it difficult to replace, which is easily due to lots of budgetary requirement for
newer technology.
Failure of telemedicine network in Madhya Pradesh, India, is an important
example, where Indian Space Research Organization (ISRO) sponsored equipment
like camera, television sets and other equipment and software were not utilized for
a longtime and became outdated and nonfunctional. Repair and replacement of
these equipment and software are so costly that government is not willing to get it
repaired and whole telemedicine network has collapsed [14].
Time gap between acquiring hardware and development of customized software
is so large that by the time software is ready, the hardware becomes obsolete. This
mismatch between software and hardware also create a bottleneck in the develop-
ment of effective telemedicine solution.
1.8 Inadequate ICT infrastructure
Many developing countries have inadequate availability of Information and
Communication Technology (ICT) such as computers, Internet network, printers,
and electricity for proper implementation and running of telemedicine program.
Internet access and power supply are other issues related to failure of telemedicine
network in rural and remote locations [14, 18, 24]. One of the important hurdles to
effective delivery of telemedicine solution to rural and remote locations in develop-
ing countries is incomplete and insufficient ICT infrastructure.
1.9 Initial huge start-up cost of ICT infrastructure
Telemedicine set up can deploy varieties of information and communication
technologies (ICTs) for transmitting information through texts, pictures, audios,
and videos to a variety of healthcare providers. Cost depends on the type of ICT
being used for the start-up. For setting an audio visual ICT platform for telecon-
sultation needs huge investment. Budgetary constraints become a major barrier in
the development of telemedicine network in developing countries [7, 18, 19, 24]. A
sustainable financial support is needed to purchase, deploy, operate, and maintain
the sophisticated telemedicine platform [19]. Telecommunication expenses, train-
ing of service providers and clients, and need for newer ICT platforms require most
of the expenditure.
1.10 Low Internet connectivity
Most of the telemedicine applications require a high speed and reliable Internet
bandwidth to run smoothly. Tele-surgery, real time tele-ophthalmology, real time
tele-radiology, and emergency consultation are some examples of such applications
[25]. Unreliable and low wideband Internet pose barriers in smooth delivery of
telemedicine service.
For real-time teleconsultations between providers and clients, there is a need for
reliable and high speed Internet availability. Internet coverage is still bottleneck in
many developing countries, especially in rural and remote areas. Most rural areas
do not have the financial capital to independently invest in a broadband network
that would provide high-speed Internet to their inhabitants. Telecommunications
(“telecom”) companies are the primary providers of high-speed Internet, but they
invest very little in rural areas because such investments are not as profitable [26].

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Barriers to Development of Telemedicine in Developing Countries
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Internet connectivity for transmitting patients’ files, records, pictures, and
videos are still limited in many areas, including in China, India, Indonesia, the
Philippines, and Vietnam [27]. Recently, it has been observed that Internet access is
growing and also the cost of Internet is coming down, which is a good sign for the
development of telemedicine on developing countries.
.. Legal barriers
Telemedicine practices has eliminated many physical and emotional barriers to
healthcare seeking but have raised many legal and ethical issues, which are nor-
mally not encountered during traditional healthcare delivery. Legal considerations
are a major obstacle to telemedicine uptake [8, 21, 28].
1.11 Online prescription
There is no legal framework of e-prescription, digital prescription, or mobile-
based SMS prescription. Digital prescriptions are not approved and accepted by
Medical Council of India (MCI) or any other regulatory authority [8]. Online
prescribing policies vary across the countries and across the states within
countries.
Concerns have been raised over various issues like whether an appropriate
patient-provider relationship has been established, lack of an adequate physical
examination of the patient, accuracy of the patient’s history given the self-
reporting of the patient over a telehealth connection, and not meeting state medi-
cal board licensing requirements [29]. There is no standardized legal framework
to protect practitioners as well as clients for online prescriptions in developing
countries.
1.12 Malpractice liability
Most of the doctors are afraid of Consumer Protection Act due to malpractice-
related issues. There is a lack of specific standard operating procedures (SOPs)/
guidelines for the telemedicine practice [8]. Legal issues surrounding patient
privacy, safety, security, and confidentiality also play vital role in teleconsultation.
Very little information exists on the extent of malpractice liability and telehealth
[29]. Medical malpractice-related legal issues should be identified and addressed for
smooth practice of telemedicine.
1.13 Licensing of telemedicine/telehealth service providers
Highly sophisticated, safe, secure, and speedy teleconsultations have reduced
the distance barrier in healthcare seeking and have improved the healthcare access.
In order to avoid malpractice in telemedicine, healthcare professionals should be
specifically trained for telemedicine as they do for traditional medicine [30]. Poor
availability of experts and trained professions raises legal implications and warrants
licensing of telemedicine providers.
The responsibility of licensing to telemedicine providers falls under the
purview of the state licensing councils or boards of a particular country. These
policies governing telemedicine and physician licensure vary widely across the
country [29].
Licensing ensures that physicians meet academic and clinical competence
standards for the telemedicine practice. It protects public from unqualified and
substandard physicians and healthcare professorial. Licensing also helps to enforce
continuing standards [31].

