I’ve heard development practitioners say telemedicine is just a poor substitute for real healthcare. That virtual consultations can’t possibly match the quality of face-to-face care. That we’re shortchanging vulnerable populations by pushing digital solutions.
The evidence from Rwanda’s Babyl platform tells a different story entirely.
New research from VoxDev reveals that telemedicine in Rwanda delivered higher-quality, faster, and lower-cost care for common conditions compared to in-person visits.
Standardized patients presenting malaria and upper respiratory infections received demonstrably better care through virtual consultations. Healthcare providers in the Babyl program:
- Asked 60% to 100% more questions about symptoms and medical history
- Prescribed 15% more optional medicines to alleviate symptoms,
- Gathered more information during consultations that were 30% shorter.
Yet here’s the paradox that should haunt every digital health implementer: Babylon Health, Babyl’s parent company, filed for Chapter 7 bankruptcy in August 2023, forcing the shutdown of operations that served 2.8 million Rwandans.
A platform delivering superior healthcare outcomes became another cautionary tale of corporate failure.
The Three Lessons That Matter
This contradiction between clinical success and business failure offers three critical lessons for digital health practitioners.
1. Evidence of impact doesn’t guarantee sustainability.
The Rwanda study used rigorous methodology with standardized patients to demonstrate that telemedicine providers prescribed fewer unnecessary drugs (15-40% reduction) and ordered 70% fewer unnecessary lab tests while maintaining or improving quality. These aren’t marginal improvements but substantial gains in both clinical quality and cost-effectiveness.
However, Babylon Health recorded a net loss of $221.4 million on global revenue of $1.1 billion by December 2022, with management expressing doubts about the company’s ability to continue operating. Superior clinical outcomes mean nothing if the underlying business model collapses.
2. The medium genuinely matters for healthcare delivery.
The Rwanda research reveals why telemedicine succeeded clinically even as the company failed commercially. Providers reported that remote communication made it easier to get information and relate to patients, partly due to reduced distractions in quiet call centers compared to busy, loud in-person clinics.
More tellingly, when standardized patients requested unnecessary antibiotics, in-person providers were significantly more likely to prescribe them (18 percentage points more for malaria, 7 percentage points for URI) compared to virtual consultations where providers felt less pressure to agree to patient requests. The distance actually improved clinical decision-making.
3. Foreign ownership creates existential vulnerabilities.
Babyl had achieved remarkable penetration in Rwanda, registering more than 2.5 million users representing 18% of the population. The platform had integrated with national insurance schemes and signed a 10-year partnership with the Rwandan government.
Despite this integration, when Babylon’s take-private deal with AlbaCore Capital and MindMaze collapsed in August 2023, operations in Rwanda were simply wound down. Twenty percent of Rwanda’s population lost access to digital health services overnight because of corporate decisions made in London boardrooms.
Building Resilient Digital Health Ecosystems
These findings demand a fundamental shift in how we approach digital health implementation in low- and middle-income countries.
We cannot continue treating digital health platforms as isolated interventions. The technical superiority of telemedicine means nothing if we don’t simultaneously build sustainable financing mechanisms and local ownership structures.
For digital health practitioners, this means:
- Prioritizing long-term sustainability over short-term scale.
- Building local capacity and ownership from day one, not as an afterthought.
- Designing platforms that can survive corporate bankruptcies and geopolitical shifts.
The irony is profound: Rwanda’s telemedicine platform demonstrated that virtual care could outperform traditional healthcare delivery on quality, efficiency, and cost metrics. Patients paid approximately 20% less out-of-pocket for malaria visits and 40% less for upper respiratory infection visits while receiving superior care.
This should be a blueprint for healthcare transformation across sub-Saharan Africa.
Instead, it became a cautionary tale about the fragility of externally dependent digital health systems. Babylon’s bankruptcy didn’t just eliminate jobs or strand investors—it severed healthcare access for millions of people who had come to rely on demonstrably superior care.
Telemedicine Is Effective
Digital health practitioners need to absorb two lessons simultaneously.
The evidence is clear that well-designed telemedicine can deliver superior healthcare outcomes in resource-constrained settings. The Rwanda study joins mounting evidence that virtual care often matches or exceeds in-person care quality while improving access and reducing costs.
But we also need to acknowledge that clinical superiority means nothing without sustainable implementation models. As the eHealth landscape reviews show, sub-Saharan Africa has documented 738 distinct digital health interventions over the past decade, with unprecedented duplication and fragmentation.
The challenge is building digital health systems that can survive their own success.
