eHealth innovations in LMICs of Africa and Asia: a literature review exploring factors affecting implementation, scale-up, and sustainability

Background: In many low- and middle-income countries (LMICs), health system challenges relating to weak governance, health workforce shortages, and geographic and economic barriers to care impede effective delivery of health services to those in need. The rapid development of information and communication technologies over the last few decades offers the potential for addressing some of these challenges with innovative solutions, especially if offered at scale. This review reflects on the features of larger and more established eHealth interventions that may contribute to their utilization, scale-up and sustainability and, ultimately, to improved health outcomes. Methods: Eight researchers conducted a literature review of eHealth innovations in LMICs of Asia and Africa. Peer-reviewed literature published between March 2010 and March 2015 was considered for inclusion in the review. Major online databases searched included Medline (via PubMed) and Web of Science. Some minor databases were also accessed. Articles addressing eHealth innovations were selected based on the following criteria: interventions located in LMICs of Asia and Africa; interventions of more than 1 year in duration; and interventions that cover at least one district or province of a country. Selected articles were analyzed and compared using a framework approach. Results: Based on specified inclusion and exclusion criteria, 14 peer-reviewed articles (eight intervention studies, six reviews) were identified that reported on eHealth innovations. Six key dimensions were identified as influential for the successful implementation, utilization and scale-up of an eHealth innovation. eHealth projects need to: be designed in response to identified health needs and priorities; be supported by an enabling environment; ensure IT systems integration; establish effective partnership between stakeholders; ensure implementation requirements are met; and pre-empt and address issues related to end users' abilities to access, trust, accept, and utilize an eHealth product. Conclusion: Consideration of the features identified in this review may be useful to health policy makers, program implementers, and innovators involved in the planning, design, and implementation of effective eHealth innovations intended to address large-scale population health needs in resource-constrained settings. Keywords: eHealth, mHealth, telemedicine, HMIS, innovation, LMICs, developing countries