ObjectiveHealth-related research in sub-Saharan Africa (SSA) has grown over the years. However, concerns have been raised about the state of research ethics committees (RECs). This scoping review examines the literature on RECs for health-related research in SSA and identifies strategies that have been applied to strengthen the RECs. It focuses on three aspects of RECs: regulatory governance and leadership, administrative and financial capacity and technical capacity of members.DesignA scoping review of published literature, including grey literature, was conducted using the Joanna Briggs Institute approach.Data sourcesBioOne, CINAHL, Embase (via Ovid), Education Abstracts, Global Health, Google Scholar, Jstor, OpenEdition (French), Philosopher’s Index, PsycINFO, PubMed, Science Citation and Expanded Index (Web of Science), reference lists of included studies and specific grey literature sources.Eligibility criteriaWe included empirical studies on RECs for health-related research in SSA, covering topics on REC leadership and governance, administrative and financial capacity and the technical capacity of REC members. We included studies published between 01 January 2000 and 18 February 2022 and written in English, French, Portuguese or Swahili.Data extraction and synthesisTwo independent reviewers screened the records. Data were extracted by one reviewer and cross-checked by another. Owing to the heterogeneity of included studies, thematic analysis was used.ResultsWe included 54 studies. The findings show that most RECs in SSA work under significant administrative and financial constraints, with few opportunities for capacity building for committee members. This has an impact on the quality of reviews and the overall performance of RECs. Although most countries have national governance systems for RECs, they lack regulations on accountability, transparency and monitoring of RECs.ConclusionsThis review provides a comprehensive overview of the literature on RECs for health-related research in SSA and contributes to our understanding of how RECs can be strengthened.
Background Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility–based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions. Objective The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Methods Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period. Results Among the 72 surveyed health facilities, 59 (82%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60%) use solar energy as their only electricity source and the other 6 (40%) have no electricity source. Similarly, among the 13 hospitals, 5 (38%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3%) PHUs have one computer each, and 37 (63%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95% confidence level within an 11% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22%) of the 72 respondents stated that device theft is a primary hindrance to digitization. Conclusions Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone.
Background The government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone’s government launched its first digital health strategy in 2018. In 2019, a broader national innovation and digital strategy was launched. The health pillar direction will use big data and artificial intelligence (AI) to improve health care in general and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies. Objective This paper presents the state of digital health solutions in Sierra Leone and how these solutions currently interoperate. This study further presents opportunities for big data and AI applications. Methods All the district health management teams, all digital health implementing organizations, and a stratified sample of 72 (out of 1284) health facilities were purposefully selected from all health districts and surveyed. Results The National Health Management Information System’s (NHMIS’s) aggregate reporting solution populated by health facility forms HF1 to HF9 was, by far, the most used tool. A health facility–based weekly aggregate electronic integrated disease surveillance and response solution was also widely used. Half of the health facilities had more than 2 digital health solutions in use. The different digital health software solutions do not share data among one another, though aggregate reporting data were sent as necessary. None of the respondents use any of the health care registries for patient, provider, health facility, or terminology identification. Conclusions Many digital health solutions are currently used at health facilities in Sierra Leone. The government can leverage current investment in HIS from surveillance and reporting for using big data and AI for care. The vision of using big data for health care is achievable if stakeholders prioritize individualized and longitudinal patient data exchange using agreed use cases from national strategies. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities and opportunities for leveraging big data to fill critical gaps necessary to achieve the national digital health vision.
BACKGROUND Government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone government launched her first digital health strategy in 2018. In 2019, a broader National Innovation and digital strategy was launched. The health-pillar direction will use Big data and Artificial Intelligence (AI) to improve healthcare in general, and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies. OBJECTIVE This paper presents the state of digital health solutions in Sierra Leone, and how these solutions currently interoperate. This study further presents opportunities for big data and AI application. METHODS All the district health management teams, Digital health implementing organizations, and sample Seventy-two health facilities representatives were surveyed. RESULTS Health facility survey shows that 94% of health facilities had at least one digital health project being implemented. The National Health Management Information (NHMIS) aggregate reporting solution was by far the most used. Half of health facilities had more than two digital health solutions in use. Data was not being exchanged among the surveyed digital health systems. CONCLUSIONS The different digital health software solutions do not share data amongst one another, though reporting data is sent as necessary. The vision of using big data for healthcare is achievable if stakeholders prioritize these healthcare exchange using agreed use cases from the national strategies. Many digital health solutions are currently used at health facilities in Sierra Leone. Government can leverage current investment in HIS from surveillance and reporting for using big data and artificial intelligence for care. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities, and opportunities for leveraging big data to fill critical gap necessary to achieve the national digital health vision.
BACKGROUND Years of health information (HIS) investment in many countries has facilitated service delivery surveillance, reporting, and monitoring. Electricity, computing hardware, and internet network are vital for health facility-based information systems. Availability of these infrastructures at health facilities are crucial for achieving the national digital health vision. OBJECTIVE The objective of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. METHODS We sampled Seventy-two health facilities distributed in all the districts in Sierra Leone, factoring in rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over two weeks period. RESULTS We found that 82% of surveyed health facilities do not have institutionally provided internet. The maternal and child health posts (MCHP) one type of primary healthcare unit (PHU) reported 60% have solar as their only electricity source, and the other 40% had no electricity source. Similarly, 38% of hospitals use generator as a primary electricity source, while 46% use national utility. All hospitals have at least one functional computer, though only seven of the 13 hospitals have four or more functional computers. Similarly, only two of the 59 PHUs had one computer each, and 37 of the PHUs have one tablet device. This healthcare infrastructure mapping provides the current state of internet connectivity, electricity, and computing hardware at health facilities in Sierra Leone. We can say with a 95% confidence level that alternative and non-traditional internet, electricity, and computing hardware are emerging as preferred options for health facility digital health coverage. CONCLUSIONS Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. Fourty-three percent of surveyed health facilities believe inadequate electricity is the biggest threat to digitization. The current trend where all health facility internets are provided by GSM service providers can be changed to other promising alternatives. This study has shown evidence of the critical gap necessary to achieve this result.
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