In Tajikistan, dermatologic services are available across the country. Yet, the most experienced dermatologists work at the National Republic Center for Dermatology and Venereology (NRCDV). Patients from across the country bypass local dermatologists and self-refer to NRCDV. Furthermore, no formal mechanisms exist for dermatologists in different cities to consult with experts at NRCDV. The authors designed a teledermatology program linking dermatologists across Tajikistan to NRCDV. They used the World Health Organization health systems framework to plan this program and define objectives. To date, 228 teledermatology consultations have taken place. The authors find that good governance is key to program implementation.