Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

Abstract

BackgroundAccess to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa.MethodsA systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards.ResultsForty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources.ConclusionsmHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system.

Policymakers and mHealth: roles and expectations, with observations from Ethiopia, Ghana and Sweden

“…Many times technology solutions designed for rural need also to fit urban areas. But it may be difficult to adapt urban solutions to fit rural needs [5,11]. …”

“…One bottleneck, even with today’s technical infrastructure, is the lack of knowledge among doctors and nurses of how to maximize the potential of existing systems, not to mention understanding and learning new mobile applications [5,14]. …”

“…These must be adopted by the parties concerned and outline the main mission and policies, including concrete steps and follow-up plans. The private sector should be involved from the start, represented by both large and small companies and also start-ups [5,10]. …”

“…Within the national authorities, it is particularly important for mHealth development to occur within a consensus between the Ministry of Health and Ministry of IT and Telecoms [5]. This must include common policies, effective utilization of common resources, partnerships with the private sector and upgrading mHealth competence within the health service [14].…”

“…As new studies add further experiences on the value of mobile information and communication solutions globally, awareness is increasing of its potentials among practitioners, researchers and decision makers. In many LMIC, confidence is growing that mHealth solutions could alleviate the problems of health systems caused by under-funding, lack of qualified staff and inefficient procedures [5]. …”