Status of Resources for Information Technology to Support Health

Information Exchange in Resource-constrained Settings

Andrew Alunyu Egwar

1,2

, Richard Ssekibuule

and Josephine Nabukenya

Department of Computer Engineering, Busitema University, Tororo, Uganda

Department of Information Systems, Makerere University, Kampala, Uganda

Keywords: eHealth, Communication Resources, Health System, ICT, LMICs.

Abstract: Various resources exist to support health information exchange (HIE). Both computerised and

uncomputerized communication resources continue to be used in resource-constrained environments, like the

Uganda health system to support HIE. Despite the rapid shift to the digital health environment, the resource

capabilities of health systems in LMICs to support robust HIE is unknown. This study surveyed the status of

resources for ICT to support ehealth communication in a resource-constrained setting. The study was

conducted in three districts, representing the urban, peri-urban and rural settings of Uganda. The qualitative

data collected was analysed with QSR NVivo 10. Results show major resource challenges including financial

constraints, funders restrictions, human resource limitations, isolated computer systems, lack of support from

management, legacy/outdated systems, intermittent/limited network bandwidth, limited hardware,

misuse/poor maintenance of the available hardware, and power outages among others. In addition, results

show a great disparity in their distribution across the healthcare sector. Therefore, we argue that much

improvement is needed if the benefits of ehealth are to be attained in LMICs. Recommendations include

specifying minimum resources for ICT required to support HIE, supervising implementation and monitoring

compliance to the standards, establish a mechanism for periodic review of the minimum standards, and finally,

align ICT funding within the mainstream funding for healthcare services. It should uniformly apply across

the board (i.e., facilities located in urban, peri-urban and urban) for the full benefits of ICT in health to be

achieved in LMICs.

1 INTRODUCTION

Low- and middle-income countries (LMICs) lag in

development and lack of resources for the wellbeing

of all (Andrews et al., 2012). The resource challenges

extend to shortages in the healthcare system.

However, ICT has found multiple applications in

LMICs as they attempt to alleviate current resource

shortages limiting service delivery in their healthcare

sector, transportation, and governance among others.

In fact, in their ICT policy document, Uganda’s

ministry of ICT identified applications of ICT for

sustainable development to span the fields of public

administration, business, education and training,

health, employment, environment, agriculture,

petroleum, science, oil and gas, as well as linguistic

and cultural diversity (Uganda’s MoICT, 2014).

Particular to this study, is the need to leverage

challenges in healthcare like high patient-physician

ratio, variable quality of care, limited medical

equipment, high cost of healthcare, corruption/fraud,

and patient monitoring problem (Lewis et al., 2012;

Madinah, 2016) by adopting ICT in support of health

information exchange (Peña-López, 2010).

According to Health ICT Industry Group, (2009)

ICT can help support Electronic Health Records

(EHR), Chronic Disease Management Systems,

Computerised Practitioner Order Entry (CPOE),

Clinical Decision Support, Electronic Transfer of

Prescription, Electronic Appointment Booking,

Personal Health Record, Telemedicine, and RFID and

Bar-coding. In fact, the use of ICT in healthcare are

categorised into health education, hospital

management system, health research, and health data

management (FrontEnders Healthcare Services Pvt.

Ltd, 2016; Lewis et al., 2012). These are geared

towards alleviating healthcare resource challenges, a

problem more pronounces in LMICs. Contrary to a

report by Lewis et al., (2012) that ranked sub-Sharan

Africa the third-best in use of technology-enabled

Egwar, A., Ssekibuule, R. and Nabukenya, J.

Status of Resources for Information Technology to Support Health Information Exchange in Resource-constrained Settings.

DOI: 10.5220/0008970004630471

In Proceedings of the 13th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2020) - Volume 5: HEALTHINF, pages 463-471

ISBN: 978-989-758-398-8; ISSN: 2184-4305

463

programmes as a percentage of all programmes, these

mostly LMICs continue to grapple with resource

shortages in Healthcare.

