ABSTRACT
Background: Digital health solutions are a potent and complementary intervention in health system strengthening to accelerate universal access to health services. Implementing scalable, sustainable, and integrated digital solutions in a coordinated manner is necessary to experience the benefits of digital interventions in health systems. We sought to establish the breadth and scope of available digital health interventions (DHIs) and their functions in sub-Saharan Africa. Methods: We conducted a scoping review according to the Joanne Briggs Institute's reviewers manual and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation. We retrieved data from the WHO Digital Health Atlas (DHA), the WHO e-Health country profiles report of 2015, and electronic databases. The protocol has been deposited in an open-source platform - the Open Science Framework at https://osf.io/5kzq7. Results: The researchers retrieved 983 digital tools used to strengthen health systems in sub-Saharan Africa over the past 10 years. We included 738 DHIs in the analysis while 245 were excluded for not meeting the inclusion criteria. We observed a disproportionate distribution of DHIs towards service delivery (81.7%, n = 603), health care providers (91.8%, n = 678), and access and use of information (84.1%, n = 621). Fifty-three percent (53.4%, n = 394) of the solutions are established and 47.5% (n = 582) were aligned to 20% (n = 5) of the system categories. Conclusions: 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. Digital health policymakers in sub-Saharan Africa need to urgently institute coordination mechanisms to terminate unending duplication and disjointed vertical implementations and manage solutions for scale. Central to this would be to build digital health leadership in countries within SSA, adopt standards and interoperability frameworks; advocate for more investments into lagging components, and promote multi-purpose solutions to halt the seeming "e-chaos" and progress to sustainable e-health solutions.
Subject(s)
Medical Assistance , Telemedicine , Humans , Africa South of the Sahara , Government Programs , Health PersonnelABSTRACT
Background: Digital Health Interventions (DHIs) refers to the utilization of digital and mobile technology to support the health system in service delivery. Over the recent years, advanced computing, genomics, and artificial intelligence are considered part of digital health. In the context of the World Health Organization (WHO) global strategy 2020-2025, digital health is defined as "the field of knowledge and practice associated with the development and use of digital technologies to improve health." The scoping review protocol details the procedure for developing a comprehensive list of DHIs in Sub-Saharan Africa and documenting their roles in strengthening health systems. Method and Analysis: A scoping review will be done according to the Joanne Briggs institute reviewers manual and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation. The protocol has been registered at the Open Science Framework (OSF) database at https://osf.io/5kzq7. The review will include DHIs conceptualized/developed/designed, adapted, piloted, deployed, scaled up, and addressing health challenges in Sub-Saharan Africa. We will retrieve data from the global DHI repository-the WHO Digital Health Atlas (DHA)- and supplement it with information from the WHO eHealth Observatory, eHealth Survey (2015), and eHealth country profiles report. Additional searches will be conducted in four (4) electronic databases: PubMed, HINARI-Reasearch4Life, Cochrane Library, and Google Scholar. The review will also include gray literature and reference lists of selected studies. Data will be organized in conceptual categories looking at digital health interventions' distinct function toward achieving health sector objectives. Discussion: Sub-Saharan Africa is an emerging powerhouse in DHI innovations with rapid expansion and evolvement. The enthusiasm for digital health has experienced challenges including an escalation of short-lived digital health interventions, duplication, and minimal documentation of evidence on their impact on the health system. Efficient use of resources is important when striving toward the use digital health interventions in health systems strengthening. This can be achieved through documenting successes and lessons learnt over time. Conclusion: The review will provide the evidence to guide further investments in DHIs, avoid duplication, circumvent barriers, focus on gaps, and scale-up successful interventions.
