ICTworks

eHealth and digital health are rapidly growing areas in healthcare. Digital health uses information and communication technologies to improve health, expanding the concept of eHealth to include digital consumers, with a wider range of smart devices and connected equipment, and encompasses other uses of digital technologies for health such as the internet of things, artificial intelligence, big data, and robotics.

eHealth and digital health solutions are a potent and complementary intervention in health system strengthening to accelerate universal access to health services. Implementing scalable, sustainable, and integrated digital solutions in a coordinated manner is necessary to experience the benefits of digital interventions in health systems.

In the scoping review, “The use of Digital Health Interventions for Health Systems Strengthening in sub-Saharan Africa over the last 10 years” we sought to establish the breadth and scope of available digital health interventions and their functions in sub-Saharan Africa.

Too Many eHealth Interventions across Africa

Sub-Saharan Africa is endowed with digital health solutions in both numbers and distinct functions. From our findings, we see documented 738 distinct digital health interventions at different levels of functioning in the SSA region over the past 10 years.

These tend to be concentrated in a few countries (eg, Kenya, Uganda, Ethiopia, Malawi) with an unprecedented level of duplication within and between countries:

• One in five do not have a link to any health service outcomes.
• Only half of the digital health interventions can be classified as “established”.
• Two of every three are only focused on solutions in one building block, limiting integration.
• Most (92%) require health worker engagement for them to work.
• The largest proportion (84%) are focused on mining data, as opposed to improving provision of services.
• A bias toward service delivery (81.7%) compared to the other five health systems strengthening building blocks
• A preference for targeting health care providers (91.8%) to the detriment of the other three target users
• A big challenge in scale-up of the interventions with only 53% reported as established.
• 84% of eHealth is focused on “data mining” of some sort, instead of improving service provision.
• 78.8% of the digital health solutions are aligned to 20% of designated system categories.

The gaps in the use of digital health to strengthen health systems are obvious. The review has highlighted the need to re-strategize ideation, development, and the scale-up of digital health in the region.

Where are eHealth System Strengthening Approaches?

The World Health Organization adopted the health system strengthening approach to improve health and equity for all. The framework prides itself as a comprehensive holistic approach to improving health outcomes. This framework is anticipated to give guidance in the alignment of interventions if the health system is to operate optimally.

The fragmentation and partiality observed in the digital health landscape in sub-Saharan Africa call attention to the need to re-align digital health investments to reflect the all-inclusive ethos of health system strengthening.

The large-scale uncoordinated implementation of digital health tools in sub-Saharan Africa is one of the barriers to achieving the full benefits of digital health in the region. Pilots and trials are typically carried out in controlled environments. Proof of concept is not enough to propel digital tools into adoption for large-scale use.

Transitioning such evidence-based interventions to large-scale complex health systems presents a new set of challenges including but not limited to government policies and the end of funding cycles from donors.  Successful implementation of digital health interventions requires a balance of a good digital tool, a receptive user, and an ideal context at the policy and implementation level.

A Situation of eHealth in e-Chaos.

Our review suggests the current digital health landscape in SSA leans more towards e-chaos than ehealth. Multiple overlapping solutions with limited focus and scalability, coupled with a demand on health workers define the existing solutions. Instead of helping to expand access to quality services demanded by populations, many of the solutions are data mining operations of limited benefit to users.

It is time for digital health policymakers in sub-Saharan Africa to establish measures and institutions to guide, coordinate and provide oversight for further adoption of digital health in the region. The aim is to stop further duplication, encourage interventions that holistically strengthen the health systems, and direct future investments towards lagging components of the health system.

A lightly edited excerpt from The use of Digital Health Interventions for Health Systems Strengthening in sub-Saharan Africa over the last 10 years by Humphrey C Karamagi, Derrick Muneene,Benson Droti, Violet Jepchumba, Joseph C Okeibunor, Juliet Nabyonga, James Avoka Asamani, Moussa Traore, Hillary Kipruto