Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations.

OBJECTIVE: to evaluate the feasibility, potential and risks of an internet-based telemedicine network in developing countries of Western Africa.
METHODS: a project for the development of a national telemedicine network in Mali was initiated in 2001, using internet-based technologies for distance learning and teleconsultations.
RESULTS: the telemedicine network has been in productive use for 12 months and has enabled various collaboration channels, including North-South, South-South, and South-North distance learning and teleconsultations. It also unveiled a set of potential problems: a) limited pertinence of North-South collaborations when there are major differences in available resources or socio-cultural contexts between the collaborating parties; b) risk of induced digital divide if the periphery of the health system is not involved in the development of the network, and c) need for the development of local medical contents management skills.
CONCLUSION: the identified risks must be taken into account when designing large-scale telemedicine projects in developing countries and can be mitigated by the fostering of South-South collaboration channels, the use of satellite-based internet connectivity in remote areas, and the valorization of local knowledge and its publication on-line.