From Pandemic Lifeline to Policy Test: Can MENA Make Telehealth Stick?

Telehealth expanded rapidly across the Middle East and North Africa (MENA) during the COVID-19 pandemic, but the region now faces a more difficult test: turning emergency adoption into routine healthcare.

A new review suggests the biggest obstacle is not public resistance, but the systems surrounding the technology. Titled "Attitudes and Determinants Affecting Telehealth and Telemedicine Use in the MENA Region: A Narrative Review," published in Healthcare by Sneha Reji, Mayssah El Nayal and Jayadevan Sreedharan, the review finds broadly positive attitudes toward digital care alongside persistently uneven use, a gap shaped by insurance, connectivity, digital literacy, cultural factors and health-system design.

The pandemic proved demand, but not sustainability

COVID-19 accelerated remote healthcare across the region. One MENA survey cited in the review found that 88.6% of respondents had no prior exposure to telehealth before the pandemic, while use increased by 251% afterward. Among active users, 89% used virtual specialist visits, while 66% said telehealth made them feel safer and protected from infection.

The figures demonstrate how rapidly health-seeking behavior can change when necessity, regulation and service availability move in the same direction. Governments and providers expanded remote consultations, telepharmacy and other digital services because conventional care suddenly became harder, and potentially riskier, to access.

However, emergency adoption is not the same as durable integration. The evidence reviewed by the authors shows that many users were not necessarily committed to continuing once the immediate crisis passed. In one study, although 66% of telehealth users felt safer during the pandemic, only 36.8% hoped to continue using it afterward.

The gap is one of the study's most important insights. The pandemic should be seen less as proof that telemedicine has permanently "arrived" and more as a large-scale stress test. It demonstrated both capability and fragility. Health systems could switch rapidly to remote care, but sustained use depends on whether digital services become embedded in normal financing, clinical workflows and patient pathways.

For policymakers deciding which pandemic-era innovations to retain, the implication is straightforward: temporary utilization can fade quickly when reimbursement is uncertain, platforms remain cumbersome or patients return to familiar face-to-face services.

The biggest barriers are structural, not attitudinal

The review repeatedly identifies broadly favorable attitudes toward digital healthcare. In Iran, 73% of surveyed nurses and midwives reported positive attitudes toward telenursing and telehealth. In Jordan, 67.8% of surveyed participants were willing to use telemedicine. A global survey of healthcare professionals cited in the paper found similarly positive expectations: 83% believed telemedicine could save physicians' time and 80% thought it could reduce staff workload, although privacy and workload concerns remained.

However, favorable sentiment sits alongside striking access barriers. One study cited in the review found limited insurance coverage affected 74.2%, internet connectivity problems 53.2%, and delayed responses from medical service centers 28.6%. About 23.3% of participants also reported needing physical examinations that could not be conducted through telemedicine.

Another finding showed that 38.3% of participants were unaware of telemedicine services and 33.5% did not know how to use them. This combination exposes the limits of strategies centered mainly on awareness campaigns. Information can help, but it cannot fix a reimbursement gap, a dropped internet connection, an inaccessible interface or a service that is financially out of reach.

The authors describe an "inverted barrier structure" in the region. Compared with some high-income settings, where clinician concerns about workflow or rapport can be prominent, parts of MENA may have relatively advanced regulations and institutional frameworks while patients still lack awareness, access or enabling conditions.

The policy implication is significant: telehealth should increasingly be treated as health-system infrastructure rather than simply a digital-health product. That means reimbursement mechanisms, reliable connectivity, multilingual interfaces, support for people with limited digital literacy and training that makes remote care workable for clinicians.

It also means resisting assumptions that digitization automatically cuts costs. The review says implementation costs and long-term returns remain uncertain and calls for more cost-effectiveness studies across MENA health systems. Remote care may reduce travel and productivity losses, but poorly integrated digital systems can also introduce new costs.

Digital health could narrow inequality or deepen it

Telehealth is often presented as an equalizer because it can connect patients in underserved areas with specialists concentrated in major cities. That potential is particularly important in MENA, where rural communities and lower-income areas can face limited access to hospitals, clinics and transportation.

But digital healthcare can reproduce existing inequality when the prerequisites for accessing it are themselves uneven. Low-income workers, older people and people with limited digital literacy face particular obstacles. Language, employment conditions, internet access and cultural norms can all determine whether a virtual consultation is genuinely accessible. Privacy concerns and sensitivities around video-based communication may create additional barriers for some users and healthcare professionals.

The problem becomes sharper in fragile and conflict-affected settings. The review notes that telemedicine interventions in Afghanistan, Libya, Syria, Iraq, Yemen and Gaza have often been initiated by humanitarian or academic institutions rather than national health systems, with services frequently concentrated on specialist consultations and tele-mental health rather than primary care.

Evidence from Gaza and the West Bank shows both digital health's resilience and its limits. One study documented healthcare workers using WhatsApp despite connectivity and power disruptions, while electronic medical records were sometimes replaced by paper records and photographs taken on phones.

For development agencies and international institutions, this points to a broader lesson: success should not be measured only by the number of digital platforms launched or consultations completed. Policymakers should ask who is actually able to use them.

By reasonable policy inference, the findings connect closely with SDG 3 on health, SDG 9 on infrastructure and SDG 10 on inequality. The development value of telemedicine lies not in digitization itself, but in whether it expands effective healthcare access for people who were previously underserved.

The next phase must turn telehealth into public infrastructure

The review's strongest policy message is that MENA countries need to move from episodic adoption toward institutionalization. That shift requires decisions that may be less visible than launching a new health app but are considerably more consequential: whether insurers reimburse virtual consultations, whether rural communities have dependable connectivity, whether clinicians are trained and supported, whether patient data are protected, and whether platforms are usable by people with different languages and levels of digital literacy.

It will also require stronger evidence. The authors call for longitudinal research examining adoption beyond the pandemic, culturally and linguistically adapted models, cost-effectiveness studies across different geographical settings and further research involving underserved groups such as older people, low-skilled workers, children and pregnant women.

It should be noted that the research is a narrative review rather than a systematic meta-analysis, includes only English-language evidence and draws heavily on cross-sectional and observational studies. Evidence is also uneven across a region encompassing vastly different income levels, political systems, infrastructure conditions and health-system capacities.

Overall, telehealth's future in MENA may depend less on whether the technology works than on whether institutions make it routinely usable. The next test is whether governments can convert emergency-era momentum into a durable layer of healthcare delivery, financed, regulated, culturally appropriate and integrated into everyday clinical practice.