Telemedicine and developing countries - successful implementation will require a shared approach

Telemedicine is often proposed as a solution to certain health-care problem s in the developing world. There seems to be little published experience on which to make judgements. A literature search revealed 39 articles, of whi ch only two related to any kind of direct clinical work; most of them were review articles or editorials. The majority of the work reported was educat ional in nature, and there has been little clinical experience. It seems pr obable that telemedicine can help with the education of health-care workers and patients; it seems likely that it could bring major benefits to the or ganization of health-care. Without proper trials, it will be impossible to determine the place of health-care in the developing world. Trials are the only way in which rational decisions can ultimately be reached regarding wh ether scarce resources should be devoted to telemedicine in developing coun tries, or whether they should be employed in more conventional health-care measures whose outcomes are known to be cost-effective.