Barriers and opportunities to implementation of sustainable eHealth Programs in Uganda: A Literature Review

1. Barriers and Opportunities to
Implementation of Sustainable
e-Health Programs in Uganda:
A Literature Review.
Vincent M. Kiberu, Maurice Mars, Richard E. Scott
Dept of TeleHealth, University of KwaZulu-Natal

2. Introduction
Developing countries:
- Most embrace e-Health Services (mHealth, telehealth
etc.)
Uganda:
- Telecommunication sector; growth has brought
opportunities for new innovations
- Healthcare sector; new technologies have positively
impacted healthcare delivery

3. Introduction
• Problems:
– Proof-of-concept; only demonstrate use
within a small context; and lack sustainability.
• Goal:
– Scalable and sustainable
• How?
– Understand current implementation status,
barriers, and opportunities

4. Methods - Literature
Structured literature review
- Grey and scientific literature
- Google Scholar, ISTAfrica, Med-e-Tel, PubMed
Google Scholar - 4 key ‘phrases’:
- e-Health in Uganda
- Telehealth in Uganda
- EMRs in Uganda
- mHealth in Uganda

5. Methods - Literature
Inclusion:
- Deliberately broad
- e-Health implementation in Uganda; English

6. Methods - Literature
Document review:
- Policy documents and reports
- Uganda’s Ministry of Health.

7. Results
Search identified 293 resources:
– PubMed – 23
– ISTAfrica - 3 conference proceedings
– Med-e-Tel - 0 conference proceedings
– Grey literature - 13 policy documents, reports
and web articles

8. Results
Search identified 293 resources:
– Google Scholar (3,239 hits)
– First 100 resources from each of 4 Google
Scholar searches
– 254 considered.

9. Results
Met inclusion criteria: 48
Themes.
mHealth 23
Electronic records systems 8
Telemedicine 6
ICT 6
Govt policy documents and reports 5

10. Discussion
Most eHealth applications:
– Proof-of-concept
– Piloted as part of Non-Government
Organization (NGO) projects
– Offered healthcare within particular
communities in Uganda

11. 18 Factors
Strategy and
management
Organisation and
management
Legal regulatory
and safety
Technical and
infrastructural

12. MOMENTUM Initiative
- 18 Critical Success Factors -
1. Check that there is cultural readiness
towards telemedicine.
2. Ensure leadership through a
champion.
3. Identify a compelling need.
4. Put together the resources needed
for deployment and sustainability.
5. Address the needs of the primary
client(s).
6. Involve healthcare professionals and
decision-makers.
7. Prepare and implement a business
plan.
8. Prepare and implement a change
management plan.
9. Put the patient at the centre of the
service.
10. Establish that the service is legal.
11. Ask advice from legal, ethical, privacy
and security experts.
12. Apply relevant legal and security
guidelines.
13. Ensure telemedicine doers and users
have “privacy awareness”.
14. Ensure needed IT and eHealth
infrastructures are in place.
15. Ensure technology is user-friendly.
16. Monitor the service.
17. Maintain good practices in vendor
relations.
18. Guarantee technology has the
potential for scale-up (i.e., “think big”)

13. Discussion - Literature
Evidence shows preparatory work is required in
relation to:
– Strategy Physical infrastructure
– ‘Need’ Technology equipment
– Readiness User and managers’ skills
– Governance Policies, regulations, guidelines

14. Discussion – Uganda - Status
• No e-Health standards.
• No national guidelines (secure management of
electronic records and services)
• Lack of e-Health competence / capacity
• Lack of preparatory work
Barriers to adoption of e-Health

15. Conclusions - Uganda
Trialled several e-Health solutions
- Donor funded
- Operated in silos
- Lacked sustainability
Evidence shows:
Lack of prior ‘essential’ planning stages
- Strategy development, needs assessment,
readiness assessment, and governance

16. Conclusions - Future
Before further implementation:
Further research to address these shortcomings
and ensure prior planning stages

17. ACKNOWLEDGEMENT
- UKZN, Nelson Mandela School of Medicine
- Supervisors and Mentors

18. THANK YOU!