Barriers and opportunities to implementation of sustainable e-Health programmes in Uganda: A literature review

Abstract

BackgroundMost developing countries, including Uganda, have embraced the use of e-Health and m-Health applications as a means to improve primary healthcare delivery and public health for their populace. In Uganda, the growth in the information and communications technology industry has benefited the rural communities and also created opportunities for new innovations, and their application into healthcare has reported positive results, especially in the areas of disease control and prevention through disease surveillance. However, most are mere proof-of-concepts, only demonstrated in use within a small context and lack sustainability. This study reviews the literature to understand e-Health’s current implementation status within Uganda and documents the barriers and opportunities to sustainable e-Health intervention programmes in Uganda.MethodsA structured literature review of e-Health in Uganda was undertaken between May and December 2015 and was complemented with hand searching and a document review of grey literature in the form of policy documents and reports obtained online or from the Ministry of Health’s Resource Centre.ResultsThe searches identified a total of 293 resources of which 48 articles met the inclusion criteria of being in English and describing e-Health implementation in Uganda. These were included in the study and were examined in detail.ConclusionUganda has trialled several e-Health and m-Health solutions to address healthcare challenges. Most were donor funded, operated in silos and lacked sustainability. Various barriers have been identified. Evidence has shown that e-Health implementations in Uganda have lacked prior planning stages that the literature notes as essential, for example strategy and need readiness assessment. Future research should address these shortcomings prior to introduction of e-Health innovations.

Women’s Decision-Making Autonomy and ICT Utilization on Access to Antenatal Care Services: Survey Results From Jinja and Kampala Cities, Uganda

“…Our findings are consistent with previous studies [16,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. This study found a strong association between ANC decision-making autonomy and women with higher education (χ 2 = 8.63, ρ = 0.035), married (χ 2 = 4.1, ρ = 0.043) and mature (36-50) (χ 2 = 8.81, ρ = 0.032); educated women were more likely to influence their decisions compared to their less educated counterparts.…”

“…Although the adoption of ICT services in enhancing access and use of ANC services was still very low, which is consistent in other studies [25], a few mothers used voice, SMS and instant messages in their daily ANC routine practices with either midwives or VHT's. The major reasons that inhibited mothers' use of ICT's in their routine ANC practices included the lack of technical skill to use the technologies, the limited knowledge of the capabilities of ICT's and the high data costs, which is consistent with other studies [20,29].…”

Telemedicine Healthcare Service Adoption Barriers in Rural Bangladesh

“…Telemedicine is a technology-based healthcare system that can contribute to better health management by integrating ICT, clinics and the internet to provide teleconsultation between clinicians and patients (Kiberu, Mars, & Scott, 2017). Rural communities in developing countries are deprived of quality health services because of poor ICT infrastructure (Hossain, Yokota, Sultana, & Ahmed, 2018).…”

“…As a developing country, Bangladesh lacks the resources to deploy telemedicine (Khan, Hossain, Hasan, & Clement, 2012). Kiberu et al (2017) found that equipment costs, and insufficient human resources allocations are considered to be potential resources barriers to telemedicine adoption. The literature further reports that change resistance among patients and health staff, human resources, uncertainty of ownership, ICT skills, policymaking, leadership and coordination, monitoring and evaluation, cultural and language barriers (Fanta, Pretorius, & Erasmus, 2015), service delivery issues (Hossain et al, 2018), hardware access (Boonstra & Broekhuis, 2010), financial resources allocation (E. Miller, 2010), resources allocation (Boonstra & Broekhuis, 2010), legal and ethical factors (Anderson, 2007), and appropriate equipment are dominant resource barriers to telemedicine adoption.…”

A systematic review of reviews to identify key research opportunities within the field of eHealth implementation

“…These establishments are also tied to organisational bureaucracy, human resources [6], various unconnected ICT systems/services [11] and organisational workflow support [20]. One key message from the literature suggests that many organisations fail to acknowledge that many barriers to the implementation and utilisation of eHealth lie and emerge from within the organisation itself [40]. For eHealth to advance healthcare services in this area, the literature recommends that eHealth applications could potentially be implemented at a level above existing organisation-centred and process-controlled systems.…”