Central to the use of ICT to support health

(ehealth) is the communication infrastructure and

supporting resources. In fact, the use cases are

facilitated by a communication infrastructure with

resources suitable to meet the stringent requirements

in a healthcare environment. However, the ICT itself

continue to face challenges in LMICs including

resource limitations, security and privacy concerns

(Blantz, 2010; Dhital, 2018). These constraints on

ICT has a bearing on their application to healthcare.

According to Blantz (2010), the resource challenges

range from connectivity problems, power shortages to

human and other nontechnical challenges. Among

these are challenges specific to ehealth infrastructure

intended to support health data handling and or

information exchange. However, resource challenges

may not be uniform across the healthcare system.

Resources distribution in LMICs tends to be along

the urban, peri-urban and rural divide. No matter the

kind of resource, they are spread across the structural

divide, with better resources reducing from developed

to least developed countries, from urban to rural

settings (Henry, 2019; Jere et al., 2013; Kuntagod et

al., 2014). Therefore, the resources for the

communication infrastructure supporting ehealth

need to be investigated across the general resource

distribution divide. Our consideration of resources

stems from the summarised definition of resources by

Alvaro et al., (2010) from the conservation of

resource theory. They believe resources are objects,

conditions, personal characteristics, and energies that

are valued for survival or that serve as a means of

achieving these resources (Alvaro et al., 2010).

Mindful that health information exchange needs to

take place irrespective of the locality of the health

facility; adequate data communication resources that

span physical, structural and energy (Alvaro et al.,

2010) are required to support such exchanges.

According to Alvaro et al., 2010, the three major

concepts of Conservation of Resources (COR) theory

that apply to this study are; one, resources are

required for adaptation and change. Healthcare

systems need to adapt to the electronic transfer of

health data. Two, the threat of loss leads to the

protection of assets/resources in this case protection

of the CIT resources and data involved in the

exchange. Three, resources must be optimized for

adaptation. Given the resource-constrained, there is a

need to optimise the available resources to achieve

HIE in LMICs.

1.1 Health Information Exchange

It is the role of delivery systems and communities who

intend to exchange health information, to set up the

communication infrastructure (McCarthy et al., 2014)

for such exchange. Health information exchange (HIE)

is the secure, electronic movement of health-related

information in a standard format between disparate

sources and users (Williams et al., 2012). To facilitate

HIE, existing communication resources need to be

robust to be able to support healthcare processes and

data communication. In this regard, the

communication infrastructure both within and across

health facilities must be properly designed and

implemented to support healthcare processes and data

exchange. Thereby supporting HIE to improve clinical

decision-making and continuity of care, while reducing

unnecessary use of services (McCarthy et al., 2014).

1.2 Why eHealth Communication

Resources?

Other studies have used or identified among other

resources sufficient storage, transport capacity (data

communication bandwidth), state-of-art hardware as

required to support health data sharing/

communications (Dixon, 2016; Sewell, 2014). The

scarce telecommunication resources like the spectrum,

numbering, and rights of way (Uganda’s MoICT,

2014) may be considered per implementation of a

communication system. To meet the time requirements

of health data, the data communication system/network

needs to be robust. In addition, network availability

and performance are considered very critical in

healthcare (Juniper Networks, 2015). In fact, Sewell,

(2014) argues that sufficient network capacity and

speed are critical for supporting current and future

healthcare technologies and applications. In fact,

Dixon, (2016) argues strongly for sufficient storage as

well as transport capacity for data and or information

exchange. Therefore, we argue that the capacity of the

communication infrastructure is dependent on these

resources, i.e., storage, transport capacity/ bandwidth,

the spectrum, available hardware, and of course

associated software platforms. If the health data

communication infrastructure is to be robust, the

design and implementation of ICT systems used within

the healthcare facility, cabling and choice of cable

category, implementation of interfaces that request

access to health records, establishment of the modes of

information exchange, security, access privileges and

privacy, must follow strict guidelines.