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8
1.14 Informed consent before teleconsultation
Need for a prior written or verbal informed consent for any telemedicine con-
sultation and treatment misrepresents telemedicine as a different form of service,
rather than as a useful tool that enhances diagnostic and treatment services.
Healthcare providers need to have a clear understanding of what their legal
and ethical responsibilities are. Similarly, patients must receive the protection of
adequate standards of care and know that the person to whom they are entrusting
their health has the proper qualifications [31].
The lack of clear-cut legal guidelines, rules, and regulations hinders the tele-
medicine to improve healthcare access and healthcare quality through information
and communication technology [31].
.. Financial barriers to telemedicine development
Although telemedicine can be leveraged to increase access to care and reduce
the cost of care but that is mainly true for the user’s point of view. Story is different
if we look from the side of providers or healthcare organizations. For establishing
a telemedicine unit, it needs lots of financial investment. It becomes more dif-
ficult for the developing countries to allocate huge budget for the investment in
telemedicine.
Establishing and operating a “Telemedicine Unit” require purchasing the
equipment needed to setup the system at both provider’s and consumer’s end (in the
hospital, clinic, or pharmacy); maintaining the equipment; training the physicians
and local healthcare workers on the technology; and compensating the physicians.
There are many other costs are involve in delivering teleconsultation like payment
of Internet and electricity bills, salary of support staff, other recurring costs etc.
These total costs are so high that many proposals of establishing or starting
telemedicine program never take off, or even if it starts, it dies soon and cannot
sustain on a long-term basis. Many telemedicine pilot projects have failed because
of high maintenance cost [14].
The costs of telemedicine are often high in developing countries, because of
low awareness between both patients and local healthcare workers, low informa-
tion technology literacy, and limited access to infrastructure and technology [27].
Telemedicine service providers are generally unable to bear all costs alone and
expect government or development partner to support financially for the sustain-
ability of the telemedicine projects.
Most of the telemedicine solutions and programs tend to be government funded,
at least in their initial phases. Due to some reasons, if government stops funding,
the system becomes unsustainable as there is no alternative business model. So
dependency on public support is another financial barrier in the development of
telemedicine in developing countries [27].
Cost incurred in purchase, installation, and maintenance of telemedicine
services (telemedicine and communication equipment) are very high and do not
give proper return on investment (ROI), so there is less economic benefits to the
practitioners, which leads to the bankruptcy and closure of many health facilities in
rural communities and also prevents further telemedicine expansion to communi-
ties needing specialized services [32]. Insurance companies do not reimburse the
teleconsultation bills and payments, which further force the practitioners to stop
the telemedicine services. Many hospitals and clinics perceive that telemedicine
solutions are too expensive to implement.

