Scaling Telemedicine for Specialist Consultations in Francophone West Africa: A Case Study of Facilitators and Barriers in Seychelles

This case study investigates the facilitators and barriers to scaling telemedicine for specialist consultations in Seychelles, a small island developing state (SIDS), between 2021 and 2026. The research addresses the persistent challenge of equitable access to specialist healthcare in geographically dispersed island nations. A qualitative methodology was employed, involving thematic analysis of national policy documents, in-depth interviews with health ministry officials, clinicians, and IT specialists, and a review of operational data from the national telemedicine platform initiated in 2022. Key findings indicate that strong political commitment and a centralised public health system were primary facilitators for initial implementation. However, significant barriers to sustainable scale-up were identified, including unreliable high-speed internet connectivity on outer islands, variable digital literacy among older patient populations, and concerns regarding the long-term financial sustainability of the service model. The study concludes that while technological infrastructure is a prerequisite, socio-cultural and economic factors are equally critical for successful adoption and scale-up. Its significance lies in providing a contextual analysis for other SIDS, demonstrating that scaling telemedicine requires an integrated strategy encompassing workforce training, patient education, and secure financing to realise its potential for strengthening health systems and advancing universal health coverage.