Pathways to optimize a pediatric telemedicine and medication delivery service: A multi-level qualitative study in Haiti

BackgroundWhile telemedicine has become an established component of healthcare delivery globally, challenges to scaling emerging initiatives persist across multiple levels. Over the last 5 years, our team has developed a pediatric telemedicine and medication delivery service (TMDS) in Haiti that integrates clinical guidance with rapid access to medications. Building on successful proof-of-concept studies, we are now well positioned to characterize both general challenges to telemedicine scale-up and those unique to the TMDS model. MethodsIn this study, we conducted focus group discussions and administered written questionaries to TMDS staff, including physicians, nurses, and medication delivery drivers. Using framework matrix analysis we identified key challenges and opportunities associated with the TMDS model. ResultsAreas for improvement related to obtaining quality information from virtual exams, the reliability of technology and communication infrastructure, conditions necessary for effective in-person exams, the limited scope of the TMDS workflow and clinical resources, and uncertainty surrounding long-term sustainability. These insights informed the development of targeted action items categorized into three domains: conceptual, physical and mission-oriented. ConclusionThe findings will guide our internal scale-up strategy and may offer guidance to similar telemedicine initiatives.