To investigate the factor of resources that

influence implementation of ehealth in LMICs, the

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study sought to answer the research question of what

minimal communication resources are required to

support sharing of Health Information in resource-

constrained settings, the study explores the following

questions: (1) what is the perception of healthcare

practitioners in resource-constrained settings regards

role of ICT in health? (2) what ehealth

communication infrastructure resources are currently

available to resource-constrained settings? (3) what

healthcare processes can the current ICT resources

support? And (4) what are the recommended

improvements to communication resources to support

HIE in low resourced environments?

The rest of the paper is organised as follows:

Section 2 presents the methodology followed to

conduct the study. In Section 3, we present the results

of the survey of the current status of resources that

support electronic health communication

infrastructure in Uganda. Finally, we discuss the

results of the survey in Section 4 before presenting

the conclusions and future works in Section 5.

2 METHODS

This was a qualitative study of communication

resources that support HIE. The study involved, one,

a literature review of health informatics literature

from PubMed Central and Google scholar regards

resources for ehealth communication in LMICs or

developing countries. The literature review

considered both peer-reviewed and grey literature

that considered resources for ehealth communication

to support HIE. We also reviewed the state of ICT

resources that may support HIE in four LMICs.

Two, an exploration of communication resources

available to health facilities in Uganda’s health system

to understand their support for healthcare processes

and identify any resource limitations. Only health

facilities at the level of health centres IV, district

hospitals and regional referral hospitals were included

in the survey. Nine health facilities were purposively

chosen from the central, eastern and northern Uganda.

The basis of choice is, first, on the basis that they

handle a high volume of patients. Second, Uganda’s

ministry of health (MoH) and or implementing partners

have supplied all of them with one form of ICT or the

other. Third, representative of rural (05 health centres

IV), peri-urban (02 peri-urban health facilities – district

hospital and regional referral hospital) and urban

setting (02 urban health facilities).

Interviews were conducted among hospital

superintendents/directors, Incharges (an officer in

charge of a health facility) of health facility, ICT

administrators and records offices of the identified

facilities. However, out of the eighteen (18)

responses, only fifteen (15) were included in the

analysis. Three (03) records were excluded because

they had missing information. In order to identify the

emerging themes, QSR NVivo 10 was used in the

analysis of the qualitative data collected.

3 RESULTS

3.1 Review of Other Studies

Only nineteen (19) peer-reviewed and grey literature

were used in the review. The key results from their

synthesis regard the role of ICT in health, resources for

ehealth communication infrastructure available to

resource-constrained settings, minimal communication

resources required to support HIE and challenges to

use of ICT in low resourced environments are

summarised below in Table 1. These were the basis of

our survey of ICT resource that supports healthcare

processes in LMICs, a case of Uganda.

Table 1: Themes emerging from the literature review.

ole o

ICT in health



Support data collection, analysis and storage



Support for clinical decisions and diagnosis

 Support for messaging and data sharing

esources

or eHealth CI/T



eHealth hardware



Application software/technologies



Mobile connectivity and Internet penetration



Access to Power/ Electricity



Literacy skills

 Security /privacy

Challenges



Lack of affordable connectivity / bandwidth



Poor infrastructure



Deployment of inappropriate technologies



Technology literacy challenges



Improper involvement of key stakeholders



Limited supporting resources like power



Inadequate policies

3.2 Case Study of Uganda

Responses used in the analysis were obtained from key

stakeholders from healthcare settings at the level of

Health Centre IVs’ and above in the study districts of

Tororo and Lira in Uganda. The hospital/health facility

superintendents, directors, Facility Incharges, ICT

officers, records officers, and ICT users represent the

decision-makers, implementers and users of ICT at

Status of Resources for Information Technology to Support Health Information Exchange in Resource-constrained Settings

465

health facility levels in Uganda. Being the key

stakeholders, their response presents a realistic account

of the status of ICT at surveyed health

facilities/districts. The response was distributed among

the respondent categories as shown in Figure 1.

