How do you get health care if the closest doctor is 18 hours from home?

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 he or she lives.

For example, it’s not unusual for rural Colombians to wait two- to five-times longer than their urban counterparts just to get a medical appointment, simply because rural regions have fewer providers. Specialty care entails even more challenges.

Need a follow-up after surgery? If you live in the hard-to-reach Amazon region, you’ll have to endure an 18-hour journey by boat. Or what if your child is struggling with balance so much, it’s hard for her to go to school? If you live in rural Chocó, she could wait months to see a specialist who can diagnose and address the problem, so she finally can learn and play. With barriers like these, it’s little surprise that rural residents aren’t able to get the same kind of care as urban residents.

“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 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. But even with this priority, finding a way to expand and formalize its piecemeal digital health initiatives was a daunting task. What MSPS wanted was a strategic roadmap. To develop it, 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 its strategic roadmap for national telehealth implementation, with data collected from six rural states—ranging from nascent to more advanced in telehealth adoption. It also had a solid estimate of how much it would cost to implement.

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 it passed a law establishing broad-stroke 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.

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 the country’s six most rural territories: Antioquia, Cesar, Choco, La Guajira, San Andrés y Providencia, and Valle del Cauca. Gathering perspectives from people in Colombia’s healthcare 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 you needed to see different health providers, some might not have access to your health records.

All health providers weren’t 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 roadmap.

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 LaGuajira, 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.

Programs like these showed Colombia had a solid foundation of existing efforts and quite a bit of local expertise. But the programs were scattered, and Colombia was aiming for systemic change. Working with MSPS, PATH, and the UdeA created 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, with 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 USD $189.6 million over five years, with digital infrastructure representing over 75 percent of costs. After that initial infrastructure investment, annual costs of continuing development of digital tools and infrastructure would amount to around $3.62 per person. That 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.”