Assessing the feasibility of eHealth and mHealth: A systematic review and analysis of initiatives implemented in Kenya

BMC Research Notes, Volume 10, No. 1, Year 2017

Interprétation

Background: The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. Results: A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. Conclusion: This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening. A search of peer reviewed and non-peer reviewed sources of relevant information was performed. The search for peer reviewed literature was conducted in PubMed, Embase, Web of Science, Econlit, SocIndex, Toc Premier, Cochrane Database of Systematic Reviews, INASP, LISTA, CAB Abstracts, Directory of Open Access Journals, EBSCOhost (incorporating Academic Search Complete) and Google Scholar. This however was not sufficient as there were large number of eHealth projects in Kenya that were not reported in peer reviewed literature. Therefore, to ensure all relevant information was captured, a search was extended to non-peer reviewed sources including web-based portals for eHealth, profit and not-for-profit organizational websites, newspaper articles, and blogs. The search was also extended to eHealth implementers who had not yet published information, government documents and organizations reports such as those of WHO, m-Health alliance and International Development Research Centre (IDRC) among others. The first search strategy was performed on all documents related to eHealth projects under implementation in Kenya in peer reviewed sources. The search terms used with AND/OR included; These search terms and key words were used so as to capture all the relevant projects in Kenya. Since eHealth is the use of use of information and communication technologies (ICT) for health [1], the key words were selected so as to address all strategic areas of implementation. The strategic areas included telemedicine, health information systems (including electronic health records), mHealth (health through the use of mobile devices) and eLearning (including distance education or learning) as defined in the Kenya National eHealth Strategy) [14]. All strategic areas of eHealth implementation were included in order to develop a comprehensive registry of projects considering this was the first situational analysis in Kenya. For the non-peer reviewed online databases, a similar search strategy using the same keywords and concepts as in the peer reviewed strategy was used as shown in Table 1. A search for relevant documents on web-portals was also undertaken including profit and not-for-profit organizations websites and blogs documenting eHealth projects in Kenya consisting of 3–5 steps as illustrated in Table 1. The next step, which can be deemed as subjective, was initiated through our research network in Kenya where personal communication with some eHealth implementers was sought to gather information relating to their innovation. Finally, hand searches of cited references in documents and reports obtained were finally used to augment the search. Opinion pieces, publications and letters to the editor lacking relevant data were excluded. The search strategy consisted of seven steps illustrated in Table 1 and involved eHealth initiatives being implemented in Kenya. Search strategy used (Source: authors’ synthesis) Since, the ICT sector and the adoption of eHealth initiatives in Kenya is fairly nascent [8], the time period was not specified. All publications selected and information included in this study had to have been implemented in Kenya with clear details of the specific eHealth application under implementation. The retrieved records from each search were screened for eligibility. Conflicting opinions were resolved through discussion amongst the authors. The description of data extracted from the eligible publications involved description of eHealth application; strategic area of project implementation (either mHealth, telemedicine, health information systems or eLearning as defined in the Kenya National eHealth Strategy) [14]; and geographic location of the project. Other descriptive criteria included thematic area or domain of the project as informed by previous research undertaken by Kallander et al. [22] and Labrique et al. [23]; project implementation period; specific health focus and evaluation status. The data on the funding source was also extracted where applicable. In instances where necessary data was not clearly stated, communication was initiated with the relevant publication authors to seek clarification and if possible share missing data. However, due to the sensitive nature of this information, most private projects were not prepared to disclose the information deemed as delicate. In light of the vast number of projects identified, efforts were made to classify the specific areas of eHealth project implementation through development of different categories. The categories facilitated assessment of the extent to which eHealth projects focused on specific facets of eHealth at the expense of others. The categorization consisted of four parts. First was the strategic area; second, the thematic area; third, the health area of focus; and finally the geographic location of all the projects being implemented. The strategic areas of project implementation were adopted from the Kenya National eHealth Strategy 2011–2017 [14] namely, telemedicine, health information systems, mHealth and eLearning. Due to overlap with other areas, the strategic area referring to health information for citizens was not analysed separately but included in other project implementation areas. The second categorization centred on thematic areas was adopted from prior research work that highlighted the most common applications in mHealth and eHealth [22, 23]. The twelve most common applications of mHealth as described by Labrique et al. [23] provides a robust framework that was applied in this study to categorize eHealth projects in Kenya. These includes: (1) client education and behaviour change communication; (2) sensors and point-of-care diagnostics; (3) registries and vital event tracking; (4) data collection and reporting; (5) electronic health records; (6) electronic decision support such as information, protocols, algorithms, checklists; (7) provider-to-provider communication such as user groups, consultations; (8) provider work planning and scheduling; (9) provider training and education; (10) human resource management; (11) supply chain management; and (12) financial transactions and incentives (i.e. use of mobile money transfers and banking services to pay for health services and incentivise patients). The health focus category entailed the specific health areas of projects focus including malaria, HIV/AIDS, tuberculosis, primary care, health care financing among others. Whilst the project geographic location category adopted, details the specific setting in which the project was executed. Most eHealth projects were designed to be implemented in specific geographical locations with a few projects implemented nationally. This study produced geo-coded maps and plotted all identified projects based on their strategic area of implementation. The maps were layered based on urbanization illustrating the number of residents living in towns with at least 2000 inhabitants [24] and marginalised counties as identified by the Commission on Revenue Allocation (CRA) [25]. The marginalised counties were identified based on the County Development Index (CDI) developed by the CRA which is a composite index consisting of indicators that measures the state of health (for example, health, education and infrastructure are all weighted at 28%, and the level of poverty in a county indicator at 16%) [25, 26]. Based on these different criteria, the following fourteen counties are classified as marginalised with CDI ranging from 0.27 to 0.52. The counties are Turkana, Mandera, Wajir, Marsabit, Samburu, West Pokot, Tana River, Narok, Kwale, Garissa, Kilifi, Taita Taveta, Isiolo and Lamu.

