Assessing the Coverage of E-Health Services in Sub-Saharan Africa A Systematic Review and Analysis

Abstract

Background: E-Health has attracted growing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. Objectives: To review publicly available literature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. Methods: Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. Results: Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002-2014. Six types of e-Health interventions were reported, with 17 studies (65%) based on telemedicine, followed by mHealth with 5 studies (19%). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19%), pathology (12%) and radiology (8%). Successes were 'widely reported' (representing 50% overall acceptance or positive feedbacks in a study) in 10 studies (38%). The prominent challenges reported were technical problems, poor inter net and connectivity, participants' selection biases, contextual issues, and lack of funds. Conclusion: E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contextually feasible, acceptable, and sustainable.