Figure 1: Distribution of responses by relevant positions.

Qualitative analysis was carried out using QSR

NVivo 10. Emerging themes include use of ICT to

support healthcare processes especially data handling

and exchange, guidelines/standards for use, advantages

of incorporating ICT in healthcare processes, current

communication resources available in health facilities

in the study districts, existing challenges, and

recommended improvements. The results depict the

views of different facility-level stakeholders. Most of

whom were record officers (41.67%) who are the key

users of ICT in the healthcare process and Incharges

(25.0%), the decision-makers at facility levels. The rest

i.e., superintendents, directors, ICT officers and ICT

users, were equally represented at 8.33%.

3.2.1 Role of ICT in Healthcare

Results in Table 2 present the views of Uganda’s

health facility stakeholders on the role of ICT to

healthcare processes. With uses ranging from

administration, data storage, laboratory, monitoring,

ordering, records, reporting, and research; various

components of the ehealth CI/T are engaged to

support health data/information exchange. Reported

modes of health data exchange range from electronic

to paper-based transfer within the facility, across

facilities, or with the MoH headquarters.

They identified ICT use in healthcare that follows

appropriate rules of data handling and exchange to be

able to achieve the advantages of improved accuracy,

monitoring, tracking, reliability of healthcare

processes, and save on cost and time.

Hardware – the hardware (HW) resources include

disks/tapes for data backup; computers (both

desktops, laptops, portable digital assistants and

phones) for computational tasks and communication;

both local network and Internet resource to facilitate

communication and health data sharing; and attached

resources such as printers, scanners among others.

These hardware resources need to be dedicated and

robust to support data collection, processing, storage,

output, and communication. To emphasise this need,

a respondent called for “computers and tablets should

not be used to do anything else”.

Table 2: Role of ICT in health facilities.

Themes Sub-Themes

# of

respondents

Usage

Administration 2/15

Data storage 3/15

Laboratory 1/15

Monitoring 2/15

Ordering 2/15

Records 7/15

Reporting 6/15

Research 1/15

Others 2/15

Support for

Health

Information

Exchange

Electronic 9/15

Interfacility 3/15

Intra-facility 6/15

Mode of exchanges 6/15

Paper-based 1/15

Rules for exchange 3/15

Advantages

Improved accuracy 3/15

Improved monitoring and

tracking

2/15

Improved reliability 1/15

Saves Money 1/15

Time-saving 2/15

Software – the software (SW) systems and

technologies that were identified as in use by the

surveyed health facilities include simple database

systems, DHIS2, eHMIS, HIS, HR Biometric system,

Medical Records, mTrac, Staff Recruitment System,

and Tally Sheets.

Human Resources – respondents identified the

need for digitally enabled human resources for

healthcare. They strongly highlighted the need for in-

service training of staff and or recruitment of digital

health workers.

Electric Power – is required to ensure that the

available hardware resources are powered to

participate in data handling and communications. In

fact, it powers the ICT equipment to ensure they

function with a large meantime between failure.

 Resources Challenges: the use of ICT in

different domains continues to experience challenges

including resource challenges. In a similar manner,

the ehealth communication infrastructure required to

facilitate health information exchange in low-

resourced settings experiences resource challenges.

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Among the identified challenges are financial

constraints, funders restrictions, HR limitations,

isolated systems-computers, lack of support from

management, legacy / outdated systems, limited

network bandwidth, and the intermittent Internet,

limited use-access, limited hardware, misuse and

poor maintenance of the available hardware, and

power outages. The number of respondents who

agreed on the existence of each of these challenges in

their facilities are summarised in Table 4.

Table 3: eHealth and supporting resources.

Resource type # of respondents

HW-Storage Hard disks/Tapes 1/15

Computers, laptops, PDAs, etc 9/15

Local area network & Internet 6/15

Printer 1/15

Scanner 2/15

SW-Systems & Technologies

Database 2/15

DHIS2 1/15

eHMIS 1/15

HIS 1/15

HR Biometric system 2/15

Medical Records 1/15

mTrac 2/15

Staff Recruitment System 1/15

Tally Sheets 1/15

HR -Available HR 2/15

- HR Training 4/15

Power 1/15

Table 4: Challenges to the use of ICT in Health Facilities.

