BackgroundOf the three million newborns that die each year, Uganda ranks fifth highest in neonatal mortality rates, with 43,000 neonatal deaths each year. Despite child survival and safe motherhood programmes towards reducing child mortality, insufficient attention has been given to this critical first month of life. There is urgent need to innovatively employ alternative solutions that take into account the intricate complexities of neonatal health and the health systems. In this paper, we set out to empirically contribute to understanding the causes of the stagnating neonatal mortality by applying a systems thinking approach to explore the dynamics arising from the neonatal health complexity and non-linearity and its interplay with health systems factors, using Uganda as a case study.MethodsLiterature reviews and interviews were conducted in two divisions of Kampala district with high neonatal mortality rates with mothers at antenatal clinics and at home, village health workers, community leaders, healthcare decision and policy makers, and frontline health workers from both public and private health facilities. Data analysis and brainstorming sessions were used to develop causal loop diagrams (CLDs) depicting the causes of neonatal mortality, which were validated by local and international stakeholders.ResultsWe developed two CLDs for demand and supply side issues, depicting the range of factors associated with neonatal mortality such as maternal health, level of awareness of maternal and newborn health, and availability and quality of health services, among others. Further, the reinforcing and balancing feedback loops that resulted from this complexity were also examined. The potential high leverage points include special gender considerations to ensure that girls receive essential education, thereby increasing maternal literacy rates, improved socioeconomic status enabling mothers to keep healthy and utilise health services, improved supervision, and internal audits at the health facilities as well as addressing the gaps in resources (human, logistics, and drugs).ConclusionsSynthesis of theoretical concepts through CLDs facilitated our understanding and interpretation of the interactions and feedback loops that contributed to the stagnant neonatal mortality rates in Uganda, which is the first step towards discussing and exploring the potential strategies and their likely impact.

This article critically examines the challenges associated with demand for immunization, including the interplay of political, social, economic and technological forces that influence the level of immunization coverage. The article suggests a framework to capture the complex and dynamic nature of the immunization process and tests its effectiveness using a case study of Ugandan healthcare provision. Field study research methods and qualitative system dynamics, a feedback and control theory based modelling approach, are used to capture the complexity and dynamic nature of the immunization process, to enhance a deeper understanding of the immunization organizational environment. A model showing the dynamic influences associated with demand and provision of immunization services, with the aim of facilitating the decision making process as well as healthcare policy interventions, is presented.

PurposeThe purpose of this paper is to develop a framework for designing sustainable telemedicine information systems in developing countries.Design/methodology/approachBoth quantitative and qualitative research methods were used. Primary data were collected from two hospitals in Uganda using a self‐administered questionnaire and an interview guide. Descriptive statistics were used to analyze survey data, while content analysis method was used to analyze interview responses. The framework was developed based on Hevner et al.'s design science framework.FindingsThe key requirements for designing sustainable telemedicine information systems in developing countries were identified as the need for speed, ease of use and affordability.Research limitations/implicationsThis study was theoretical in nature. Although primary data were used, the researchers were unable to carry out a series of practical tests of this framework with prototype systems on a cross‐section of users.Practical implicationsDesign and sustainability of telemedicine information systems is still a big challenge to most developing countries, despite its wide usage in the developed countries. While various telemedicine frameworks exist, not much has been done to adequately address the issue of design for sustainability. This paper proposes an appropriate framework that will guide telemedicine information systems designers on designing telemedicine systems that are sustainable in local conditions of developing countries.Originality/valueThe main contribution of this paper is in the area of information systems design for sustainability, from a developing country perspective. The paper also extends on the constructs of design science research theory and shows how they can be applied in information systems design and evaluation.

Food security concepts are extensively used in households as a measure of welfare, to conceptualise operational usefulness in the design, implementation, and evaluation of policies. Most research is focused on improving food security and sustainability and the patterns still remain tenuous. This article explores food security indicators for sustainability by using system dynamics to understand the interconnectedness of the food security system. This is done by analysing quantitative and qualitative concepts of food security indicators. The simulation result shows dynamics of cropland decreasing with increasing population as they need food, energy and space to survive.

Food security (FS) challenges exist in both the developed and the developing countries, the difference being the severity and the proportion of the population affected. Previous studies maintain that chronic food insecurity at subsistence farming level has persisted due to a number of factors including unsustainable subsistence agriculture and livelihood policies, lack of inputs, poor conservation methods, weak extension services, unregulated markets, limited land among others. This article investigates FS challenges at subsistence farming level using system dynamics tools. The emerging system dynamics model is conceptualised into four sectors; food production, sales, income and food consumption, representing a real-life food security system. The model is used to evaluate policies for better livelihoods as well as explore strategies for profitable subsistence farming and food security.