For a developing country such as Ethiopia with a difficult mountainous terrain andrnlimited transportation infrastructure coupled with one of the lowest patient-doctorrnratios anywhere in the world (almost 30,000 to 1), telemedicine offers a costeffectivernhealth-care system. This awareness is slowly gaining traction in therncountry with a pilot program entering a trial stage. Looking forward, however, wernargue that telemedicine should play a more prominent role in the national healthcarernplan mainly due to its cost-effectiveness and the availability of a substantialrnnumber of Ethiopian physicians living abroad - in some accounts more Ethiopianrnphysicians live outside Ethiopia than inside - whose expertise can be tapped.rnTo study the past and current effort on the application of telemedicine in Ethiopia,rna survey of government, public and private hospitals was conducted. The surveyrnincluded stakeholders of the health care system of the country through interviewsrnand questionnaires. The result of the survey indicated that there have been fewrnattempts to introduce telemedicine in Ethiopia. These efforts were found to berneffective in creating awareness about the benefits of telemedicine; but with arnlimited scope. The study also investigates interests of the growing number ofrnprivate hospitals that may have sufficient funds to implement telemedicinernsystems and identifies the specific area of telemedicine the private hospitals wouldrnbe interested.rnFurther, we propose a comprehensive design of network architecture for a nationwiderntelemedicine network that connects all regional hospitals and health centersrnwith the urban public and government hospitals. Specifically, we propose a highrnlevel telemedicine network architecture, which can be implemented over thernexisting/emerging ICT infrastructure in Ethiopia to. The network connects allrnregional clinics with public/government urban hospitals for the purpose of datarntransmission in the form of text and images, as well as instantaneous access tornpatient information. We also propose a web based telemedicine system, whichrnprovides basic services for medical tele-consultation. The system can be used byrnhealth care providers to store and retrieve patient information, to write referralsrnand give feedback to referrals, by using a web based Graphical User Interface.rnSince implementation of telemedicine could be challenged by factors such asrnmedical ethics and medico-legal issues as well as user's resistance, we havernpresented these challenges. In the long run, we propose that the success ofrntelemedicine efforts in the country will depend on its financial and operationalrnsustainability. Commercialization, as one possible vehicle of financialrnsustainability is investigated.