Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa
Open accessAbstract
BACKGROUND: Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. METHODS: A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. RESULTS: Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. CONCLUSION: Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings.
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Our findings suggest that the successful integration of mobile applications into service delivery may necessitate targeted changes in human resources available at certain health facilities.
“First, our findings suggest that the successful integration of mobile applications into service delivery may necessitate targeted changes in human resources available at certain health facilities [62].”
From Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana (2016) · cites this paper as [62]
The Results and discussion section identifies a lack of dedicated monitoring and evaluation staff and says that weak supervision at primary-care facilities needs intervention. The Conclusion also identifies organisational capacity as a barrier to scaling up mHealth. These passages support a possible need for workforce-related changes, but do not specifically establish targeted changes to staffing at particular facilities. (LLM, conf=0.82)
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- Authors
- Leon, N., Schneider, H., & Daviaud, E.
- Affiliations
- South African Medical Research Council (ZA)
- University of the Western Cape (ZA)
- Corresponding author
- Leon, Natalie
- Venue
- BMC Medical Informatics and Decision Making
- Published
- 2012-11-05
- Volume
- 12
- Issue
- 1
- Pages
- 123-123
- ISSN
- 1472-6947 (ISSN-L)
- PMC
- PMC3534437
- OpenAlex
- W2148500499
- Cited by
- 200
- References
- 30
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 7 · 2023: 5 · 2022: 13 · 2021: 22 · 2020: 24 · 2019: 16 · 2018: 25 · 2017: 26 · 2016: 20 · 2015: 15 · 2014: 12 · 2013: 1
- FWCI
- 15.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UWC Research Repository (University of the Western Cape) (submittedVersion, cc-by)
- University of the Western Cape Electronic Theses and Dissertations Repository (University of the Western Cape) (submittedVersion, other-oa)
- Funders
- Atlantic Philanthropies
- University of Cape Town
- Centers for Disease Control and Prevention
- Medical Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- mobile health, scale-up, community-based care, information and communication technologies, interoperability, health information privacy, sustainable finance, eHealth policy, primary care, implementation capacity, South Africa
- MeSH terms
- Community Health Services, Decision Making, Organizational, Diffusion of Innovation, Humans, Medical Informatics, South Africa, Organizational Culture, Qualitative Research, Cell Phone
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