Developing countries, including Sub-Saharan Africa (SSA), account for a large percentage of the global disease burden, e.g. Malaria, HIV, Tuberculosis, etc. 1 The World Health Organization (WHO) estimates that HIV/AIDS, tuberculosis, and malaria claim approximately 3 million lives in SSA each year.2 This has further been exacerbated by the COVID-19 pandemic.

Accessing healthcare in SSA poses significant challenges such as the scarcity of healthcare facilities, particularly in remote and rural areas, the high cost of healthcare services, coupled with low-income levels, and the shortage of skilled healthcare professionals, including doctors and nurses.3

Access to quality healthcare and impact can significantly improve when decision-making is evidence-based, and trend projections are supported by quality data. The foundation for quality health data lies in data that is collected, managed, and used by medical professionals, and healthcare facilities and available for national databases and trend analysis. Digital health technologies, including Electronic Medical Records (EMRs) and Electronic Health Records (EHRs), enhance access to healthcare by facilitating quick and accurate retrieval of patient information, improving care coordination among healthcare providers, and reducing duplication of tests and procedures.4 Electronic records can also support telemedicine and remote healthcare services, enabling patients in remote or underserved areas to receive timely medical care and consultations from a distance, thus expanding access to healthcare services.

The EMR refers to everything one would find in a paper chart. Examples are medical history, diagnoses, medications, immunization dates, and allergies. While EMRs work well within a practice, they are limited because they do not easily travel outside the healthcare facility. An EHR is a digital record of health information. It can contain more information than an EMR such as insurance information, demographic data, and data imported from personal wellness devices.1

The use of EMRs/EHRs at healthcare facilities can significantly improve access to care, health outcomes, and quality of care. Providing patients access to their data and providing the ability to share it with a variety of medical professionals can significantly improve the quality and affordability of care. 5 It is the right of patients to own their medical data; here EMRs/EHRs play an enabling role.

Over the past decade, EMR/EHR systems have been gradually adopted in various countries across SSA to improve healthcare delivery, enhance data management and cost-effectiveness. The adoption and scale-up from paper-based systems to a digital system have not been without challenges which are but are not limited to challenges related to high costs, fragmentation, lack of guidelines and policies, patient data security, lack of standardization, patient inaccessibility, lack of trust at the user level, limited infrastructure plus lack of integration and interoperability.

The myriad of adoption challenges makes the SSA EMR/EHR market unique in the sense that it requires customized EMR/EHR systems that can conform to the local requirements of the operations of the region. A study recently concluded by AHB showed key market drivers that can inform EMR/EHR developers when creating a system that is fit for purpose and fit for adoption in the SSA setting:

Regulatory adherence is the basis to operate and scale any EMR/EHR

Most of the public hospitals at tertiary and secondary healthcare levels are well vast in terms of infrastructure and alignment with the national guidelines and policies since they key in their health data in the national health database (usually the DHIS2). Therefore, most EMR/EHR systems that are currently operational in the public system at secondary and tertiary levels have the potential to scale and be used at a national level. However, private sector EMR/EHR systems operate following the regulations set by the government, but they often operate on their own and as such do not share their data with the DHIS2 or the existing national database.
The minimum general regulatory adherence are the eleventh or tenth revision of the International Classification of Diseases (ICD 10/11), Fast Healthcare Interoperability Resources (HL7®FHIR®), World Health Organization Standards, and local Ministries of Health standards.

SSA healthcare provider preference: Flexibility of cloud-based data systems above hardware storage and management

The majority of healthcare providers in the SSA setting are not keen to develop and invest in bulky hardware to store data; instead, they would like to work via existing platforms that require low-investments costs and take up limited space. Therefore, a cloud-based system for EMR/EHR usage and storage is most suitable. The cloud-based system allows healthcare providers a certain level of flexibility in terms of storage size, sharing of data, and cost control in terms of maintenance and subscription fees.

Incorporate multiple-user interfaces to enhance the usability reach of the EMR/EHR

Currently, a challenge that many SSA-based healthcare providers face is that the EMR system they use has a low level of interface capability between different systems. This creates a miss-match and lack of collaboration between different departments with varied IT systems including EMR/EHR systems. EMR/EHR systems should incorporate multiple user interfaces to cater to the diverse needs and roles of healthcare professionals within a healthcare facility. It is important to note that while multiple user interfaces can enhance usability and efficiency, it is crucial to maintain consistency in terms of data integration, security, and user experience across all interfaces to ensure a cohesive and unified EMR system. As the setting in African hospitals and clinics is dynamic, disease trends can rapidly change in a quick timespan, to adequately respond to changes an EMR/EHR system needs to have certain capabilities that allow for flexibility and adaptability.
Furthermore, blockchain-based systems can offer an innovative way to mitigate data and cyber security issues. Moreover, their inclusion of Artificial Intelligence (AI) capabilities facilitates forward-thinking decision-making for end users by providing data-driven reports, predictive analysis, and insights.

Invest in trust, ownership, and capacity strengthening of EMR/EHRs at healthcare provider level

The SSAs healthcare sector is characterized by various resource constraints that pose challenges to the implementation and adoption of EMR/EHR systems. This involves limited infrastructure in terms of electricity, internet, and mobile connectivity, and inadequately trained personnel. To cushion these challenges and mitigate risks, EMR/EHR systems need to maintain robust offline capabilities to ensure seamless workflow during periods of limited access to electricity and the internet. In addition, investments, and time to train and sensitize the implementers of the EMR/EHRs are key as they are the main users of the system.
In addition, the provision of backup technical support, either by the developer or IT personnel, is highly recommended.
African health systems are becoming more patient-focused with the introduction of digital health. It is increasingly possible to receive remote care. EMR/EHR systems need to be fit for purpose and not only enable outpatient and inpatient care management but also include remote care management and data capturing capabilities.

EMR/EHRs in SSA: Customizable, dynamic, cost-effective, and light – A one-size-fits-all approach would not fit

In conclusion, an ideal EMR/EHR system tailored for SSA must prioritize a holistic approach that considers the region’s unique healthcare challenges and opportunities. By adhering to country-specific regulations, ensuring the flexibility of cloud-based data storage, offering multiple user interfaces, and promoting seamless data exchange, the system can cater to diverse healthcare settings and varying levels of digital literacy.

Moreover, its ability to support resource-constrained environments, facilitate system integration and interoperability and emphasize patient-centeredness and remote care capabilities can revolutionize healthcare access and delivery in the region. By addressing these essential aspects, stakeholders can lay the foundation for a technologically advanced, patient-centric, and efficient healthcare ecosystem in SSA. What this exactly looks like, differs per healthcare facility and disease contextual, cultural, and geographical situation; there is no one-size fits all solution.

About Africa Health Business (AHB)

AHB is a dynamic and influential pan-African advisory and consulting firm driven by the compelling vision of “in Africa, by Africa, for Africa”. Headquartered in Nairobi, Kenya, AHB is dedicated to strengthening the private sector to play an impactful role in solving Africa’s healthcare challenges. We provide tailor-made market insights, strategic focus and foster productive stakeholder engagements to enhance access to equitable healthcare across Africa.
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641365/
  2. https://www.niaid.nih.gov/research/niaid-research-sub-saharan-africa
  3. https://www.frontiersin.org/articles/10.3389/fpubh.2022.856397/full
  4. https://www.healthit.gov/faq/what-are-advantages-electronic-health-records
  5. https://www.postdicom.com/en/blog/advantages-and-disadvantages-of-ehr

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