Bridging the digital health divide - telemedicine accessibility in low- and middle-income countries during post-pandemic recessions - Letter to the Editor

Sep 29, 2026

Uploaded by hdkawk

Letter to the Editor argues that COVID-19 accelerated telemedicine adoption, yet benefits remain sharply unequal in low- and middle-income countries amid post-pandemic recessions. It attributes widening health disparities to economic fragility, pre-existing digital infrastructure gaps, limited internet connectivity, device unaffordability, and digital literacy barriers. The correspondence presents examples from India, Kenya, and Guatemala and proposes remedies including public-private partnerships, low-tech SMS approaches, targeted subsidies, and integrating digital literacy with community health-worker support.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the Editor

Digital inequity drivers in LMIC recessions

Evidence of health impacts

Strategies to bridge the divide

Conclusion

Letter to the Editor Bridging the digital health divide: telemedicineaccessibility in low- and middle-income countriesduring post-pandemic recessions Muhammad Usman Iqbal, MBBSa , Muhammad Rashid Javed, MSa , Fatima Hajj, MDb ,* Dear Editor, The COVID-19 pandemic accelerated the global adoption oftelemedicine, yet its benefits remain starkly unequal, particularlyin low- and middle-income countries (LMICs) grappling withrecessions. Economic fragility, compounded by pre-existingdigital infrastructure gaps, has deepened health disparities inunderserved regions. This correspondence highlights the urgentneed to address telemedicine inequity as a critical determinant ofhealth outcomes in LMICs during economic crises In LMICs, recessions strain already limited resources, divertingfunds from digital infrastructure development. A critical barrier isthe lack of internet access, with only 28% of sub-Saharan Africa’spopulation having reliable connectivity, compared to 87% inhigh-income countries[1] . Device affordability further exacerbatesinequities; smartphone ownership in LMICs such as Bangladeshand Nigeria remains below 40%, with costs prohibitive for low -income households[2] . Additionally, digital literacy gaps, particu -larly among rural and elderly populations, hinder effective tele -medicine use[3] . During recessions, these challenges intensify asgovernments deprioritize digital investmentsand households cutspending on data plans or devices. For instance, in India, pan -demic-related job losses forced 65% of rural families to reducemobile data expenditures, directly limiting telehealth access[4] . Telemedicine inequity exacerbates existing health disparities.Maternal health outcomes in LMICs illustrate this starkly. InKenya, only 12% of pregnant women in rural areas accessedtelehealth during lockdowns, contributing to a 32% rise inmaternal mortality [5] . Chronic disease management has alsosuffered; diabetes patients in Guatemala’s indigenous commu -nities faced 50% higher hospitalization rates due to telehealth aDepartment of Medicine, King Edward Medical University, Lahore, Pakistan andbFaculty of Medicine, Lebanese University, Beirut, Lebanon Sponsorships or competing interests that maybe relevant to content are disclosedatthe end of this article. *Corresponding author. Address: Faculty of Medicine, Lebanese University, Beirut1101, Lebanon. Tel.: +961 81001507. E-mail: fatimalalala2001@gmail.com(F. Hajj). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is anopen access article distributed under the terms of the Creative CommonsAttribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where itispermissible to download and share the work provided itis properly cited. The workcannot be changed in any way or used commercially without permission from thejournal. Annals of Medicine & Surgery (2026) 88:993–994Received 20 September 2025; Accepted 5 November 2025Published online 25 November 2025http://dx.doi.org/10.1097/MS9.0000000000004350 barriers[6] . Such disparities underscore how economic down -turns intersect with digital exclusion to worsen health outcomes. First, public-private partnerships (PPPs) can scale affordabletelemedicine initiatives. Rwanda’s Babyl Telemedicine, for exam -ple, partnered with the government to subsidize consultations forlow-income users, demonstrating the potential of PPPs to expandaccess[7] . Second, low-tech innovations like SMS-based platforms(e.g., Malawi’s mHealth program) can reach populations withbasic mobile phones[8] . Third, policy interventions, such assubsidizing device costs and data plans for vulnerablegroups – as seen in Brazil’s Internet para Todos initiative –are critical to reducing financial barriers [9] . Finally, integrat -ing digital literacy into primary education and leveragingcommunity health workers as telemedicine intermediariescan address skill gaps in offline areas[10] . In conclusion, the post-COVID-19 r

FAQs

Why does telemedicine access stay unequal in low- and middle-income countries during recessions?

Recessions strain limited resources, worsen funding gaps for digital infrastructure, and amplify barriers such as low connectivity, high device and data costs, and limited digital literacy—especially in rural and elderly populations.

What health impacts are highlighted as consequences of telemedicine inequity?

The letter cites maternal health impacts in Kenya, where rural telehealth access during lockdowns was limited and associated with a rise in maternal mortality. It also describes poorer chronic disease management, including higher hospitalization rates among diabetes patients in Guatemala’s indigenous communities.

What interventions does the letter recommend to improve telemedicine equity?

It proposes scaling affordable telemedicine through public-private partnerships, using low-tech SMS-based platforms, subsidizing device costs and data plans for vulnerable groups, and strengthening digital literacy via primary education and community health-worker intermediaries.

Sep 29, 2026

Uploaded by hdkawk