Deployment of Low-Latency Satellite Technology for Telemedicine: A Backhaul Solution for Improving Rural Health Care Connectivity in Developing Countries
Restricted accessReview articleFirst published online April, 2026
Deployment of Low-Latency Satellite Technology for Telemedicine: A Backhaul Solution for Improving Rural Health Care Connectivity in Developing Countries
In developing countries, satellite-based technology can aid critical telemedicine applications and other digital health services in critically underserved areas. Affordable, high-speed broadband services can and should be accessible to all citizens. Remote locations are necessary to support various critical services, including education and training, telehealth applications, remote patient monitoring, and warning systems, particularly during disasters. Currently, however, these services are limited to urban centers, leaving rural areas without access to specialized health care services. This digital divide significantly impacts health care delivery, with only 48% of rural populations having internet access compared with 83% in urban areas.
Methods:
The goal of this study was to assess the suitability of Geostationary Earth Orbit (GEO), Medium Earth Orbit (MEO), and Low Earth Orbit (LEO) satellites for telemedicine and health care backhaul connectivity. To achieve this, the study conducted a comparative analysis of the systems, highlighting their respective advantages and limitations in terms of latency, coverage, and deployment costs. A systematic literature review and the assessment of real-world case studies and worldwide datasets complemented this analysis. Case studies from Starlink deployments in North America and Sub-Saharan Africa and Amazon’s Project Kuiper were evaluated.
Results:
LEO satellites demonstrated significantly lower latency (20–50 ms) compared with MEO (100–300 ms) and GEO (600 ms) systems. Cost analysis revealed LEO services ($110–$500 per month) were substantially more affordable than MEO ($250–$1,000 per month) and GEO ($500–$2,000 per month) alternatives. Starlink deployments achieved download speeds of 50–250 Mbps with sub-50 ms latency, enabling real-time telemedicine consultations that met clinical standards. Rural telemedicine consultations increased by over 300% in areas with LEO satellite coverage.
Conclusions:
Our findings suggest that the LEO Starlink satellite technology would provide the most cost-effective backhaul broadband connectivity for real-time telemedicine services, given its low latency needs (20–50 ms), which enable high-quality video calls and remote diagnostics. We recommend using an LEO-based satellite network as the best approach to extend internet services to underserved remote communities due to its low latency and cost-effectiveness in aiding health care delivery in developing countries.
HudsonH. Research on community networks: What’s old is new again. SSRN. 2022; doi: 10.2139/ssrn.4212025
2.
AbdellatifB, ShiblMM, KhattabT, et al.Caching through the skies: The case of LEO satellites connected edges for 6G and beyond. ArXiv [Preprint]. 2023; doi: 10.36227/techrxiv.22298902.v1
World Bank. World development report 2016: Digital dividends [Internet]. Washington (DC): World Bank; 2016. [cited 2025 Jul 31] Available from: https://www.worldbank.org/en/publication/wdr2016
7.
YaacoubE, AlouiniM-S. Efficient fronthaul and backhaul connectivity for IoT traffic in rural areas. IEEE Internet Things M, 2021; 4(1):60–66; doi: 10.1109/IOTM.0001.1900061
HesseBW. Role of the internet in solving the last mile problem in medicine. J Med Internet Res, 2019; 21(10):e16385; doi: 10.2196/16385
10.
HaleemA, JavaidM, SinghRP, et al.Telemedicine for health care: Capabilities, features, barriers, and applications. Sens Int, 2021; 2:100117.
11.
YaacoubE, AlouiniMS. A key 6G challenge and opportunity—connecting the remaining 4 billions: A survey on rural connectivity. ArXiv, 2019. Preprint Available from: https://arxiv.org/abs/1906.11541
QuZ, ZhangG, CaoH, et al.LEO satellite constellation for the Internet of Things. IEEE Access, 2017; 5:18391–18401; doi: 10.1109/ACCESS.2017.2735988
15.
MaS, ChouYC, ZhangM, et al.LEO satellite network access in the wild: Potentials, experiences, and challenges. arXiv [Preprint]. 2024. Available from: https://arxiv.org/abs/2405.06801
16.
