E health in low to middle income countries
Electronic health (e health or eHealth) is often defined as healthcare practices supported by electronic processes and communication,[1] and includes mHealth, which in turn is often defined as the practice of medicine and public health supported by mobile devices.[2] However, definitions vary, and include many other areas of computer science and engineer (such as informatics, cyber security, cloud computing and human computer interaction) as well as medicine, public health, anthropology and even public policy. A study in 2005 found 51 unique definitions for e health alone.[3] Limited funding for medical technology, low levels of education and poor infrastructure for delivering and maintaining technology severely limit medical decision support and medical diagnostics in low to middle income countries (LMICs)[4 6] However, the rapidly increasing coverage of smart mobile devices, not only in developed regions of the world, but also in the world's rural communities and LMICs have spurred the development of mHealth solutions.[7] Despite the enormous potential for leap frog dynamics in healthcare, mHealth technologies have only seen very limited success, as reported in scientific literature.[8] Key challenges for mHealth solutions in lower resource environments include not only cost, but also the socio cultural context and the formal or informal healthcare systems in place. It has been highlighted that, for a successful implementation of mHealth initiatives, their integration into the existing infrastructure, supporting and complementing resources available is crucial.[9] This includes working with frontline community healthcare workers to ensure ownership and committed participation.[10] By far the greatest potential for big wins lies in LMICs, where oligopolistic practices, proprietary protocols, vested interests and outdated regulation is often less than in richer countries.[5,11] Of course, there is a flipside to this issue, in that limited regulatory oversight often exists, which can lead to highly variable quality, ethical standards, and safety for medical devices, and the systems to which they are attached. Finally, the issue of scalability and financial sustainability are rarely addressed, or included in the design in the first place. This special issue presents a collection of articles which aims to address these issues, present best practices and useful frameworks, in order to generate discussion and to move forward the field of e health and mHealth, particularly in LMICs.
Journal of medical engineering technology