Table 1_Telemedicine in the sky: prospects and challenges for the aviation sector in Sub Saharan Africa.docx

The rapid growth of commercial aviation in Sub-Saharan Africa (SSA), combined with an increasing prevalence of chronic disease among travelers and limited in-flight medical resources, has elevated in-flight medical emergencies as a significant public health concern. Telemedicine presents a transformative opportunity to enhance aeromedical care. However, its adoption within SSA's aviation sector remains critically underdeveloped and underexplored in the literature. This integrative review examines the prospects and challenges of integrating telemedicine into SSA's aviation sector and generates context-specific recommendations to inform policy and practice. We conducted a comprehensive literature search across Scopus, Web of Science, PubMed, African Journals Online and Google Scholar, supplemented by grey literature. Thirty-five sources were synthesized across four analytical domains, with Rogers’ Diffusion of Innovations (DOI) theory providing the theoretical framework for the analysis. Six prospect domains were identified: real-time teleconsultations; multimodal biometric data transmission; continuity-of-care; psychosocial benefits for passengers and cabin crew; financial and operational/brand gains all aligning with the DOI attribute of relative advantage. However, these prospects are constrained by persistent challenges including unreliable satellite connectivity, ageing aircraft fleets, fragmented regulatory frameworks, cybersecurity vulnerabilities, financial barriers and inadequate cabin crew training. Recommendations are directed at three stakeholders namely, airline operators, aviation regulators and health policymakers and are anchored in regional realities. The review concludes that telemedicine holds transformative potential for SSA's expanding aviation sector, yet its realization demands harmonized regulatory action, targeted investment and capacity building tailored to the regions’ realities. Robust primary research within SSA's aviation health context is urgently needed to move beyond inferential evidence.