Scaling up eHealth applications in low- and middle- income countries: An example that succeeded

Abstract

Background: Despite barriers such as financial and infrastructural challenges, there are many successfully implemented eHealth projects in Low- and Middle-Income Countries (LMICs). However, project scale-up and sustainability remains a pressing issue. This study analyses in detail an example of one such successful eHealth project: cStock in Malawi, an eHealth tool used to improve child health. This study aims to identify lessons that can be derived from our study of cStock, with support from the literature. Methods: In this research, a literature review was first conducted to scope existing literature on LMIC eHealth projects. Secondly, a qualitative study was conducted using five Key Informant interviews of individuals directly involved in the cStock case. Thematic content analysis of these interviews was conducted to identify themes. Findings: Six major themes were identified from my view: (1) facilitators and barriers to cStock implementation; (2) facilitators and barriers related to the scale-up and sustainability of cStock; (3) the impact of the COVID-19 pandemic on cStock operations; (4) the continuing role of paper records in cStock; (5) the transition of cStock and other health systems to full electronic systems in Malawi; and (6) a related set of recommendations for improving cStock operations and future LMIC eHealth projects. Conclusions and Implications: Despite the strong commitment of the Malawi government to the cStock project, it is widely recognized in Malawi public health system that cStock does not, at this time, have a sustainable financial model. Similar practices of financial precariousness may apply to most LMIC eHealth projects with reliance on external international finance. This study contributes to the growing literature on eHealth and focuses on enabling characteristics and barriers to LMIC eHealth project implementations, scale-ups, and sustainability. Further research is needed to investigate sustainable financial models that are more likely to achieve success for future LMIC eHealth projects.