RESUMO
Background and Objective: Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. Methods: We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Results: Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. Conclusion and Global Health Implications: The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.
RESUMO
Background: Digital health interventions (DHIs) have increased exponentially all over the world. Furthermore, the interest in the sustainability of digital health interventions is growing significantly. However, a systematic synthesis of digital health intervention sustainability challenges is lacking. This systematic review aimed to identify the barriers and facilitators for the sustainability of digital health intervention in low and middle-income countries. Methods: Three electronic databases (PubMed, Embase and Web of Science) were searched. Two independent reviewers selected eligible publications based on inclusion and exclusion criteria. Data were extracted and quality assessed by four team members. Qualitative, quantitative or mixed studies conducted in low and middle-income countries and published from January 2000 to May 2022 were included. Results: The sustainability of digital health interventions is very complex and multidimensional. Successful sustainability of digital health interventions depends on interdependent complex factors that influence the implementation and scale-up level in the short, middle and long term. Barriers identified among others are associated with infrastructure, equipment, internet, electricity and the DHIs. As for the facilitators, they are more focused on the strong commitment and involvement of relevant stakeholders: Government, institutional, sectoral, stakeholders' support, collaborative networks with implementing partners, improved satisfaction, convenience, privacy, confidentiality and trust in clients, experience and confidence in using the system, motivation and competence of staff. All stakeholders play an essential role in the process of sustainability. Digital technology can have long term impacts on health workers, patients, and the health system, by improving data management for decision-making, the standard of healthcare service delivery and boosting attendance at health facilities and using services. Therefore, management changes with effective monitoring and evaluation before, during, and after DHIs are essential. Conclusion: The sustainability of digital health interventions is crucial to maintain good quality healthcare, especially in low and middle-income countries. Considering potential barriers and facilitators for the sustainability of digital health interventions should inform all stakeholders, from their planning until their scaling up. Besides, it would be appropriate at the health facilities level to consolidate facilitators and efficiently manage barriers with the participation of all stakeholders.
