"initiate-build-operate-transfer"-a strategy for establishing sustainable telemedicine programs in developing countries: Initial lessons from the balkans

Rifat Latifi, Ronald C. Merrell, Charles R. Doarn, George J. Hadeed, Flamur Bekteshi, Ismet Lecaj, Kathe Boucha, Fatmir Hajdari, Astrit Hoxha, Dashurije Koshi, Mateja De Leonni Stanonik, Blerim Berisha, Kadri Novoberdaliu, Arben Imeri, Ronald S. Weinstein

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

Original languageEnglish (US)
Pages (from-to)956-969
Number of pages14
JournalTelemedicine and e-Health
Issue number10
StatePublished - Dec 1 2009


  • Balkans
  • IBOT model
  • International Virtual e-Hospital
  • Virtual educational network

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management


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