Health Informatics in Developing Countries: Going beyond Pilot Practices to Sustainable Implementations: A Review of the Current Challenges
Open accessAbstract
OBJECTIVES: Information technology is an essential tool to improve patient safety and the quality of care, and to reduce healthcare costs. There is a scarcity of large sustainable implementations in developing countries. The objective of this paper is to review the challenges faced by developing countries to achieve sustainable implementations in health informatics and possible ways to address them. METHODS: In this non-systematic review of the literature, articles were searched using the keywords medical informatics, developing countries, implementation, and challenges in PubMed, LILACS, CINAHL, Scopus, and EMBASE. The authors, after reading the literature, reached a consensus to classify the challenges into six broad categories. RESULTS: The authors describe the problems faced by developing countries arising from the lack of adequate infrastructure and the ways these can be bypassed; the fundamental need to develop nationwide e-Health agendas to achieve sustainable implementations; ways to overcome public uncertainty with respect to privacy and security; the difficulties shared with developed countries in achieving interoperability; the need for a trained workforce in health informatics and existing initiatives for its development; and strategies to achieve regional integration. CONCLUSIONS: Central to the success of any implementation in health informatics is knowledge of the challenges to be faced. This is even more important in developing countries, where uncertainty and instability are common. The authors hope this article will assist policy makers, healthcare managers, and project leaders to successfully plan their implementations and make them sustainable, avoiding unexpected barriers and making better use of their resources.
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Failure of e-Health projects has been attributed to poor initial planning and research design, insufficient computing skills, lack of change management and lack of technology readiness.
“Failure of e-Health projects has been attributed to poor initial planning and research design, insufficient computing skills, lack of change management and lack of technology readiness.”
From Barriers and opportunities to implementation of sustainable e-Health programmes in Uganda: A literature review (2017) · cites this paper as [83]
The Results sections on resource and infrastructure limitations, health IT agendas, and the trained workforce identify inadequate infrastructure, weak planning frameworks, and shortages of informatics skills as barriers to sustainable e-Health implementation in developing countries (pages not provided). The paper does not specifically attribute project failure to poor research design or lack of change management, and its discussion of technology readiness is chiefly about infrastructure. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAlthough several telehealth projects are medically and technically viable, their permanence constitutes a major challenge, especially in developing countries.
“Although several telehealth projects are in fact medically and technically viable solutions, their permanence constitutes a major challenge (14), especially in developing countries (15).”
From A mixed methods systematic review of success factors of mhealth and telehealth for maternal health in Sub-Saharan Africa (2017) · cites this paper as [15]
The lack of legislation for data confidentiality and ethics are key contributors to patient privacy and security concerns.
“This finding is consistent with other studies which identified the lack of legislation for data confidentiality and ethics as key contributors to patient privacy and security concerns [34, 38–41].”
From Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar (2021) · cites this paper as [39]
User preference for free text data over standardised data coding affected semantic interoperability.
“Studies have shown that user preference for free text data over standardised data coding affected semantic interoperability [38, 39].”
From Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar (2021) · cites this paper as [39]
The lack of agreement on national data and security standards are barriers to interoperability.
“The lack of agreement on national data and security standards are barriers to interoperability [38–40].”
From Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar (2021) · cites this paper as [39]
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- Authors
- Luna, D., Almerares, A., Mayan, J. C., González Bernaldo de Quirós, F., & Otero, C.
- Affiliations
- Hospital Italiano de Buenos Aires (AR)
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Corresponding author
- Luna, Daniel
- Venue
- Healthcare Informatics Research
- Published
- 2014
- Volume
- 20
- Issue
- 1
- Pages
- 3
- ISSN
- 2093-3681 (ISSN-L)
- 2093-369X
- PMC
- PMC3950262
- OpenAlex
- W2142949663
- Cited by
- 176
- References
- 46
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 14 · 2023: 14 · 2022: 12 · 2021: 21 · 2020: 23 · 2019: 16 · 2018: 12 · 2017: 15 · 2016: 14 · 2015: 5 · 2014: 2
- FWCI
- 1.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Healthcare Informatics Research (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- health informatics, sustainable implementation, developing countries, implementation barriers, eHealth policy, health information infrastructure, privacy and security, interoperability, health informatics workforce, patient safety
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