Résumé de l’IA

Study Justification:

– The study aims to assess the feasibility of eHealth and mHealth initiatives in Kenya.
– It provides a situational analysis of eHealth projects in Kenya, including their areas of focus and geographic distribution.
– The study addresses the need for cost-effective solutions to health and health system challenges in Kenya.

Highlights:

– A total of 69 eHealth projects were identified, including 47 mHealth projects, 9 health information system projects, 8 eLearning projects, and 5 telemedicine projects.
– The projects were mainly focused on primary care, HIV/AIDS, and maternal and child health.
– Only 8 projects were rigorously evaluated under randomized control trials.
– Most projects were implemented in Nairobi, with few projects in marginalized areas.
– The study highlights the need for improved evaluation of eHealth projects and increased implementation in marginalized areas.

Recommendations:

– Conduct rigorous evaluations of eHealth projects to assess their effectiveness.
– Increase implementation of eHealth projects in marginalized areas to improve health equity.
– Focus on expanding eHealth initiatives in areas such as telemedicine and eLearning.
– Strengthen partnerships between government, non-profit organizations, and private sector to support eHealth implementation.

Key Role Players:

– Government agencies responsible for health and ICT policies and regulations.
– Non-profit organizations working in the health sector.
– Private sector companies specializing in ICT and healthcare.
– Health professionals and organizations involved in eHealth implementation.
– Academic institutions conducting research and providing training in eHealth.

Cost Items for Planning Recommendations:

– Funding for project implementation, including equipment, software, and infrastructure.
– Human resources for project management, training, and support.
– Evaluation and research costs to assess the impact and effectiveness of eHealth initiatives.
– Capacity building and training programs for healthcare professionals and ICT specialists.
– Public awareness campaigns to promote the use of eHealth services.
– Monitoring and maintenance costs for ongoing support and updates to eHealth systems.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The systematic review provides a situational analysis of eHealth initiatives in Kenya and includes a comprehensive search strategy involving both peer-reviewed and non-peer-reviewed sources. The review identifies a total of 69 eHealth projects in Kenya, categorized by strategic area of implementation, health purpose and focus, geographic location, evaluation status, and thematic area. However, the abstract does not provide information on the methodology used for the systematic review, such as inclusion and exclusion criteria, data extraction process, or quality assessment of the included studies. Additionally, the abstract does not mention any limitations of the review or potential biases. To improve the strength of the evidence, the authors should provide more details on the methodology used, including the search strategy, study selection process, and quality assessment. They should also acknowledge any limitations or potential biases in the review.

