BMC Med Inform Decis Mak - Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa.

Tópicos

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Resumo

CKGROUND: 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.

Resumo Limpo

ckground mobil phone technolog demonstr potenti improv health servic deliveri littl guidanc inform decis acquir implement mhealth technolog scale health system use case communitybas health servic cbs south africa appli framework apprais opportun challeng effect implement mhealth scale health systemsmethod qualit studi review benefit challeng mhealth communitybas servic south africa combin key inform interview site visit local project document review use framework adapt three approach review sustain inform communic technolog ict lesson local experi elsewher form basi wider consider scale challeng south africaresult four key system dimens identifi assess govern stewardship organis technolog financi system south africa opportun success implement mhealth includ high preval mobil phone support polici environ ehealth success use mhealth cbs number project welldevelop ict industri howev weak key health system area organis cultur capac use health inform manag poor avail use ict primari health care technolog challeng includ complex ensur interoper integr inform system secur privaci inform final challeng sustain financ requir larg scale use mobil phone technolog resourc limit settingsconclus background health system weak ict environ limit implement capac remain uncertain potenti benefit mhealth cbs retain immedi largescal implement appli health system framework facilit systemat apprais potenti challeng scale mhealth cbs south africa may use polici practic decisionmak low middleincom set

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