Systematic Review of Barriers to Telehealth Adoption Among Marginalized and Underserved African Populations

Telehealth has emerged as a transformative tool in expanding access to healthcare, particularly in regions with limited healthcare infrastructure. In Africa, however, the widespread adoption of telehealth remains uneven, with marginalized and underserved populations experiencing persistent barriers to access and utilization. This systematic review critically examines the multidimensional barriers impeding telehealth adoption among these populations across the African continent. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and African Index Medicus databases, covering studies published between 2012 and 2024. Inclusion criteria focused on peer-reviewed articles and grey literature that examined telehealth access, usage, or policy within marginalized or underserved African communities. Thematic synthesis of the included studies revealed five primary categories of barriers: infrastructural limitations, digital literacy and access divide, socio-cultural resistance, regulatory and policy gaps, and affordability and sustainability concerns. Infrastructural limitations, including poor internet connectivity and inconsistent electricity supply, were found to be the most pervasive. A significant proportion of the population lacks access to smartphones or digital platforms necessary for telehealth services. Additionally, digital literacy was identified as a critical barrier, particularly among older adults, rural dwellers, and low-income households. Socio-cultural factors, including mistrust of digital health technologies and preference for in-person consultations, also hinder adoption. Moreover, weak telehealth regulatory frameworks and data privacy concerns limit implementation at scale. Affordability emerged as a cross-cutting issue, with the cost of devices and data services rendering telehealth inaccessible for many. The review further highlights the lack of targeted policies that prioritize marginalized groups in digital health strategies. In conclusion, overcoming these barriers requires a multisectoral approach involving governments, private sector stakeholders, civil society, and international partners. Efforts must prioritize digital infrastructure development, culturally sensitive user training, subsidized access models, and inclusive telehealth policies. Only through coordinated action can telehealth become a truly equitable healthcare solution for Africa’s underserved populations.