05 May 2012
Health systems in low– and middle–income countries continue to face considerable challenges in providing high–quality, affordable and universally accessible care. In response, policy-makers, donors and programme implementers are searching for innovative approaches to eliminate the geographic and financial barriers to health. This has resulted in mounting interest in the potential of e–health (the use of ICT for health) and m–health (the use of mobile technology for health, a subset of e–health) in low- and middle-income countries.
Developing countries are experiencing an unprecedented increase in the number of users of cell phone and internet technologies, as well as a decline in the price of devices and services.1–4 As a result, many health programme implementers and policy–makers are exploring the extent to which e– and m–health (henceforth referred to simply as e–health) can help address the challenges faced by resource–constrained health markets in terms of the availability, quality and financing of health care. This increasing interest is evidenced by the growing number of events, web sites and literature focused on e–health, including the Saving Lives at Birth Grand Challenge,5 the recent Health Affairs thematic issue on e–health in the developing world,the m–health summits that took place in Washington, DC, United States of America,and Cape Town,South Africa, and the survey recently conducted by the World Health Organization on the use of m–health by its Member States
Despite the increased interest – perhaps bordering on excess – in some individual programmes, in low– and middle–income countries the e–health field is still relatively nascent. Few programmes have gone to scale and implementation has typically been fragmented and uncoordinated. To date, the literature on e-health in low– and middle-income countries has largely consisted of articles describing single uses of technology in health care delivery,as well as theoretical discussions and recommendations surrounding the implementation of e–health–based programmes and policies,with few examinations of the actual global landscape of these programmes. One exception is a white paper commissioned by Advanced Development for Africa that lays out a series of case studies and provides best-practice recommendations from e-health experts.Another paper reviews the evidence on the impact of e–health in low- and middle-income countries.The aforementioned WHO survey of Member States’ utilization of m–health presents a systematic andscaping of health programmes; nevertheless, the survey relied on local government knowledge, which is often limited when it comes to the private sector, where much of the e–health activity is taking place.
By analysing health programmes in low– and middle–income countries that engage the private sector, our paper fills gaps in the e-health literature and provides new insight into several central questions. It examines specifically the geographic distribution of technology–enabled programmes, the key issues technology can address in the health sector, and the key challenges posed by the adoption and implementation of technology for health-related purposes.