In the South American country of Colombia, a remarkable 96 percent of the population is covered by health insurance. But a Colombian’s chance of seeing a health care provider varies greatly depending on where they live.
It’s not unusual for rural Colombians to wait two to five times longer than their urban counterparts to get a medical appointment because rural regions have fewer providers. For example, some people in the Amazon region have to spend 18 hours on a boat traveling along the river just to reach the closest city for a check-up after surgery.
Specialty care entails even more challenges. In rural Chocó, children who need specialized medical help might spend months waiting for a specialist to visit their community.
“In some areas, people can travel for hours, sometimes on improvised stretchers, just to reach a health facility,” said Gracey Vaughn, a deputy director at PATH’s Center of Digital and Data Excellence. “These kinds of challenges inevitably worsen health outcomes and increase costs for families and the health system.”
The Colombian Ministry of Health and Social Protection (MSPS) has long seen telehealth as a transformative tool—a way for people to receive care without having to leave their community. “We know we can save lives through the use of technology,” said Esteban Granada Aguirre, a specialist in telemedicine with MSPS.
But even with this priority, finding a way to expand and formalize its piecemeal digital health initiatives was a daunting task. To develop a plan, MSPS partnered with PATH and the University of Antioquia (UdeA), which, together, could offer global expertise in digital health plus local academic leadership.
Within a year, Colombia had a strategic roadmap for national telehealth implementation, with data collected from six states—ranging from nascent to more advanced in telehealth adoption. It also had a solid estimate of how much it would cost to implement.
The big picture: An equitable national strategy
Telehealth isn’t a new idea in Colombia. It’s been a tool within parts of the country’s health system since at least 2010, when Colombia passed a law establishing broad telehealth guidelines. That law spawned a series of new rules, parameters, and initiatives. Universities, health care providers, and local governments began independently establishing their own telehealth programs. The idea seemed to be taking off.
“The roadmap turns fragmented initiatives into a coherent national strategy, aligning disparate projects under one vision to strengthen primary health care and build enduring telehealth services—not just another fleeting pilot.”— Gracey Vaughn, Deputy Director, PATH’s Center of Digital Excellence
But MSPS recognized that rural residents—those who could benefit most from virtual health care visits—were being left behind. Committed to closing this gap, the agency sought to move beyond an ad hoc approach toward a national program.
Working in partnership with MSPS, PATH and UdeA first set about understanding the key barriers to accessing care, focusing on six of the country’s territories: Antioquia, César, Chocó, La Guajira, San Andrés y Providencia, and Valle del Cauca. By gathering perspectives from people in Colombia’s health care system through surveys, interviews, and workshops, the team realized one problem was fragmentation. Different municipalities had their own sets of regulations. Some regions were left out altogether. Many lacked reliable digital infrastructure. Others relied on paper medical records, which hindered the transfer of information. That meant if a patient needed to see different health providers, some of those providers might not have access to the patient’s health records.
Not all health providers were using standardized medical billing codes, either, making it harder to track health care data and monitor costs. And the quality of telehealth services varied widely, with some patients reporting the care they received didn’t meet their needs.
With that information, PATH and UdeA began looking ahead at how to turn that fragmented system into an equitable, coherent national system that would serve the needs of rural residents along with their urban counterparts. Colombia would need practical, prioritized recommendations, with realistic cost estimates—a costed roadmap.
Practical suggestions to turn goals into reality
Colombia already had some promising telehealth programs. In Chocó State, for example, when ultrasounds in high-risk pregnancies were reviewed remotely by a big-city specialist, pregnancy-related complications dropped by 30 percent. In La Guajira, patients who met virtually with mental health counselors were more likely to follow medication recommendations. Telehealth programs at the UdeA helped reduce unnecessary referrals while also improving detection of heart problems.
Individual patients have seen many benefits. In the Amazon, an elderly woman got advice from a specialist without leaving her home, saving her a long, tiring, and costly trip by river. In another case, a family in Chocó was convinced their young daughter had nerve problems affecting her balance. A specialist online realized all she needed was the right eyeglasses, a diagnosis that allowed her to go back to school and join her friends.
Results like these showed Colombia had a solid foundation of existing efforts and quite a bit of local expertise. But the programs were scattered. “Telehealth is a solution that brings health care professionals closer to all municipalities and homes, regardless of location,” said Juan Fernando Mesa Valencia, a doctor at UdeA. “We wanted this approach to become commonplace, stable, and sustainable. That’s why so many of us were committed to developing a clear and coherent path forward.”
Working with MSPS, PATH and the UdeA began by creating a larger framework grounded in global best practices—one that was also adapted to Colombia’s local context. Following this roadmap, Colombia’s telehealth would both protect patient privacy and align with national goals. It would be people centered, truly attuned to the needs of both patients and health care providers. It would be culturally responsive to the people who use it. It would be sustainable, with reliable digital connectivity and platforms that patients and providers could count on for the long run—which includes economic sustainability.
The roadmap then digs into a series of practical suggestions, including standardizing billing codes and reimbursements, implementing digital literacy training for health care workers, simplifying processes for new providers, and identifying financing mechanisms to sustain infrastructure improvements for the long haul. The final product is aligned with Colombia’s long-term agenda, evidence-based recommendations, and investment guidance to allocate resources efficiently.
“In short, the roadmap turns fragmented initiatives into a coherent national strategy, aligning disparate projects under one vision to strengthen primary health care and build enduring telehealth services—not just another fleeting pilot,” Vaughn said.
PATH estimated an investment of about US$189.6 million over five years, with digital infrastructure representing over 75 percent of costs. After that initial infrastructure investment, annual costs to continue developing digital tools and infrastructure would amount to around $3.62 per person. This amount doesn’t account for cost savings that, evidence shows, come from improved health care access.
“Global evidence and Colombia’s existing programs offer evidence that telehealth reduces inefficiencies and improves equity,” Vaughn said. “That means healthier populations and better resource allocation over time.”
