#servicedesignresearch

When Systems Don’t Fit: What Telemedicine Looks Like on the Ground

Telemedicine is often positioned as a solution - efficient, scalable, and accessible. But what happens when it meets the realities of everyday healthcare systems?

Through our research, a different picture began to emerge. Not one of failure, but of friction. After spending quite some time on the field, we gathered our observations and findings and synthesized them into our research insights.

For many doctors, teleconsultations are not a priority. They’re seen as interruptions to tasks that don’t justify the time they demand. When measured against already stretched responsibilities, the incentive simply isn’t there.

At the same time, MLHPs (Mid-Level Health Providers) are caught in a system of targets. The pressure to meet numbers can sometimes come at the cost of attention - shifting focus away from the patient in front of them to the system behind them.

Patients, on the other hand, are drawn in by one of the strongest motivators: free medication. And yet, subcentres- the very access points meant to deliver this promise - are often understocked. The expectation to adopt digital systems exists alongside a lack of basic infrastructure, creating a gap between policy and practice.

Continuity of care also begins to break down. Without access to their own health records, patients are left vulnerable to repeated tests, incomplete histories, and even mistreatment over time.

Even access to teleconsultations themselves isn’t guaranteed. A randomized allocation system means not every patient gets through - introducing uncertainty into a system that is meant to improve access.

And finally, there’s the question of expertise. Specialists - arguably the most valuable resource in telemedicine - are often the least available, as they are stretched thin and used as generalists across cases.

To add to this, the subcentres are initially given targets so that they could adopt the new system and get used to this. While this is an expectation, they barely have the basic necessities like a stable internet connection to meet the targets.  

These insights point toward a larger question: Are we designing telemedicine for scale, or for the realities of the people within it? If telemedicine promises accessible healthcare, why does it still feel out of reach?

We’re now moving into the next phase - translating these tensions into opportunities for intervention. Would love to hear your thoughts, critiques, or experiences with similar systems.

If you’ve worked within layered public systems, especially in rural or resource-constrained contexts, we would love to hear your perspective. You can write to us at [email protected]. Until next time!