Why do entrepreneurial mHealth ventures in the developing world fail to scale?

Telemedicine is an increasingly common approach to improve healthcare access in developing countries with fledgling healthcare systems. Despite the strong financial, logistical and clinical support from non-governmental organisations (NGOs), government ministries and private actors alike, the majority of telemedicine projects do not survive beyond the initial pilot phase and achieve their full potential. Based on a review of 35 entrepreneurial telemedicine and mHealth ventures, and 17 reports that analyse their operations and challenges, this article provides a narrative review of recurring failure modes, i.e. factors that lead to failure of such venture pilots. Real-world examples of successful and failed ventures are examined for key take-away messages and practical strategies for creating commercial viable telemedicine operations. A better understanding of these failure modes can inform the design of sustainable and scalable telemedicine systems that effectively address the growing healthcare disparities in developing countries.