Abstrait

A search of peer reviewed and non-peer reviewed sources of relevant information was performed. The search for peer reviewed literature was conducted in PubMed, Embase, Web of Science, Econlit, SocIndex, Toc Premier, Cochrane Database of Systematic Reviews, INASP, LISTA, CAB Abstracts, Directory of Open Access Journals, EBSCOhost (incorporating Academic Search Complete) and Google Scholar. This however was not sufficient as there were large number of eHealth projects in Kenya that were not reported in peer reviewed literature. Therefore, to ensure all relevant information was captured, a search was extended to non-peer reviewed sources including web-based portals for eHealth, profit and not-for-profit organizational websites, newspaper articles, and blogs. The search was also extended to eHealth implementers who had not yet published information, government documents and organizations reports such as those of WHO, m-Health alliance and International Development Research Centre (IDRC) among others. The first search strategy was performed on all documents related to eHealth projects under implementation in Kenya in peer reviewed sources. The search terms used with AND/OR included; These search terms and key words were used so as to capture all the relevant projects in Kenya. Since eHealth is the use of use of information and communication technologies (ICT) for health [1], the key words were selected so as to address all strategic areas of implementation. The strategic areas included telemedicine, health information systems (including electronic health records), mHealth (health through the use of mobile devices) and eLearning (including distance education or learning) as defined in the Kenya National eHealth Strategy) [14]. All strategic areas of eHealth implementation were included in order to develop a comprehensive registry of projects considering this was the first situational analysis in Kenya. For the non-peer reviewed online databases, a similar search strategy using the same keywords and concepts as in the peer reviewed strategy was used as shown in Table 1. A search for relevant documents on web-portals was also undertaken including profit and not-for-profit organizations websites and blogs documenting eHealth projects in Kenya consisting of 3–5 steps as illustrated in Table 1. The next step, which can be deemed as subjective, was initiated through our research network in Kenya where personal communication with some eHealth implementers was sought to gather information relating to their innovation. Finally, hand searches of cited references in documents and reports obtained were finally used to augment the search. Opinion pieces, publications and letters to the editor lacking relevant data were excluded. The search strategy consisted of seven steps illustrated in Table 1 and involved eHealth initiatives being implemented in Kenya. Search strategy used (Source: authors’ synthesis) Since, the ICT sector and the adoption of eHealth initiatives in Kenya is fairly nascent [8], the time period was not specified. All publications selected and information included in this study had to have been implemented in Kenya with clear details of the specific eHealth application under implementation. The retrieved records from each search were screened for eligibility. Conflicting opinions were resolved through discussion amongst the authors. The description of data extracted from the eligible publications involved description of eHealth application; strategic area of project implementation (either mHealth, telemedicine, health information systems or eLearning as defined in the Kenya National eHealth Strategy) [14]; and geographic location of the project. Other descriptive criteria included thematic area or domain of the project as informed by previous research undertaken by Kallander et al. [22] and Labrique et al. [23]; project implementation period; specific health focus and evaluation status. The data on the funding source was also extracted where applicable. In instances where necessary data was not clearly stated, communication was initiated with the relevant publication authors to seek clarification and if possible share missing data. However, due to the sensitive nature of this information, most private projects were not prepared to disclose the information deemed as delicate. In light of the vast number of projects identified, efforts were made to classify the specific areas of eHealth project implementation through development of different categories. The categories facilitated assessment of the extent to which eHealth projects focused on specific facets of eHealth at the expense of others. The categorization consisted of four parts. First was the strategic area; second, the thematic area; third, the health area of focus; and finally the geographic location of all the projects being implemented. The strategic areas of project implementation were adopted from the Kenya National eHealth Strategy 2011–2017 [14] namely, telemedicine, health information systems, mHealth and eLearning. Due to overlap with other areas, the strategic area referring to health information for citizens was not analysed separately but included in other project implementation areas. The second categorization centred on thematic areas was adopted from prior research work that highlighted the most common applications in mHealth and eHealth [22, 23]. The twelve most common applications of mHealth as described by Labrique et al. [23] provides a robust framework that was applied in this study to categorize eHealth projects in Kenya. These includes: (1) client education and behaviour change communication; (2) sensors and point-of-care diagnostics; (3) registries and vital event tracking; (4) data collection and reporting; (5) electronic health records; (6) electronic decision support such as information, protocols, algorithms, checklists; (7) provider-to-provider communication such as user groups, consultations; (8) provider work planning and scheduling; (9) provider training and education; (10) human resource management; (11) supply chain management; and (12) financial transactions and incentives (i.e. use of mobile money transfers and banking services to pay for health services and incentivise patients). The health focus category entailed the specific health areas of projects focus including malaria, HIV/AIDS, tuberculosis, primary care, health care financing among others. Whilst the project geographic location category adopted, details the specific setting in which the project was executed. Most eHealth projects were designed to be implemented in specific geographical locations with a few projects implemented nationally. This study produced geo-coded maps and plotted all identified projects based on their strategic area of implementation. The maps were layered based on urbanization illustrating the number of residents living in towns with at least 2000 inhabitants [24] and marginalised counties as identified by the Commission on Revenue Allocation (CRA) [25]. The marginalised counties were identified based on the County Development Index (CDI) developed by the CRA which is a composite index consisting of indicators that measures the state of health (for example, health, education and infrastructure are all weighted at 28%, and the level of poverty in a county indicator at 16%) [25, 26]. Based on these different criteria, the following fourteen counties are classified as marginalised with CDI ranging from 0.27 to 0.52. The counties are Turkana, Mandera, Wajir, Marsabit, Samburu, West Pokot, Tana River, Narok, Kwale, Garissa, Kilifi, Taita Taveta, Isiolo and Lamu.

