eHealth innovations in LMICs of Africa and Asia: a literature review exploring factors affecting implementation, scale-up, and sustainability

Abstract

Background: In many low-and middle-income countries (LMICs), health system challenges relating to weak governance, health workforce shortages, and geographic and economic barriers to care impede effective delivery of health services to those in need. The rapid development of information and communication technologies over the last few decades offers the potential for addressing some of these challenges with innovative solutions, especially if offered at scale. This review reflects on the features of larger and more established eHealth interventions that may contribute to their utilization, scale-up and sustainability and, ultimately, to improved health outcomes. Methods: Eight researchers conducted a literature review of eHealth innovations in LMICs of Asia and Africa. Peer-reviewed literature published between March 2010 and March 2015 was considered for inclusion in the review. Major online databases searched included Medline (via PubMed) and Web of Science. Some minor databases were also accessed. Articles addressing eHealth innovations were selected based on the following criteria: interventions located in LMICs of Asia and Africa; interventions of more than 1 year in duration; and interventions that cover at least one district or province of a country. Selected articles were analyzed and compared using a framework approach. Results: Based on specified inclusion and exclusion criteria, 14 peer-reviewed articles (eight intervention studies, six reviews) were identified that reported on eHealth innovations. Six key dimensions were identified as influential for the successful implementation, utilization and scale-up of an eHealth innovation. eHealth projects need to: be designed in response to identified health needs and priorities; be supported by an enabling environment; ensure IT systems integration; establish effective partnership between stakeholders; ensure implementation requirements are met; and preempt and address issues related to end users' abilities to access, trust, accept, and utilize an eHealth product. Conclusion: Consideration of the features identified in this review may be useful to health policy makers, program implementers, and innovators involved in the planning, design, and implementation of effective eHealth innovations intended to address large-scale population health needs in resource-constrained settings.

A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men

“…In addition to theory and content, length of intervention, mode of presentation and other technical issues could make the eHealth intervention easy to use and thereby increase its effect [122][123][124]. For example, several studies suggested that the intervention should be integrated with existing infrastructures, developed in platforms that enable participants to access the intervention via various devices, and tested carefully before launching the intervention to ensure usability [62,73].…”

An Exploratory Study on the Evaluation of eHealth Interventions in Uganda: Practices, Challenges and Insights

“…Evaluation of eHealth implementations is a challenging undertaking [9,38,39]. There are a few published evaluations on eHealth implementations [6,30,[40][41][42][43] especially in the developing countries [39]. The difficulty is because such evaluation does not focus on technology only but often needs to consider how the technology components interact with other processes in the eHealth implementation [44], which in turn broadens the scope of the evaluation [45,46].…”

“…Healthcare administrators and policymakers are expected to select interventions that increase the quality and efficiency of services, care, and support high performance of health systems [1][2][3]. The application of information and communication technology (ICT) is becoming more popular in healthcare management and has proved to improve the effectiveness, access, quality and efficiency of the healthcare systems [4][5][6][7]. The WHO [8] notes that the application of eHealth is necessary if universal health coverage is to be realised.…”

Change, Connectivity, and Challenge: Exploring the Role of Health Technology in Shaping Health Care for Aging Populations in Asia Pacific

“…12 However, use of social media also places new demands on clinicians and health practitioners, in particular around ensuring that the information provided is of sufficient quality and that the privacy of patients is protected, 24 which have been shown to be major concerns among older users. 4,[25][26][27][28][29] Case Study 1: A voice-based service to provide individualized, real-time feedback to help control type 2 diabetes Kim et al 21 investigated the use of a "ubiquitous health care service" (known as u-health care), to support elderly patients with diabetes in Seoul, South Korea, to manage glucose control without causing hypoglycemia. Because ease of use was found to be a significant limitation in a previous study by the same authors, 31 patients in this study used a voice-based reporting system that allowed them to send health data, including information on blood glucose levels, diet, exercise habits, and medication adherence through to a u-health care center using their existing home or cellular telephone.…”

“…To date, few published studies on health technologies have included robust evaluations of their effectiveness. 15,22,29,33,53 This is a particular issue for interventions that are relatively novel, such as robotics and 3D printing. However, there remain significant uncertainties as to the effectiveness of even established technologies.…”