Challenges # of respondents

Financial constraints 4/15

Funders interest 2/15

HR limitations 5/15

Isolated systems-computers 3/15

Lack of support from

management

2/15

Legacy / outdated systems 3/15

Limited BW-Internet 3/15

Limited HW 2/15

Limited use-access 3/15

Misuse & poor maintenance 2/15

Power 3/15

Others 6/15

Other challenges that may negatively influence

adoption and use of ICT in healthcare were identified

as missing technologies, the inexistence of the ICT

department, improper/unbalanced planning for the

ICT department, and limitation in the digital health

skills of their workers.

 Security / Privacy Guidelines: there are various

threats to the electronic sharing of health data (11/13).

However, these threats can be minimised by a set of

guidelines on the use of ICT in healthcare. Among the

standards identified as required to regulate the use of

ICT in healthcare are access restrictions whether

physical, password, pin, unique patient or practitioner

codes and access logs (see Table 5). Management plays

a key role in the development and enforcement of such

guidelines.

Table 5: Current security and privacy guidelines for

handling health data in a digital environment.

Sub-Themes # of respondents

Threats 11/15

Privacy and security measures

Access-Log 1/15

Restrictions 6/15

Unique codes

Patient unique code 4/15

Practitioner unique code 3/15

Role of management 2/15

 Suggestions for Improvement: table 6 present

views of respondents on how the use of ICT can be

improved to better serve healthcare processes. Their

views included the provision of data backup storage,

minimising ICT resource challenges that were

summarised in Table 4, better management, training

of staff in digital health skills, better stakeholders’

involvement, and adoption of user-friendly and

supportive technologies.

Table 6: General views on improving ICT for health.

Sub-Themes # of respondents

Data Storage 1/15

Improved resources 3/15

Management role 3/15

Training 5/15

Stakeholders 2/15

Supportive technologies 1/15

Further analysis was done, first, to examine the

distribution of the resources for ICT across the urban,

peri-urban and rural setting. Results show unequal

distribution as presented in Figure 2. The resources

are high in health facilities in urban settings and

decrease tremendously in rural settings. In fact,

similar resource categories in a rural setting are under

half those in urban settings. Second, to explore how

the responses vary by categorises of respondents.

Respondents were categorised into superintendents of

regional referral hospitals and directors of district

hospitals, medical officers who are in charge of

Status of Resources for Information Technology to Support Health Information Exchange in Resource-constrained Settings

467

Health Centre IVs, officers in charge of ICT in the

respective referral and district hospitals, record

officers at the level of Health Centre IVs and district

hospitals, and ICT users at the surveyed health

facilities. The result presented in Figure 3 shows

strong views were expressed by the In charge of

health facilities, ICT officers and Records officers.

Counts in Figure 3 represents the number of times

respondents expressed strong views concerning the

identified themes.

Third, we compared results from the survey of

Uganda to those obtained from the literature review

of four other LIMCs in Africa. With the exception of

available bandwidth, the results presented in Table 7

show Uganda has similar or even better ICT resources

when compared to the four reviewed LMICs.

Figure 2: Urban, peri-urban and rural distribution of CIT resources.

Figure 3: Distribution of responses by respondent categories.

Table 7: Comparing the state of ICT resources in Uganda to other Four LMICs in Africa (ITU, 2019; WHO & ITU, 2015;

Asingwire, 2018; Bhatia et al., 2015; and Uganda’s MoICT, 2018).