ChenZN, QingX, TangX, et al.Phased array metatennas for satellite communications. IEEE Commun Mag, 2022; 60(1):46–50; doi: 10.1109/MCOM.001.2100538
17.
IEEE Standards Association. IEEE standard for letter designations for radar-frequency bands. IEEE Std 521-2002. New York: IEEE; 2002.
LiuX, WangY, ZhangL, et al.Low Earth orbit satellite communication for 6G: Opportunities and challenges. Sci Rep, 2025; 15:95869; doi: 10.1038/s41598-025-95869-z
20.
AbdulwahidMM, KurnazS, TürkbenAK, et al.Inter-satellite optical wireless communication (Is-OWC) trends: A review, challenges, and opportunities. Eng Appl, 2024; 3(1):1–15.
21.
ChaudhryAU, YanikomerogluH. Laser inter-satellite links in a Starlink constellation. ArXiv [Preprint]. 2021; doi: 10.48550/arXiv.2103.00056
22.
BhattacharjeeD, MadoeryPG, ChaudhryAU, et al.On-demand routing in LEO mega-constellations with dynamic laser inter-satellite links. ArXiv, 2024; doi: 10.48550/arXiv.2406.01953[Preprint]
23.
ScheidP, LamDM, ThömmesA, et al.Telemicrobiology: A novel telemedicine capability for mission support in the field of infectious medicine. Telemed J E Health, 2007; 13(2):108–117; doi: 10.1089/tmj.2007.0043
24.
LuanY, SunF, ZhouJ. A service-caching strategy assisted by double DQN in LEO satellite networks. Sensors (Basel), 2024; 24(11):3370; doi: 10.3390/s24113370
25.
NaZ, PanZ, LiuX, et al.Distributed routing strategy based on machine learning for LEO satellite network. Wirel Commun Mob Comput, 2018; 2018:3026405; doi: 10.1155/2018/3026405
RauschM, SchaeblerA, ScheidPL, et al.Biosensors supporting health care in missions—expert consensus on the status of implementation in the military and future tasks. Health Prom Phys Act, 2022; 20(3):29–35; doi: 10.55225/hppa.438
28.
VölkF, SchwarzRT, LorenzM, et al.Concept and evaluation of mobile cell connectivity over a satellite backhaul for future 5G networks. In: Proc IEEE GlobalSIP. 2018; p. 1025–9; doi: 10.1109/GlobalSIP.2018.8646360
29.
FurqanM, GoswamiB. Satellite communication networks. In: TianYC, LevyDC., editors. Handbook of real-time computing. Singapore: Springer; 2022. p. 961–82; doi: 10.1007/978-981-4585-87-3_70-1
IsraelO. Starlink and satellite broadband coverage mapping [Internet]. 2025. [cited 2025 Jul 31] Available from: https://starlink-map.com
32.
ChenN, SongY, CaoY, et al.Network-layer perspectives on satellite–terrestrial integrated networks in 6G: A comprehensive review. Engineering, 2025; 54:69–92; doi: 10.1016/j.eng.2025.05.012
33.
LinZ, NiZ, KuangL, et al.NGSO satellites’ beam hopping strategy based on load balancing and interference avoidance for coexistence with GSO systems. IEEE Commun Lett, 2023; 27(1):278–282; doi: 10.1109/LCOMM.2022.3213912
34.
KangSY, JoMS, ChoiJY, et al.Cost effectiveness of reusable launch vehicles depending on the payload capacity. Aerospace, 2025; 12(5):364; doi: 10.3390/aerospace12050364
35.
TevensA, IradukundaB, BaileyB, et al.Can LEO satellites enhance the resilience of the internet to multi-hazard risks? In: Int Conf Passive Active Netw Meas. Cham: Springer Nature; 2024. pp. 170–95.
36.
OsoroOB, OughtonEJ. A technoeconomic cost framework for satellite networks applied to low Earth orbit constellations: Assessing Starlink, OneWeb, and Kuiper. ArXiv [Preprint]. 2021; doi: 10.48550/arXiv.2108.10834
37.
