Implementing an e-Health Solution in Low- and Middle- Income Countries: Considerations, Recommendations and Concerns

The role of eHealth, defined as the use of information and communication technology to promote, empower and facilitate health and wellbeing of communities, is currently well-established. eHealth has been presented as an enabling solution at many levels including health prevention, access to healthcare, and delivery of health services to name a few. The impact of digital health solutions has been particularly prominent in low- and middle- income countries (LMICs) where health systems are facing several challenges. These challenges include the lack of qualified/trained health workers, shortage of supply, high-cost of services, and infrastructural deficiencies. The aforementioned have collectively aggravated the inequity in access to health services among different members of the community, with the most vulnerable, such as those living in underserved rural areas and refugees, becoming increasingly susceptible and vulnerable.

The wide scope of the multi-branched field of digital health has allowed its employment in different forms of technologies such as: mobile health, artificial intelligence, electronic health records, telehealth and wearables in order to address a wide range of health conditions (e.g. hypertension, diabetes, women’s health, mental health, adolescent health, communicable diseases, etc.) among different populations (e.g. adolescent, elderly, pregnant women, refugees, rural communities, etc.). The flexibility of the field coupled with its rapid growth and popularity has allowed its adaptation to emergent and changing needs of populations and global health events, with the most recent example being the COVID-19 pandemic. Increased interest in the potentials of eHealth approaches has also been highlighted among policymakers and program implementers, as well as in the increased investment of donors in innovative approaches that could reduce or eliminate barriers of access to healthcare, imposed by the nature of the health systems in LMICs.[2] This has been particularly evident during the COVID-19 pandemic whereby millions of US dollars were poured into the development of, and research on digital health interventions that could be used for surveillance, prevention, diagnosis, and treatment in the context of COVID-19.

Despite the promising effectiveness of digital health solutions, failures have also been reported.[3] To maximize the success of such solutions in LMICs, important considerations should be taken into account. At the top of the list comes the need to achieve a deep understanding of the target population and the characteristics bound to it (e.g. who are they; whether or not they own mobile phones; whether or not they have access to internet connection; what their digital health literacy level is; specific gender dynamics, etc.). To ensure that a solution is tailored to the needs of the target population, it is necessary to engage the target population or end users at different levels including: the design and development of the solution, the testing, and the fine-tuning. It is also pivotal to understand their satisfaction and perceived value post-implementation. On the other hand, it is important for the team planning the intervention/solution to assess the facilitators and barriers of implementation. Special considerations should also be made to the enabling environment within the context in hand, defined by the World Health Organization (WHO) as ‘the attitudes, actions, policies and practices that support the effective and efficient functioning of organizations and program whereby for digital health, this includes factors such as the leadership, governance mechanisms, regulatory and policy frameworks, strategy and financial investment, workforce capacity, standards and interoperability, and sociocultural considerations’.[4]

Conclusively, ensuring that a digital health solution is contextualized requires a number of considerations, many of which are specific to LMICs. It remains important that researchers and implementers consistently and systematically report lessons learned from implementation (even if these lessons report undesired/unsuccessful outcomes), in order for experts and researchers in the field to account for reported factors while designing their solutions. In compliment to reporting, policy makers and donors need to make informed decisions on their investment in digital health.

The Global Health Institute at the American University of Beirut addresses ehealth through its E-Sahha Program. More information on this program is available, here: E-Sahha Program

Filters: eHealth, LMICs, Policy

Contributors

[1] Division Manager, Arm for Specialized Service Initiatives & Support (ASSIST); Manager, NGO Initiative; Program Coordinator, E-Sahha Program (ESP), Global Health Institute, American University of Beirut

References

[2] Lewis, T., Synowiec, C., Lagomarsino, G., & Schweitzer, J. (2012). E-health in low-and middle-income countries: findings from the Center for Health Market Innovations. Bulletin of the World Health Organization, 90, 332-340.

[3] Granja, C., Janssen, W., & Johansen, M. A. (2018). Factors determining the success and failure of eHealth interventions: systematic review of the literature. Journal of medical Internet research, 20(5), e10235.

[4] WHO guideline Recommendations on Digital Interventions for Health System Strengthening. Geneva: World Health Organization; 2019. 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541905/