Resources

Kenya South Africa Rwanda Tanzania Uganda

Average available Bandwidth (Mbps) 12.2 6.7 ─ ─ ─ ─ 4.0

Internet penetration ─ ─

 

─

Mobile Network connectivity ─ ─

 

─



Hardware resources



─

  

Security /privacy ─ ─ ─ ─ ─ ─



Literacy skills ─

 

─ ─



Access to Power ─ ─ ─

  

Key: =Very High (above 80%), ─=High (61%-80%), =Medium (41%-60%), ─=Low (21%-40%), =Very

Low (below 21%), ─ ─=Not sure/missing information.

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4 DISCUSSION

The hardware and software resources should be robust

enough to provide a reliable transport environment for

data sharing. Remembering that resources must be

optimized for adaptation (Alvaro et al., 2010), the

healthcare environment requires robust processing

power and communication capacity to meet the

stringent life-saving time requirements. The results

show a discrepancy in requirements for the resources

like the one suggested by HealthIT, (2013) and those

identified for Uganda. Whereas the practitioners

expressed aspiration for state-of-the-art CI resources,

the ministry recommended improved equipment,

existing resources for ehealth CI remains limited in

Uganda’s health system. These recommendations are

in line with the suggestions by respondents for

resource improvement, e.g., MoH “need to install

reliable internet service”, “provide power backup

sources”, and “Computers in all the departments and

these computers can be networked”. Not only are

appropriate resources for the CI required, but also a

proper design and implementation that furthers the

aims of healthcare delivery (McCarthy et al., 2014).

For HIE and interoperability to exist across the

healthcare system, the design and implementation of

such infrastructure need to follow agreed standards.

Whereas a previous study identified multiple

ehealth technologies in Uganda’s healthcare

environment (Huang et al., 2017), this survey only

identified nine software technologies. This could

partly be attributed to failure to sustain donor

technologies after the project duration, or lack of

skills to continue their use or financial constraints

among others. The initiative by Uganda’s MoH to

promote technologies like DHIS2 and mTrac in a

drive to promote standardisation of interoperable

systems could have also discouraged the use or

further adoption of diverse systems. Whatever the

software system / technology, it must be robust to

perform the required tasks as stated by a respondent

“All you need is very robust software systems, once

you have it the others can be automatic”. However,

network connectivity remains poor in rural areas.

This hampers HIE efforts. An earlier study on the

practical challenges for large-scale deployment of

mHealth solutions in LMICs confirms it, saying “for

always-on data, connectivity does not work when

deployed in rural…”(Kuntagod et al., 2014).

The disparity in the distribution of resources is

attributed to a lack of standards to guide the

establishment of the ehealth communications

infrastructure, financial limitations, and limited

support or improper prioritisation by management.

For example, whenever the mains power supply is

off, there is a lack of a fails-over power backup supply

in the form of no fuel to run the generators, or failed

solar installation, etc.

In fact, identified challenges to use of ICT

resources in health majorly centre around a limitation

in financial resources as summarised in this response:

“We have very limited budget, data, for example,

is not easily affordable. We normally take advantage

of partners who have interest in certain things and

avail data for this and this. Otherwise, our budget is

very limited. We can’t support the ICT sector

effectively. The hardware has wear and tear, the

maintenance cost is very high”.

Existing ICT resources are donor-funded,

confirming the arguments of Huang et al., (2017);

however, they come with stringent restrictions on use.

Sustainability tends to last for only the duration of the

funding. Technologies in use are able to improve

healthcare processes, for example, the monitoring and

supplies tracking system is able to expose corrupt

behaviours thereby saving on money. “Because you

can monitor all the vouchers and the transactions

from the stores and can count how many tablets were

used. This would help save a lot of money”.

As regards the role of ICT in healthcare, we argue

that, although ICT presents much promise to support

HIE, existing communication resources are still

inadequate in Uganda’s health system. Multiple-use

cases of ICT in healthcare have been highlighted in

these resource-constrained settings (Lewis et al.,

2012), however, the advantages are still restricted to

administrative tasks. There is a need to extend this to

HIE related processes. Similar dilemma including the

problem of the cross-system linkup, lack of

commonly defined and consistently implemented

standards, privacy/security concerns, cost of

implementation, and availability of necessary

infrastructure like power, Internet, among others

(Lewis et al., 2012; Peña-López, 2010) exist in other

resource-constrained healthcare settings.