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1.15 Reimbursement and insurance barriers
Reimbursement of telemedicine services has been reported as one of the impor-
tant barriers in developed countries [17, 22, 33, 34]. When patient avails healthcare
services through telemedicine system, insurance claim may not cover the cost of
care as it is not delivered through traditional healthcare system. Such discrimination
seldom occurs in developing countries, where health insurance is still a rare com-
modity [30].
.. Social barriers in the development of telemedicine
Social and culture milieu of the community and society of a particular country
also creates lots of barriers in adapting, utilizing, and sustaining telemedicine
services. The lack of ICT literacy, awareness, language barriers, and cultural gaps
between the service providers and patients etc. are also major factors, which
prevent further development and expansion of telemedicine network in developing
countries.
1.16 Resistance to change
A lack of support to newer ICT tools has been observed from both parties
(providers and users). Several studies have revealed that the resistance to change
has been reported toward telemedicine from providers (physicians) as well as from
users (clients/patients) for newer technology [14, 19, 25, 33, 35].
1.17 ICT literacy
In developing countries where general literacy is not even adequate, we can
imagine the awareness level of population toward ITC literacy. Poor awareness
toward modern technologies and their use in delivering health care seems to be a big
barrier in developing countries. People in developing countries are not much aware
about the benefits offered by telemedicine. Even physicians are short of IT knowl-
edge and not updated. Poor awareness level creates fears and resistance toward ICT
technology and create hurdle in the adoption and development of telemedicine. Age
also plays an important role. Many older physicians do not feel comfortable dealing
with ICT technology. Some patients, particularly older patients, are hesitant about
the new technology.
Many healthcare professionals are not comfortable working with computers and
modern gadgets and consider technology extra work for them. They also fear that
telemedicine may lead to job loss or a reduction in their bedside presence [27, 33].
1.18 Lack of confidence
There is lack of confidence in patients about the outcome of telemedicine. It is
difficult for them to believe that machine can provide healthcare demands without
visiting physician face to face [25]. This cultural perception and attitude toward
newer technology also possess threat to the development of telemedicine. Even
many physicians also think that patient consultation and treatment are incomplete
without touching the patient and prefer face-to-face consultation than remote
consultation through ICT platform. Some medical practitioners do not want to opt
telemedicine practice due to the fear of medical indemnity.

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10
Barriers to adoption and sustainability of rural telehealth embody several factors
that must be considered when planning, developing, implementing, and evaluating
a rural telehealth program [32].
1.19 Industry-oriented telemedicine
There are three players in the telemedicine viz. physicians as service providers,
IT Industry as supplier of technology, and public as user. One of the major hurdles
of development of telemedicine in developing countries is the passiveness of
provider physician and users.
Most of the telemedicine tools and technologies are developed and supplied by
the developed countries and they have strong market influence in the developing
countries. IT industry people are very active and try to influence policy makers
and administrators in the health system to sell their IT technology (telemedicine-
related hardware and software). Their focus is only to sell and install the tele-
medicine tools and equipment and leave the system for the physician to run.
Failure is bound to happen if providers and users are not taken into account
while developing the telemedicine platform. For example, in Madhya Pradesh,
India, ISRO and top-level administrators at ministry level decided to implement
telemedicine solutions across the state but it failed badly as there were no takers at
ground level. Physicians were not convinced and adequately trained for newer tech-
nology and public as a user was not aware about the benefit of the platform [14].
2. Conclusion
Health care in developing countries is in the midst of a paradigm shift, from a
traditional provider-centered, disease-oriented approach to a patient-centered, health-
management model. Telemedicine has influenced almost all aspects of healthcare and
many success stories have reported the role of telemedicine in improving healthcare
access, reducing cost of care, and enhancing the quality of care. Telemedicine could be an
important tool in achieving healthcare coordination and reducing healthcare disparities.
Despite of so much development and successful work in the field of telemedi-
cine, it has yet to become integral part of healthcare system. Success of telemedicine
only depends when it becomes integral part of healthcare delivery system and not
as a stand-alone project. Now, it is time to take telemedicine from pilot mode to
routine operational mode in mainstream health services delivery system.
There is tremendous pressure on governments to provide accessible affordable and
quality healthcare to its people. Only alternative and innovative methods like telemedi-
cine can help to fulfill this gap. Current status of telemedicine in developing countries is
not very satisfactory and passing through a stage of crisis. This chapter has explored the
various barriers in the development of telemedicine in developing countries.
These various barriers mentioned above are impeding the speed of expan-
sion of telemedicine in developing countries. It is now time to minimize the
abovementioned barriers and remove the bottlenecks for smooth development of
telemedicine network across the globe for the betterment of humanity.
Acknowledgements
The author would like to thank the Department of Public Health and Family
Welfare Madhya Pradesh and National Health Mission Madhya Pradesh for

11
© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Barriers to Development of Telemedicine in Developing Countries
DOI: http://dx.doi.org/10.5772/intechopen.81723
providing funding support to conduct telemedicine evaluation survey from where
experience has been shared here.
Conflict of interest
The author declares that he has no competing interest with anyone in publishing
this chapter.
Notes/thanks/other declarations
No other declarations.
Author details
SuryaBali1,2*
1 Department of Community and Family Medicine, All India Institute of Medical
Sciences Bhopal, Bhopal, Madhya Pradesh, India
2 Telemedicine Centre, All India Institute of Medical Sciences Bhopal, Bhopal,
Madhya Pradesh, India
*Address all correspondence to: surya.cfm@aiimsbhopal.edu.in

12
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