Global Health researchers examine the opportunities and challenges of eHealth in low resource countries
By: Danielle Denwood and Andreea Predoiu. Photo credit: D-Tree International
eHealth is the cost-effective and secure use of information communication technology in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research [1]
Digital health solutions such as eHealth can accelerate how people worldwide achieve higher standards of health, and access services that promote and protect their health and well-being. Working towards achieving the 2030 UN Agenda for Sustainable Development, eHealth can accelerate progress across the health-related Sustainable Development Goals such as SDG 3 (Good Health and Wellbeing).
It has been well documented that eHealth has the potential to improve quality of healthcare services, and to scale up delivery particularly in low resource countries (LRCs). This potential has resulted in it being mainstream for countries to have eHealth policies and LRCs demonstrating a continued interest in eHealth uptake. According to a 2016 WHO Report, there has been significant progress in eHealth planning as over 50% of member states have an eHealth strategy in place [2].
Recently, research conducted by Global Health faculty member Dr. Norm Archer and team set out to determine the factors that influence the successful implementation of eHealth in LRCs. They wanted to understand the barriers from the perspectives of professional eHealth users that have applied experience in four LRCs (India, Egypt, Kenya, and Nigeria) [3].
“Good health care is essential to an economically viable society”, Archer states. He further explains, “we take this for granted in technologically advantaged countries, where healthcare improvements through eHealth support are rapidly becoming the norm everywhere”.
It is significant to recognize that communication technologies like that of eHealth present new opportunities, and an organized and integrated approach is needed. However, sustainable implementation of eHealth strategies does not always follow due to challenges, in particular the limited resources and infrastructure, lack of focus on eHealth agendas, ethical and legal considerations, lack of common system interoperability standards, unreliable power, and shortages of trained workers [4].
Archer identifies that LRCs encounter a number of different obstacles related to the financial, resource and infrastructure hurdles which includes:
- Shortage of infrastructure to support eHealth: reliable electric power, widespread digital communication networks, trained health professionals, trained technologists, and digital health record systems
- Necessary capital and operating funds for:essential systems and costs of educating, training, and paying professional staff
He explains that funding “is in short supply because healthcare and specifically eHealth is in competition with other governmental agencies”.
In discussion with Archer about the planning process for implementing eHealth he explains that we “must also consider that eHealth support alone will not improve healthcare unless provision is made to focus on problems that are degrading the health of citizens”. He emphasizes that “only a good government, with a focus on citizen healthcare, can make overall eHealth adoption in LRCs happen globally”.
He also brings into focus the attention needed as well to sanitation systems, pure water supplies, vaccination and other protection against COVID-19, tuberculosis, malaria, other contagious diseases, better care and proper nutrition for pregnant women and small children, etc. Archer advocates that, “there is no point in acquiring and using eHealth systems if these health problems are allowed to fester; this would be a misallocation of scarce resources, leading to certain failure”.
To learn about the perspectives of eHealth users, the research team focused on two of the five existing eHealth success factors: 1) technology and its support infrastructure, and 2) user acceptance. Opinions of the participants varied, however, the results showed that while implementation effectiveness had a positive impact, a lack of technological infrastructure reduced impact. The research also highlighted the need for an uptake of telemedicine in rural and remote areas, including that privately funded organizations such as hospitals were farther ahead in utilization of eHealth than those publicly funded.
As a significant step in understanding the use of local eHealth experience by examining the opinions of eHealth users, the findings of the study can contribute to the design of eHealth systems and strategies. The approach and model used in this study can be easily modified to investigate the adoption of eHealth in other developing countries and to support implementation in accordance with their health priorities.
References:
[1] Lewis T, Synowiec C, Lagomarsino G, Schweitzer J. E-health in low- and middle-income countries: findings from the center for health market innovations. Bull World Health Org. 2012 May 1;90(5):332-340.
[2] WHO, Global diffusion of eHealth: Making universal health coverage achievable, in WHO Conference, WHO, Editor. 2016, WHO: Geneva, Switzerland.
[3] Granja, C., W. Janssen, and M.A. Johansen, Factors determining the success and failure of eHealth interventions: Systematic review of the literature. J Med Internet Res, 2018. 20(5): p. e10235.
[4] Norm Archer, Cynthia Lokker, Maryam Ghasemaghaei, Deborah D. DiLiberto, (2021), eHealth Implementation Issues in Low Resource Countries: A Model, Survey and Analysis of User Experience. J Medical Internet Research.
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