Adoption of Telemedicine in African Health Policy in Pre and Post COVID-19 Eras: Innovations, Limitations,...

Telemedicine in Africa has evolved from small-scale pilots to an essential tool for enhancing healthcare access, efficiency, and equity. Early efforts faced challenges due to limited infrastructure, high costs, and weak policies. The COVID-19 pandemic accelerated telemedicine adoption, exposing the need for stronger digital health strategies. Despite interest, many countries still struggle with regulation, coordination, and scaling sustainable implementations. This review examines the development and policy adoption of telemedicine across Africa before and after the pandemic, identifying key innovations, ongoing challenges, and lessons to guide future digital health planning.

A narrative review was conducted, with study selection guided by PRISMA transparency standards. A structured search was conducted across PubMed, Google Scholar, Web of Science, Cochrane Library, Scopus, and policy databases from the WHO, the African Union, and UNECA. The search included publications from 2000 to 2025, focusing on English-language studies addressing telemedicine policies or implementation in African countries.

The COVID-19 pandemic accelerated adoption, driving rapid innovation and policy shifts. In Nigeria, platforms such as MobiHealth, Tremendoc, and Dokilink expanded access via phone and WhatsApp, maintaining care during lockdowns. In South Africa, regulatory reforms enabled consultations without prior doctor-patient relationships, allowing 97% of patients to be managed virtually and reducing hospital burden. Nurse-led teleconsultations improved access, while a remote diabetes program reduced mortality by 20% among high-risk patients. Telepsychiatry expanded mental health services, and SMS-based interventions remained the most widely used due to affordability and accessibility. Despite progress, policy responses were uneven. South Africa's rapid reforms contrasted with Nigeria's fragmented frameworks, which lacked enforceable telemedicine provisions. Persistent challenges include weak data governance, limited interoperability, inadequate funding, and "pilotitis," where projects fail to scale.

Telemedicine adoption in Africa has grown markedly since COVID-19 but remains constrained by infrastructural and regulatory weaknesses, and variable acceptance. Strengthening legal frameworks, improving infrastructure, and increasing awareness among providers and communities are vital to sustain progress, integrate telehealth into routine care, foster innovation, and enhance equitable healthcare across the continent.