title: A Review and Critique of Teledermatology in the South African Public Health Sector.
abstract: Nearly 80% of the world's population live in developing countries in Asia, Africa, and Latin America. Many of these countries must face a triple or quadruple burden of disease with severely limited resources and health systems. South Africa (SA) is one such country, and recognises the potential for e-health to moderate these limitations. Dermatological issues remain a concern in SA and globally. Indeed, the World Health Organisation (WHO) has recognised that a number of diseases are most likely to manifest themselves through a dermatological problem before becoming full-blown. However, there is an acute shortage of dermatologists in SA. Teledermatology has promise as a service delivery intervention. This study reports on the current status of teledermatology services in the public health sector of SA.
  
  
  METHODS
  The study adopted a qualitative, inductive research approach based on a structured literature review of teledermatology in SA. A modified Momentum-Treat tool was used to critique identified teledermatology services.
  
  
  RESULTS
  159 resources were identified, of which 68 were excluded. The remaining 91 resources revealed a history of ad hoc teledermatology services, of which few remained active. Requests for teledermatology service confirmations provided some feedback, together with follow-up meetings and interviews.
  
  
  CONCLUSIONS
  No evidence of scaling of teledermatology services and integration into routine healthcare was found. Of eight services, 4 remain active. Review and modified Momentum-Treat critique showed opportunities for improved readiness assessment, programme governance, and alignment to government policy direction, in order to improve scaling and sustainability.
  
  
  CONCLUSIONS
  Full-scale teledermatology integration is possible, but stronger programme development is needed. Findings will inform development of a teledermatology scale-up framework to assist with future integration of teledermatology into routine healthcare.
authors: Department of Telehealth, University of KwaZulu-Natal, South Africa.
authors: Laticha E M
authors: LE
authors: Walters
authors: Department of Telehealth, University of KwaZulu-Natal, South Africa.
authors: Maurice
authors: M
authors: Mars
authors: Department of Telehealth, University of KwaZulu-Natal, South Africa.
authors: Richard E
authors: RE
authors: Scott
mesh_terms: D003880:Dermatology / Q000379:methods*; D006801:Humans; D017150:Public Sector; D013019:South Africa; D017216:Telemedicine