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ehealth
Introduction
• The introduction of ehealth is beneficial in making health care
more accessible and increasing patient safety . Many health
informatics solutions are developed in high-income countries then
attempted to be downscaled for Sub-Saharan African (SSA)
countries, however most projects failed or were relegated to
indefinite pilot project status . (Kipruto, et al., 2022).
• To build sustainable health informatics solutions in SSA, an
understanding of baseline conditions in each country is necessary.
• In this case our preferred CDSA would be ehealth.

Definition of ehealth
• eHealth is one of the most rapidly growing digital health in sub-
Saharan Africa. It’s a deliberate innovation to increase accessibility
and equity to health care services and information (Holst, et al.,
2020)
• The World Health Organization (WHO), defines eHealth as the use of
information and communication technologies (ICT) to improve health
care (WHO, 2016)
• digital health is the field of knowledge and practice associated with
the development and use of digital technologies to improve health.
.

Definition cont.
• Digital health expands 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 , digital medical equipment, big data
(EHR), mhealth(mobile health), electronics monitors etc.
• Sub-Saharan Africa is endowed with digital health solutions in both
numbers and distinct functions. It is lacking in coordination,
integration, scalability, sustainability, and equitable distribution of
investments in digital health.

ehealth cont.
• Sub-Saharan Africa has embraced the call to utilize digital health to
strengthen service delivery. Governments, donors, private entities,
and universities responded to the call to innovate scalable and
sustainable digital interventions to strengthen health systems and it
has arguably become a leader in the development of digital health
interventions to support service delivery .
• Digital health interventions are intended to empower greater
efficiency and transparency by interconnecting the different
components of a functional health system .

ehealth cont.
• The sustained push to integrate digital health into service
delivery has yielded an immense number of digital
interventions in the region.
• However, there is a scantiness of systematic evidence on the
number and functions of digital tools in the region.

ehealth cont.
• However there is a fragmented approach for development of
e-health solutions in each countries with limited coordination
between multiple systems which are launched either by
private or government agencies
• There are diverse digital health interventions adoption at
different levels of functioning in the SSA region over the past
10 years. These tend to be concentrated in a few countries
(e.g., Kenya, Uganda, Ethiopia, Malawi).

Challenges faced in adoption of ehealth is Africa
• The eagerness to exploit this potential has resulted in an
unstructured scramble to develop digital health interventions in
sub-Saharan Africa led to unintended and extreme duplication of
digital tools which indicates lack of a coordinated approach and
weak partnerships. multiple similar tools are used within and
between countries
• Most countries adopted use of ehealth and focused on solutions in
one building block, limiting integration.
• Most (92%) require health worker engagement for them to work,
requiring need for more health workers or increase in workload.

Challenges cont.
• There was limited knowledge on application of certain gadget In
ehealth and limited knowledge on usage of the established
systems.
• large-scale uncoordinated implementation of digital health tools is
a barriers to achieving the full benefits of digital health in the
region.
• Most of the recording and reporting is still paper- based at the
facility level and there has been slow migration to digital system
retarding the progression in adoption of electronic health record.

Challenges cont
• Based on our research, the SSA region seems to have the
• capacity to provide appropriately trained IT medical professionals.
they have improved university systems and can produce medical
and computer science graduates. 62.5%
• However only37.5% of the SSA countries have an adequate
educational system in place to provide trained graduates in medical
fields and computer science areas.
• 18 of the countries are falling behind in this aspect. The human
capacity of IT workers in each SSA country reveals an urgent need
for such expertise

Challenges cont.
• There is a large variation of electricity access for healthcare facilities
in SSA countries . most healthcare facilities in SSA rely on the
national power grid for electrical supply which is unreliable and
susceptible to blackouts, causing difficulties in running basic medical
equipment and functionalities .
• Healthcare facilities opted for backup generators , but a constant
fuel supply is needed to keep the generators running this is
hindered because of fuel shortage
• In Uganda, high demand for electricity have hindered the
development of e-Health .

Challenges cont.
• Some of the challenges were with language and poor usability ,
failure to fit e-health solutions into their workflows and a lack of
training .
• There has also been a lack of governmental support in terms of
campaigns to advocate e-health use and enabling policies and laws
that favor the users.
• The primary users of e-health solutions are healthcare workers and
members of the public, use is dependent upon digital literacy and
ultimately literacy of the population. Unfortunately, most countries
in SSA have adult literacy rates as lower than 40%.

solutions
• The aim is to stop further duplication, encourage interventions that
holistically strengthen the health systems.
• direct future investments towards lagging components of the
health system.
• All stakeholders need to re-look the digital health focus and
funding model to minimize the collapse of interventions after the
initial pilot and trial phase
• Solar power is the most popular alternative energy available for
mobile use and larger use . Other alternative sources such as
portable solar chargers, power banks, external batteries, and
commercial charging services can be used.

Solutions cont.
• Training of health professionals.
• Government commitment.
• Sensitization of public in use of ehealth.

References
• Kipruto, H., Muneene, D., Droti, B., Jepchumba, V., Okeibunor, C.J.,
Nabyonga-Orem, J. and Karamagi, H.C., 2022. Use of Digital Health
Interventions in Sub-Saharan Africa for Health Systems
Strengthening Over the Last 10 Years.
• Holst, C., Sukums, F., Radovanovic, D., Ngowi, B., Noll, J. and Winkler,
A.S., 2020. Sub-Saharan Africa—the new breeding ground for global
digital health. The Lancet Digital Health, 2(4), pp.e160-e162.
• Ong, K., 2003. Why Do Projects Fail?. Medical Informatics.
• Kiregu Gicheru, J., 2016. National stakeholder perspectives on the
development of the Regional Centre of Excellence for Biomedical
Engineering and eHealth (CEBE) (Doctoral dissertation, University of
Rwanda).

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