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.

ObjectivesThis paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access.MethodsThis exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients.ResultsProfit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised such as aspirations to serve the disadvantaged, personal ambition, desire for greater social status, obligations to continue family business and adverse family events.The discussion of private sector motivations and strategies is framed using the Business Policy Model. This model is comprised of three components:products and services, and efforts to make these attractive including patient-friendly discounts and service-packages, and building ‘good’ doctor-patient relationships;the market environment, cultivated using medical brokers and referral fees to bring in fresh clientele, and receipt of pharmaceutical incentives; and finally,organisational capabilities, in this case overcoming human resource shortages by relying on medical staff from the public sector, consultant specialists, on-call and less experienced doctors in training, unqualified nursing staff and referring complicated cases to public facilities.ConclusionsIn the context of low public sector capacity and growing healthcare demands in urban Bangladesh, private for-profit engagement is critical to achieving universal health coverage (UHC). Given the informality of the sector, the nascent state of healthcare financing, and a weak regulatory framework, the process of engagement must be gradual. Further research is needed to explore how engagement in UHC can be enabled while maintaining profitability. Incentives that support private sector efforts to improve quality, affordability and accountability are a first step in building this relationship.