JMIR Publications

ABSTRACT

Background:

Years of health information (HIS) investment in many countries has facilitated service delivery surveillance, reporting, and monitoring. Electricity, computing hardware, and internet network are vital for health facility-based information systems. Availability of these infrastructures at health facilities are crucial for achieving the national digital health vision.

Objective:

The objective of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample.

Methods:

We sampled Seventy-two health facilities distributed in all the districts in Sierra Leone, factoring in rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over two weeks period.

Results:

We found that 82% of surveyed health facilities do not have institutionally provided internet. The maternal and child health posts (MCHP) one type of primary healthcare unit (PHU) reported 60% have solar as their only electricity source, and the other 40% had no electricity source. Similarly, 38% of hospitals use generator as a primary electricity source, while 46% use national utility. All hospitals have at least one functional computer, though only seven of the 13 hospitals have four or more functional computers. Similarly, only two of the 59 PHUs had one computer each, and 37 of the PHUs have one tablet device. This healthcare infrastructure mapping provides the current state of internet connectivity, electricity, and computing hardware at health facilities in Sierra Leone. We can say with a 95% confidence level that alternative and non-traditional internet, electricity, and computing hardware are emerging as preferred options for health facility digital health coverage.

Conclusions:

Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. Fourty-three percent of surveyed health facilities believe inadequate electricity is the biggest threat to digitization. The current trend where all health facility internets are provided by GSM service providers can be changed to other promising alternatives. This study has shown evidence of the critical gap necessary to achieve this result.