In further analysis, first, we discovered that the

resource decreases uniformly from urban to the rural

healthcare settings, with power tending towards zero

in the rural health facility. This high-power outage

without an alternative source of power requires

immediate action as called for by a respondent

“Something must be done about this frequent power

interruption”. We acknowledge that respondents in

urban settings expressed the strong presence of

software resources (SW) above other resource

categories as represented in Figure 2. This is possible

because the first stopover for new technological

innovations is in urban health facilities and only a few

Status of Resources for Information Technology to Support Health Information Exchange in Resource-constrained Settings

469

scales over to rural settings. Also, the availability of

supporting resources like power, internet, technical

human resource, etc may be enabling factors.

Second, we realised that although ehealth users

were majorly from urban settings where there are

more ICT resources, they couldn’t state the

advantages of ehealth in facilitating healthcare

processes (see Figure 3). It was also surprising that

the interviewed superintendents and directors

couldn’t properly state the advantages of ehealth.

Overall, the facility managers and direct users of

ehealth technologies expressed little opinion on the

merits of the use of using ICT in healthcare as

compared to their counterparts, the Incharge of health

centre IVs, ICT officers and records officers. This

shows the managers are disengaged from decisions

regards acquisition and use and possibly ICT are

imposed on them by NGOs, implementing partners

and or governments. The users lack proper orientation

to adopt the use of ICT and therefore find it difficult

to use. This could explain why many respondents

recommend management support and training. “We

need training of staff. Some people might have not

been trained, so they find difficulty in handling it”.

Third, a comparison of the state of resources for

ICT in four other LMICs in Africa indicate that

Although Uganda has not yet achieved much progress

regards electronic HIE, her ICT resource environment

is similar or even better than some of the countries

that have made much progress. In fact, other LMICs

who are hesitant on adapting ehealth in support of

their healthcare services can learn from this

comparison.

5 CONCLUSIONS

The survey of ICT resources being used in health to

support ehealth communication in three regions of

Uganda revealed major challenges to the acquisition,

establishment, and management of the ehealth

communication infrastructure. Furthermore, the

resource distribution is unevenly spread across the

rural, peri-urban and urban settings. Both these

challenges and the uneven spread negatively

influence health information exchange both within a

health facility and across health facilities

respectively. Although the survey only involved three

districts in Uganda, we believe the findings from this

study are representative of the status of ehealth

communication resources in the whole country.

The findings of this study can inform Uganda’s

MoH (and any other resource-constrained LMIC) to

standardise the ehealth communication infrastructure

of their healthcare systems. Recommendations for

improvement include; (1) the MoH needs to specify

minimum resources for ICT required to support HIE,

both within and across healthcare organisations. This

includes standardisation of the design and

implementation of ICT systems to support HIE. The

technology systems at the healthcare facility level, the

cabling and cable category, interfaces, modes of

information exchange, security, access privileges and

privacy need to be standardised. (2) The MoH needs

to supervise implementation and monitoring

compliance to the standards. Changes to be

implemented may include those that create a uniform

enabling environment for HIE, for example, connect

all health facilities to the national backbone, provide

alternative power sources like solar power, etc. (3)

Establish a mechanism for periodic review of the

minimum standards for ICT supporting HIE. And

finally, (4) Align ICT funding within the mainstream

funding for healthcare services.

In another ongoing study, we are reviewing global

standards for ehealth CI/T to determine criteria for

selecting standards suitable to support HIE in LMICs.

We also intend to develop a structured process that

can be used by LMICs to adopt standards for ehealth

CI/T, monitor implementation and compliance with

such standards.

ACKNOWLEDGEMENTS

This study was funded in part by the Swedish

International Development Cooperation Agency

(Sida) and Makerere University under Sida

contribution No: 51180060.

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