Matériaux

https://efashare.b-cdn.net/materials/0d10a9cb6a99284a7c0fe1f7df9515a307aba35923af051b7448b8825dea1ae9/13104_2017_2416_MOESM1_ESM.docx

Innovations

Based on the information provided, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide pregnant women with access to information and resources related to maternal health, such as prenatal care, nutrition, and postpartum care. These applications can also include features like appointment reminders and medication tracking.

2. Telemedicine: Establish telemedicine programs that allow pregnant women in remote or underserved areas to consult with healthcare providers through video conferencing or phone calls. This can help overcome geographical barriers and provide access to specialized care.

3. Electronic Health Records (EHRs): Implement electronic health record systems that enable healthcare providers to easily access and share maternal health information across different healthcare facilities. This can improve coordination of care and reduce duplication of tests or procedures.

4. Remote Monitoring Devices: Develop and deploy remote monitoring devices that allow healthcare providers to remotely monitor the health of pregnant women, such as blood pressure, heart rate, and fetal movements. This can help detect potential complications early and enable timely interventions.

5. Health Information Systems: Improve existing health information systems to capture and analyze data related to maternal health, including maternal mortality rates, access to prenatal care, and utilization of maternal health services. This data can inform targeted interventions and resource allocation.

6. Capacity Building and Training: Invest in training programs for healthcare providers, particularly in marginalized areas, to enhance their knowledge and skills in providing quality maternal healthcare. This can help address the shortage of skilled healthcare professionals in these areas.

7. Public-Private Partnerships: Foster collaborations between the public and private sectors to leverage resources and expertise in improving access to maternal health. This can involve partnerships with technology companies, telecommunications providers, and non-profit organizations.

