Testing a top-down strategy for establishing a sustainable telemedicine program in a developing country: The arizona telemedicine program-u.s. army-republic of panama initiative

Silvio Vega, Ivette Marciscano, Michael Holcomb, Kristine A. Erps, Janet Major, Ana Maria Lopez, Gail P. Barker, Ronald S. Weinstein

Research output: Contribution to journalArticle

8 Scopus citations


Objective: Many developing countries have shown interest in embracing telemedicine and incorporating it into their healthcare systems. In 2000, the U.S. Army Yuma Proving Ground (YPG) initiated a program to assist the Republic of Panama in establishing a demonstration Panamanian rural telemedicine program. YPG engaged the Arizona Telemedicine Program (ATP) to participate in the development and implementation of the program. Materials and Methods: The ATP recommended adoption of a "top-down" strategy for creating the program. Early buy-in of the Panamanian Ministry of Health and academic leaders was regarded as critical to the achievement of long-term success. Results: High-level meetings with the Minister of Health and the Rectors (i.e., Presidents) of the national universities gained early program support. A telemedicine demonstration project was established on a mountainous Indian reservation 230 miles west of Panama City. Today, three rural telemedicine clinics are linked to a regional Ministry of Health hospital for teleconsultations. Real-time bidirectional videoconferencing utilizes videophones connected over Internet protocol networks at a data rate of 768 kilobits per second to the San Felix Hospital. Telepediatrics, tele-obstetrics, telepulmonology, teledermatology, and tele-emergency medicine services became available. Telemedicine services were provided to the three sites for a total of 1,013 cases, with numbers of cases increasing each year. These three demonstration sites remained in operation after discontinuation of the U.S. involvement in September 2009 and serve as a model program for other telemedicine initiatives in Panama. Conclusions: Access to the assets of a partner-nation was invaluable in the establishment of the first model telemedicine demonstration program in Panama. After 3 years, the Panamanian Telemedicine and Telehealth Program (PTTP) became self-sufficient. The successful achievement of sustainability of the PTTP after disengagement by the United States fits the Latifi-Weinstein model for establishing telemedicine programs in developing countries.

Original languageEnglish (US)
Pages (from-to)746-753
Number of pages8
JournalTelemedicine and e-Health
Issue number10
StatePublished - Oct 1 2013



  • Extreme environments
  • policy
  • tele-emergency medicine
  • tele-infectious disease
  • tele-obstetrics
  • telecardiology
  • teledermatology
  • telehealth
  • telemedicine
  • telepulmonology
  • teleradiology

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management

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