Table 4. Meso- and macro-level factors identified by participants.

Level	Factors identified by key informant
Meso
Technical	Lack of telemedicine equipment Lack of equipment maintenance Lack or poor quality of internet connection Lack or poor quality of electricity supply Lack of training
Organizational	Lack of information on telemedicine Undersupply of human resources
Ethical	Lack of an ethical framework for telemedicine
Macro
Legal	Lack of a legal framework for telemedicine
Political	Dysfunction of the Telemedicine National Steering Committee Non-translation of political will into concrete actions Lack of consideration of telemedicine as a political priority Lack of a national telemedicine strategy
Financial	High investment, operating, training and maintenance costs Scarcity of funding sources No physician compensation for telemedicine use
Socioeconomic and Cultural	Religious and socio-cultural beliefs about telemedicine Healthcare worker strikes Social conflicts (Casamance) Patient poverty