International Telecommunication Union. 5G backhaul and fronthaul via satellite connectivity. ITU-T Study Group 13 [Internet]. Geneva: ITU; 2024. [cited 2025 Jul 31] Available from: https://www.itu.int/en/ITU-T
ScheidPL. Use of telemedicine within the diagnosis of parasites and viruses. Wien Klin Wochenschr, 2012; 124 (Suppl 3):10–13; doi: 10.1007/s00508-012-0240-z
KodheliO, GuidottiA, Vanelli-CoralliA. Integration of satellites in 5G through LEO constellations. ArXiv [Preprint]. 2017; doi: 10.48550/arXiv.1706.06013
HenryC. SpaceX and Amazon face billions in upfront costs for LEO constellations. SpaceNews [Internet]. 2021. [cited 2025 Jul 31] Available from: https://spacenews.com
European Space Agency. Spectrum management for LEO constellations [Internet]. 2022. [cited 2025] Available from: https://www.esa.int
62.
Federal Communications Commission. Starlink user terminal reports and pricing [Internet]. 2022. [cited 2025 Jul 31] Available from: https://www.fcc.gov
63.
United Nations Office for Outer Space Affairs. Space debris mitigation guidelines [Internet]. Vienna: UNOOSA; 2021. [cited 2025 Jul 31] Available from: https://www.unoosa.org
64.
Scott KruseC, KaremP, ShifflettK, et al.Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare, 2018; 24(1):4–12; doi: 10.1177/1357633X16674087
65.
EdirippuligeS, ArmfieldNR. Education and training to support the use of clinical telehealth: A review of the literature. J Telemed Telecare, 2017; 23(2):273–282; doi: 10.1177/1357633X16632968
66.
NouriSS, Adler-MilsteinJ, ThaoC, et al.Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review. J Am Med Inform Assoc, 2020; 27(5):834–841; doi: 10.1093/jamia/ocaa024
67.
MarsM, ScottRE. Being spontaneous: The future of telehealth implementation? Telemed J E Health, 2017; 23(9):766–772; doi: 10.1089/tmj.2016.0155
68.
U.S. Department of Health & Human Services. Health Insurance Portability and Accountability Act of 1996 (HIPAA) [Internet]. Washington (DC): HHS; 2021. [cited 2025 Jul 31] Available from: https://www.hhs.gov/hipaa/index.html
69.
European Parliament and Council. Regulation (EU) 2016/679 on the protection of natural persons with regard to the processing of personal data (General Data Protection Regulation). Off J Eur Union, 2016; L119:1–88.
70.
KimaniK, OduolV, LangatK. Cyber security challenges for IoT-based smart grid networks. Int J Crit Infrastruct Prot, 2019; 25:36–49; doi: 10.1016/j.ijcip.2019.01.001
71.
HathaliyaJJ, TanwarS. An exhaustive survey on security and privacy issues in Healthcare 4.0. Comput Commun, 2020; 153:311–335; doi: 10.1016/j.comcom.2020.02.018
72.
MeszarosJ, JirotkaM. Issues of trust and trustworthiness in telemedicine, e-health and m-health. Comput Law Secur Rev, 2020; 38:105427; doi: 10.1016/j.clsr.2020.105427
73.
MatraciaM, KishkMA, AlouiniMS. Exploiting wind turbine-mounted base stations to enhance rural connectivity. IEEE Commun Mag, 2021; 59(12):50–56; doi: 10.1109/MCOM.001.2100468
74.
Broadband Commission for Sustainable Development. The state of broadband 2024: Leveraging AI for universal connectivity [Internet]. Geneva: Broadband Commission; 2024. [cited 2025] Available from: http://handle.itu.int/11.1002/pub/82319ceb-en
75.
International Telecommunication Union. Shared uses of telecommunication infrastructure as possible methods for enhancing the efficiency of telecommunications (Recommendation ITU-T D.264) [Internet]. Geneva: ITU; 2020. [cited 2025 Jul 31] Available from: https://www.itu.int/rec/T-REC-D.264-202004-I
Telehealth interventions and outcomes across rural communities in the United States: Narrative review. J Med Internet Res, 2021; 23(8):e29575; doi: 10.2196/29575
