“Initiate–Build–Operate–Transfer”—A Strategy for Establishing Sustainable Telemedicine Programs in Developing Countries: Initial Lessons from the Balkans

Abstract

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

Access to Specialized Care Through Telemedicine in Limited-Resource Country: Initial 1,065 Teleconsultations in Albania

“…The institutionalization of telemedicine program within the fabric of the nation's healthcare system is vital for sustainability; it must become an integral, long-term part of the system with its standards, protocols, and procedures that governs the telemedicine program. 8 This phase of the IBOT has to be planned well in advance to be successfully executed.…”

“…3 This model has been successfully utilized to establish telemedicine and e-health education services in other countries both in the Balkans region and in Africa. [4][5][6][7] Currently, the Albanian program is in the last phase or Transfer phase, the final element of the IBOT strategy.…”

Perspective on COVID-19: Finally, Telemedicine at Center Stage

“…40 In addition, telemedicine has great potential for large scale manmade or natural disasters and emergencies that are characterized by unpredictability to place, time, and the number of injured people as well as their injury severity score, when other mode of transmission of information is not possible, or when the terrestrial infrastructure is lacking or has been destroyed by war or neglect, or simply did not exist at all. [41][42][43][44][45] As a result of these studies, a number of nation-wide telemedicine programs have been established 46,47 and have successfully increased access to care, particularly, specialized care. Telemedicine for disaster should be part of the nation-wide mass casualties structured centers that mimic trauma and stroke centers in high-income countries.…”

Public Hospital Facilities Development Using Build-Operate-Transfer Approach: Policy Consideration for Developing Countries

“…A BOT is a concession in which a private entity (in the form of an agency or consortium) agrees to finance a new infrastructure project and commits to meet the performance standards set by the government (12). The private partner raises the necessary funds for the construction of new facilities and is entitled to retain the ownership of the facilities and buildings during the term of the contract.…”

“…The private partner raises the necessary funds for the construction of new facilities and is entitled to retain the ownership of the facilities and buildings during the term of the contract. The term of the contract must be adjusted to allow for the return of the investment of the private entity (13). The public party commits to purchase a minimum level of the private partner's products to allow the private partner to cover its expenses.…”