title: "Initiate-build-operate-transfer"--a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the balkans.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care & Emergency Surgery, University of Arizona , Arizona Health Sciences Center, Tucson, Arizona. Rlatifi@email.arizona.edu
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Merrell
authors.forename: Charles R
authors.initials: CR
authors.lastname: Doarn
authors.forename: George J
authors.initials: GJ
authors.lastname: Hadeed
authors.forename: Flamur
authors.initials: F
authors.lastname: Bekteshi
authors.forename: Ismet
authors.initials: I
authors.lastname: Lecaj
authors.forename: Kathe
authors.initials: K
authors.lastname: Boucha
authors.forename: Fatmir
authors.initials: F
authors.lastname: Hajdari
authors.forename: Astrit
authors.initials: A
authors.lastname: Hoxha
authors.forename: Dashurije
authors.initials: D
authors.lastname: Koshi
authors.forename: Mateja
authors.initials: M
authors.lastname: de Leonni Stanonik
authors.forename: Blerim
authors.initials: B
authors.lastname: Berisha
authors.forename: Kadri
authors.initials: K
authors.lastname: Novoberdaliu
authors.forename: Arben
authors.initials: A
authors.lastname: Imeri
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Weinstein
mesh_terms: D003906:Developing Countries; D017146:Models, Organizational; D016730:Program Development / Q000379:methods*; D017216:Telemedicine / Q000458:organization & administration*; D015022:Yugoslavia