Telehealth in Low-Income Countries: A Systematic Review of Health Outcomes, Access, Equity, and Policy Implications
Description
This systematic review, “Telehealth in Low-Income Countries: A Systematic Review of Health Outcomes, Access, Equity, and Policy Implications”, was conducted by Dr. Fernan Torreno and Frincess Flores to examine how telehealth interventions affect health outcomes and access in low-income countries (LICs). LICs face severe challenges, including workforce shortages, weak infrastructure, and inequitable access to essential services. Telehealth—through SMS reminders, teleconsultations, mobile health applications, and remote monitoring—has been identified as a scalable and cost-effective strategy. While its benefits are well established in high-income countries, its role in LICs is less understood. Following PRISMA 2020 guidelines and PROSPERO registration, six databases and grey literature were systematically searched (2010–2024). Thirty studies involving 45,600 participants were included: 12 randomized controlled trials, eight quasi-experimental, and 10 observational. Risk of bias was assessed with RoB 2 and ROBINS-I, while certainty of evidence was appraised using GRADE. Findings showed that telehealth significantly improved chronic disease outcomes (diabetes, hypertension), maternal-child health utilization, HIV adherence, and adolescent mental health. Interventions reduced travel costs and improved rural access but equity gaps persisted, particularly for women and low-literacy populations. Barriers included unreliable electricity, poor connectivity, weak regulation, and donor dependence, while facilitators included community health worker involvement, NGO partnerships, and mobile phone penetration. The authors conclude that telehealth in LICs is effective and aligns with Sustainable Development Goals 3, 5, and 10. However, sustainability requires infrastructure investment, robust policy frameworks, and equity-sensitive design. Telehealth must be institutionalized within universal health coverage strategies to evolve from short-term pilots into transformative health system reforms.
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Steps to reproduce
This study was designed as a systematic review, following the PRISMA 2020 guidelines to ensure transparency and rigor. The protocol was registered in PROSPERO prior to implementation, setting predefined eligibility criteria and methods. A comprehensive search was carried out across six electronic databases—PubMed, Scopus, Embase, Web of Science, CINAHL, and the Cochrane Library—for studies published between 2010 and 2024. To capture unpublished or non-indexed work, grey literature was also searched from sources such as the World Health Organization, the World Bank, and relevant NGOs. Eligibility was guided by the PICOS framework: • Population: patients and healthcare providers in countries classified as low-income by the World Bank. • Interventions: any form of telehealth (e.g., SMS reminders, teleconsultations, mobile apps, remote monitoring, hybrid models). • Comparators: standard or routine care, or baseline measures when comparators were not available. • Outcomes: clinical results (e.g., blood pressure, HbA1c, adherence), healthcare utilization (e.g., antenatal visits, ART adherence), and equity outcomes (gender, rural/urban, literacy). • Study design: randomized controlled trials, quasi-experimental studies, and observational studies. Screening and data extraction were conducted independently by both authors using Rayyan QCRI to minimize bias. A standardized form was used to extract data on study characteristics, populations, interventions, comparators, outcomes, and implementation factors. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. GRADE was applied to evaluate the certainty of evidence. Findings were synthesized narratively due to heterogeneity of interventions and outcomes, with results presented in thematic tables and visualized using PRISMA and risk-of-bias figures.
Institutions
- Saint Paul University Manila
- Pangasinan State University