8. Community Engagement and Education: Implement community-based programs that raise awareness about the importance of maternal health and empower women to seek timely and appropriate care. This can involve community health workers, peer support groups, and educational campaigns.

9. Financial Incentives: Explore innovative financing models, such as conditional cash transfers or mobile money incentives, to encourage pregnant women to seek and adhere to maternal health services. This can help overcome financial barriers and improve access to care.

10. Policy and Advocacy: Advocate for policies and regulations that prioritize and support maternal health, including increased funding for maternal health programs, improved infrastructure, and equitable distribution of healthcare resources. This can create an enabling environment for innovation and sustainable improvements in maternal health access.

AI Innovations Description

The recommendation to improve access to maternal health based on the described systematic review and analysis of eHealth initiatives in Kenya is to prioritize and scale up eHealth projects focused on maternal and child health (MNCH).

The review found that only 11 out of 69 eHealth projects were specifically focused on MNCH. Given the importance of maternal health in reducing maternal mortality and improving overall health outcomes, it is crucial to invest in and expand eHealth initiatives in this area.

Furthermore, the review highlighted the need for rigorous evaluation of eHealth projects. Only 8 out of the 69 projects were rigorously evaluated under randomized control trials. Conducting thorough evaluations will provide evidence of the effectiveness and impact of these initiatives, which can inform decision-making and resource allocation.

Additionally, the review revealed that few eHealth projects were implemented in marginalized areas and least urbanized counties with greater healthcare needs. To address geographical inequities and improve access to maternal health services, it is important to prioritize the implementation of eHealth projects in these underserved areas.

In summary, the recommendation is to prioritize and scale up eHealth projects focused on maternal and child health, conduct rigorous evaluations of these initiatives, and ensure implementation in marginalized areas and least urbanized counties to improve access to maternal health services in Kenya.

AI Innovations Methodology

Based on the description provided, one potential innovation to improve access to maternal health in Kenya could be the implementation of eHealth and mHealth initiatives specifically targeting maternal and child health (MNCH). These initiatives could include mobile applications or platforms that provide pregnant women and new mothers with access to important health information, appointment reminders, and communication channels with healthcare providers. Additionally, telemedicine services could be utilized to connect pregnant women in remote or underserved areas with healthcare professionals for virtual consultations and monitoring.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of antenatal care visits, percentage of births attended by skilled healthcare providers, and maternal mortality rates.

2. Collect baseline data: Gather existing data on the selected indicators to establish a baseline measurement of access to maternal health in Kenya. This data can be obtained from national health surveys, government reports, and healthcare facilities.

3. Design intervention scenarios: Develop different scenarios that represent the potential impact of the eHealth and mHealth initiatives on improving access to maternal health. Consider factors such as the coverage and reach of the initiatives, the level of user engagement, and the availability of healthcare resources.

4. Simulate the impact: Use mathematical modeling or simulation techniques to estimate the impact of each scenario on the selected indicators. This can involve creating a mathematical model that incorporates the relevant variables and simulating the outcomes based on different input parameters.

5. Analyze the results: Compare the simulated outcomes of each scenario to the baseline data to assess the potential impact of the eHealth and mHealth initiatives on improving access to maternal health. Evaluate the effectiveness of each scenario in achieving the desired outcomes.

6. Refine and iterate: Based on the analysis of the results, refine the scenarios and input parameters as necessary. Repeat the simulation process to further explore the potential impact of different intervention strategies.

7. Communicate findings: Present the findings of the simulation analysis in a clear and concise manner, highlighting the potential benefits of the eHealth and mHealth initiatives in improving access to maternal health. Use the results to inform decision-making and guide the implementation of the recommended innovations.

It is important to note that this methodology is a general framework and the specific details and techniques used may vary depending on the available data, resources, and expertise.

Auteur

Dima Health

Statistics:

Citations: 50

Identifiers:

DOI: 10.1186/s13104-017-2416-0

Research Areas:

Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Technology and Innovations

Study Countries:

Kenya

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Systematic Review

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