Telemedicine Readiness in East African Regional Centres of Excellence: An Assessment of Digital Infrastructure, Services, and Human Resources

Abstract

Background: The East African Community (EAC) faces inequalities in access to specialised healthcare, shortages of skilled health professionals, and limited digital infrastructure. Telemedicine can extend specialised services and clinical expertise across geographic boundaries, but implementation requires adequate digital infrastructure, skilled human resources, interoperable systems, and supportive governance. The EAC Regional Centres of Excellence (RCoEs) are strategically important as regional hubs for specialised healthcare delivery, advanced training, research, and innovation. However, recent evidence on their digital readiness for telemedicine and the alignment of their digital assets and institutional capacities with telemedicine requirements is limited. This study assessed digital assets and capacity for telemedicine in EAC RCoEs to identify readiness gaps and inform regional policy, investment, and capacity-building priorities.
Methods: A descriptive qualitative study was conducted across six EAC RCoEs in Burundi, Kenya, Rwanda, Tanzania, and Uganda from April to May 2025. Data were collected through document reviews, structured assessments using a Telemedicine Assessment Framework, observation, and semi-structured interviews with executive leaders, Information and Communication Technology (ICT) personnel, healthcare professionals, and supporting staff. Thematic analysis was undertaken using ATLAS.ti version 23.2.1(ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) to identify patterns and barriers affecting readiness.
Results: The RCoEs demonstrated foundational digital infrastructure, but readiness for advanced telemedicine was constrained by infrastructural, governance, workforce, interoperability, financing, and regulatory gaps. Key challenges included unreliable internet connectivity, limited specialised telemedicine platforms, inadequate formal training in virtual care, weak data governance, limited adoption of Health Level Seven (HL7) and Fast Healthcare Interoperability Resources (FHIR) standards, insufficient dedicated Digital Health (DH) financing, and inadequate telemedicine policies. Existing digital systems predominantly supported academic and administrative functions rather than clinical telemedicine, indicating a mismatch between available digital assets and clinical requirements.
Conclusion: The EAC RCoEs have foundations for telemedicine but require coordinated action. Priorities include strengthening digital infrastructure and connectivity, workforce competencies, interoperability, data governance, financing, and regulatory frameworks. A coordinated EAC regional telemedicine policy and standards-aligned interoperability framework could strengthen RCoEs as regional DH hubs, improve equitable access to specialised healthcare, and contribute to Universal Health Coverage (UHC).