by Caroline Perrin Franck, Salim Azzabi, Joscelyn Magdeleine, Pierre Sauvé, Derrick Muneene, Alain Labrique
Bulletin of the World Health Organization, 2026 April 16; 104(6):427–434.
Abstract
Evidence suggests telehealth can be cost-effective and improve outcomes, including in cross-jurisdictional settings. We examined how cross-border telehealth could support health system transformation and consulted experts to identify priority policy considerations for integrating services across jurisdictions. We conducted a multimethod policy analysis comprising a narrative review informed by targeted searches and policy mapping, pre-Delphi working-group discussions, and a three-round modified Delphi consensus process with 18 experts in health policy, health-care regulation, telehealth implementation and international trade. We then made our draft findings available for World Health Organization-hosted public consultation, incorporating feedback and updating our narrative review. Our finalized challenge–policy matrix included 20 key challenges that we categorized within seven domains: knowledge and awareness; policy and governance; technology and operational issues; data security and privacy; quality and ethical standards; financial and economic factors; and adaptability and resilience. In our detailed challenge–policy matrix we identify national and international required policy actions for all 20 key challenges, which we summarize as: reinforce regulatory frameworks and international commitments; strengthen governance and coordination; build digital health capacity; ensure data privacy and security; and promote sustainable financing models. From a public health perspective, cross-border telehealth is essential for the strengthening of global health systems. Tackling the challenges of regulatory heterogeneity, exclusion from international trade agreements, digital literacy, language barriers and financial constraints requires that regulatory, technological and operational constraints be addressed through international policy cooperation. Priorities include interoperable regulatory frameworks, reduction or removal of unnecessary barriers, infrastructure investment, data protection, sustainable financing and emergency preparedness.
From the Introduction
Telehealth, the delivery of health services at distance via information and communication technologies, has expanded rapidly in recent years, accelerated by technological advances, economic growth and the occurrence of the coronavirus disease 2019 (COVID-19) pandemic. Utilization to support continuity of care increased exponentially during the pandemic (by an estimated 38-fold), with particularly strong uptake in specialities suited to remote delivery such as radiology, pathology and peer-to-peer specialist consultations. Evidence suggests telehealth can be cost-effective and improve outcomes, including in cross-jurisdictional settings.
A growing subdomain is cross-border telehealth, where patients, providers and/or supporting platforms operate in different jurisdictions. In practice, cross-border telehealth is most common in services deliverable at distance with limited physical interaction. Illustrative examples include: peer-to-peer tele-consultative critical care services linking specialists to remote facilities in Afghanistan, Kenya, Pakistan and United Republic of Tanzania; and telehealth deployments supporting international mass gatherings such as the Hajj, during which Saudi Arabia’s Seha Virtual Hospital provided nonstop, round-the-clock multilingual telehealth services for millions of pilgrims. Language barriers are typically managed through bilingual clinicians, interpreter-supported workflows and digital translation tools.
Global health spending reached 9.8 trillion United States dollars (US$) in 2021, so even modest growth in digitally delivered services across borders can have material implications for access, workforce distribution and resilience, particularly in underserved settings and during emergencies. Although cross-border telehealth (categorized within international trade in services) represents a small proportion of overall health service delivery, its significance is increasing. Trade in medical services is sizeable (global exports of health services totalled US$ 94.4 billion in 2022), and digitally delivered cross-border services, including telehealth, expanded during the COVID-19 pandemic even as travel-related health trade declined. Market estimates suggested rapid growth in cross-border telehealth to around US$ 8 billion in 2022, an increase of approximately sixfold since 2005.
According to World Trade Organization (WTO) data, in 2022 the leading exporters of cross-border telehealth services included the European Union, Australia, Cuba, India, Singapore, United Arab Emirates and United States of America, and the leading importers included the European Union, India, Norway, Qatar, Singapore, United Kingdom of Great Britain and Northern Ireland, and the USA. These patterns provide an approximation of where cross-border provision and demand are concentrated….
As telehealth expands, these gaps show that the main constraint on cross-border telehealth is not technology but fragmented policy, governance and financing across countries. These challenges must be resolved to unlock the full potential of telehealth in advancing relevant sustainable development goals and universal health coverage (UHC).
In this context, our objectives were to examine how cross-border telehealth could support health system transformation, and to consult experts to identify priority policy considerations for integrating services across jurisdictions.
NOTE: Well worth reading the whole paper. MB