JMIR Publications

ABSTRACT

Background:

In low- and middle-income countries (LMICs), maternal, newborn, and child health (MNCH) face significant challenges due to infrastructure limitations, access disparities, and service delivery inefficiencies. To address these issues, the Sehatmandi mHealth application was deployed in 189 health facilities across Afghanistan's Bamyan and Badakhshan provinces, aiming to enhance health services through real-time data monitoring and improved accountability.

Objective:

This study explores the enablers, challenges, and lessons learned for the long-term sustainability of this digital health intervention in conflict-affected settings, Afghanistan.

Methods:

A cross-sectional qualitative study was conducted, employing in-depth interviews with 24 stakeholders, including facility managers, administrators, and decision-makers. Participants were selected via stratified purposive sampling until theoretical saturation. Data, collected using a semi-structured guide and transcribed into English, was analyzed through thematic content analysis using NVivo. Ethical approvals were obtained, and informed consent was secured.

Results:

Enablers such as enhanced performance monitoring, accountability, and timely reporting were found to improve data quality and application effectiveness. Crucially, offline data entry features addressed accessibility limitations in remote areas by enabling data capture without internet connectivity, with subsequent synchronization. However, the intervention faced significant challenges that hindered its sustainable use. Poor internet connectivity and electricity shortages directly impacted data transmission and application functionality, highlighting the necessity of reliable internet access and a stable power supply. Additionally, device malfunctions, high staff turnover, and inadequate training disrupted workflow and data accuracy. To ensure long-term sustainability, robust follow-up and monitoring, continuous capacity building, and sustained funding are essential. Furthermore, device malfunctions, high staff turnover, and inadequate training disrupted workflow and compromised data accuracy. To ensure sustainability, robust follow-up and monitoring mechanisms, continuous capacity-building initiatives, and sustained funding are essential. Despite these hurdles, participants recognized the application's potential to improve evidence-based decision-making and health outcomes in conflict-affected settings.

Conclusions:

The Sehatmandi application demonstrated significant potential to strengthen health services through real-time data monitoring, accountability, and accessibility in resource-constrained and conflict-affected settings. However, sustainable digital health interventions require reliable internet access in remote regions and long-term funding. This study offers valuable insights for scaling and sustaining mHealth solutions in LMICs.