Implementing telemedicine for medical abortion within the public health system: a qualitative study on implementation bottlenecks and solutions in South Africa.

BACKGROUND: Abortion in South Africa is legal, but there are still many barriers to access and high utilisation of the informal sector. Telemedicine for medical abortion is an alternative model that has been found to be a safe, effective, and acceptable option to increase access to abortion services. This study aimed to understand how key informants view telemedicine for medical abortion and how they view potential bottlenecks and solutions concerning implementation in the public sector of South Africa. METHODS: We conducted interviews between February and March 2023 with 19 key informants across telemedicine and medical abortion provision, policy, and research. Through a qualitative design, we analysed the interviews using inductive content analysis. We used Baker et al.'s model of the implementation pathway to conceptualise and discuss the findings. RESULTS: The findings showed that respondents perceived telemedicine as a valuable complement to in-clinic care to increase access to safe abortions. Respondents identified clinical concerns and logistical challenges as implementation bottlenecks and believed these could be overcome with innovative thinking and by drawing on existing resources. They suggested that research, leadership, collaboration, and policy alignment would help increase stakeholder willingness and capacity to build health system readiness. Across the implementation process, respondents viewed it necessary to consider users' needs and adapt to contextual differences. CONCLUSIONS: This study identified telemedicine as a valuable model for increasing access to safe abortion services. Respondents outlined considerations and actionable steps to overcome implementation bottlenecks and guide the implementation of telemedicine for medical abortion in the public sector of South Africa and similar settings.