A conceptual framework for sustainable eHealth implementation in resource-constrained settings

Abstract

There is evidence that several eHealth pilot projects in developing countries could not progress to full-scale implementation — sometimes referred to as the ‘pilotitis’ of the eHealth system. The sustainable eHealth implementation frameworks reported in the literature are linearly modelled, and fail to reflect the nonlinear and dynamic complexity of eHealth systems implementation. This study proposes a sustainable eHealth implementation framework to support the long-term sustainability of eHealth systems in developing countries. The framework addresses the nonlinear and dynamic relationships among elements of the ecosystem in the implementation of eHealth through feedback systems by following a system dynamics method. A literature review and systems approach is used to understand the interactions between the elements of a sustainable eHealth system. System dynamics modelling is applied to develop a nonlinear and dynamic model of sustainable eHealth implementation. The study indicates that the long-term sustainability of eHealth depends not only on technological factors, but also on economic, social, and organisational factors. Moreover, the causal loop diagram highlights the dynamic interplay between the factors of a sustainable eHealth system through feedback loops.

Daar is bewyse dat verskeie elektroniese-gesondheid (e-gesondheid) proefprojekte in ontwikkelende lande nie kon vorder tot volskaalse implementering nie. Die volhoubare implementering van e-gesondheid raamwerke wat in die literatuur rapporteer word, is lineêr gemodelleer en reflekteer nie die ware nie-lineariteit en dinamiese kompleksiteit wat hiermee assosieer word nie. Hierdie studie stel ʼn volhoubare e-gesondheid implementeringsraamwerk voor om die langtermyn volhoubaarheid van e-gesondheidstelsels in ontwikkellende lande te ondersteun. Die raamwerk adresseer die nie-lineêre en dinamiese verhoudings tussen elemente van die ekosisteem in die implementering van e-gesondheid deur terugvoer stelsels deur ʼn stelseldinamika benadering te volg. ʼn Literatuurstudie en ʼn stelselsbenadering is gebruik om die interaksies tussen die elemente van ʼn volhoubare e-gesondheid-stelsel te verstaan. Die resultate toon dat die langtermyn volhoubaarheid nie net van tegnologiese faktore afhang nie, maar dat ekonomiese, maatskaplike en organisatoriese faktore ook ʼn rol speel. Die oorsaaklike-lus diagram beklemtoon die dinamiese wisselwerking tussen die faktore van ʼn volhoubare e-gesondheidstelsel.