State of Digital Health Communication Infrastructure in LMICs: Theory, Standards and Factors Affecting Their Implementation

Abstract

A robust communication infrastructure is required to support healthcare data sharing required to facilitate patient-centred care. Components that make up the digital health communication infrastructure (DHCI) include software and digital health applications, the hardware, network, security and personnel that use the infrastructure to capture, process, store and or share health data/information [1–4]. Actually, in a digital health information-sharing environment, communications engage people and things including the physical backbone that supports the digital health applications [3]. However, in low and middle-income countries (LMICs) constrained by resources, there are only limited components of the DHCI and are often in a poor/ inadequate state [1, 5, 6]. Furthermore, proper management of these DHCI components is required to realise its full potential in supporting patients and the public. Nevertheless, the skills required to develop, deploy, maintain and use digital health technologies are greatly lacking which has continued to hinder LMICs’ from reaping the expected benefits from their digital health implementations [7]. Several reasons have been given for the poor state of these DHCI components including limited funding, lack of technical skills, inadequate legal and governance frameworks leading to uncoordinated implementations, and limited political support among others [6–8]. These challenges can be categorised into financial, technical and management/governance problems, both internal and external. The challenges have resulted in diverse implementations of digital health (DH) systems that lack interoperability [6, 8, 9] and therefore are unable to support secure, reliable healthcare data sharing on time [7]. The telecommunications domain has conceptualised the use of standards as a solution to the problem of interoperability of communications systems [10]. Similarly, health systems have adopted the standardisation approach to address such gaps.