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Cited by 200Mobile Health and mHealth ApplicationsICT in Developing CommunitiesTelemedicine and Telehealth Implementation

The DOI matches its Crossref record; 26 of the 30 references it cites were found in a registry or an index.

Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

Open access
Leon, Natalie, Schneider, Helen, Daviaud, Emmanuelle·2012·BMC Medical Informatics and Decision Making
DOI 10.1186/1472-6947-12-123PMC PMC3534437
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Abstract

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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Figure 1 Health systems framework for decision-making about mHealth for community-based health services. The framework adapts and draws on three existing approaches to reviewing various eHealth applications. Figure 1 illustrates the four health systems dimensions that should be considered when applying a health systems perspective to appraise the challenges of scaling up mHealth; stewardship and organisational, technological and financial systems. Each dimension has two or more elements that are important to consider when making decisions about acquiring and or scaling up mHealth.
Figure 1 Health systems framework for decision-making about mHealth for community-based health services. The framework adapts and draws on three existing approaches to reviewing various eHealth applications. Figure 1 illustrates the four health systems dimensions that should be considered when applying a health systems perspective to appraise the challenges of scaling up mHealth; stewardship and organisational, technological and financial systems. Each dimension has two or more elements that are important to consider when making decisions about acquiring and or scaling up mHealth.CC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 19

  1. World Health Organization: Legal frameworks for eHealth. 2012, WHO, Geneva
  2. World Health Organization: mHealth: new horizons for health through mobile technologies: second global survey on eHealth. 2011, WHO, Geneva
  3. The Rockefeller Foundation: From Silos to Systems: An Overview of eHealth’s Transformative Power. 2010, Rockefeller Foundation, New York
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  7. de Tolly K, Nembaware V, Skinner D: Encouraging HIV testing through SMS: Can it work, and do content and dosage impact?. 2011, South African AIDS Conference, Durban, South Africa
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  9. Vital Wave Consulting: Health Information Systems in Developing Countries: A Landscape Analysis. 2009, Vital Wave Consulting, Palo Alto, California
  10. Grameen Foundation: Mobile technology for community health in Ghana: What it is and what Grameen Foundation has learned so far. 2011, Columbia University, New York
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  12. Ogunmefun C, Mothibe N, Friedman I: Electronic Community Care Giver (CCG) Study: A summative evaluation of the implementation of an Electronic Monitoring and Evaluation Solution for CCG programmes. 2010, Health Systems Trust, Durban
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  14. deTolly K, Technau K, Benjamin P: Helping HIV+ mothers protect their babies: Improving follow-up and HIV testing rates of exposed infants through SMS. 2011, South African AIDS Conference, Durban
  15. eHealth Strategies: European countries on their journey towards national eHealth infrastructures: eHealth Strategies Report. 2011, European Commission, Belgium
  16. Statistics South Africa: National Department of Health: Assessment of the health information system in South Africa, 2009: Technical report. 2009, Statistics South Africa, Pretoria
  17. National Department of Health: District health information system (DHIS) rapid needs assessment. 2012, Government of South Africa, Pretoria
  18. Lehmann U, Sanders D: Community health workers: What do we know about them?. 2007, WHO: Evidence and Information for Policy, Department of Human Resources for Health, Geneva
  19. Odendaal A, Mtshizana Y, Lewin S, Hausler H: A formative evaluation of integrated community-based treatment and adherence support models for TB and HIV clients. 2011, Medical Research Council of South Africa and TB Care Association, Cape Town

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Metadata

Authors
Leon, N., Schneider, H., & Daviaud, E.
Affiliations
  • South African Medical Research Council (ZA)
  • University of the Western Cape (ZA)
Corresponding author
Leon, Natalie
ORCID
Venue
BMC Medical Informatics and Decision Making
Publisher
Springer Science and Business Media LLC
Published
2012-11-05
Volume
12
Issue
1
Pages
123-123
ISSN
1472-6947 (ISSN-L)
DOI
10.1186/1472-6947-12-123
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
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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