Global Diffusion of the Internet X: The Diffusion of Telemedicine in Ethiopia: Potential Benefits, Present Challenges, and Potential Factors

Delivery of healthcare services presents many challenges for governments in most developing countries. Some of these challenges include financial and human resources issues that might affect governments\u27 ability to manage and transform scarce resources to meet healthcare needs. Telemedicine, a healthcare delivery technology where physicians examine patients from distant locations using information technologies, is reported to be increasingly helpful in meeting the needs of the healthcare sector in developing nations such as those in sub-Saharan Africa. This conceptual study reports on the sectoral adoption of telemedicine in Ethiopia, a sub-Saharan African country. We examine the potential benefits of telemedicine diffusion in Ethiopia, addressing the country\u27s healthcare needs, and discussing the obstacles and challenges. Based on previous literature, as well as experiences drawn from other developing nations, we address three potential factors that could influence the diffusion of telemedicine in Ethiopia: active participation of institutions of higher education, Ethiopian foreign alliances, and government involvement. Although the initial successes are relatively small and involve isolated projects, they have been promising and have set the stage for researchers to investigate prevailing projects so as to gain better understanding of the aforementioned factors. Our study does not claim that telemedicine can solve all of Ethiopia\u27s medical challenges; however, we contend that it is a starting point to reach Africans that live in areas with limited medical facilities and personnel. Hence, our study could have far reaching implications as the world looks to help this country, and by extension, other developing countries, to overcome their medical challenges and join the information society

A framework for evaluating telemedicine-based healthcare inequality reduction in Ethiopia : a grounded theory approach

Text in EnglishTelehealth makes healthcare services accessible by underserved and resource-constrained rural communities of developing countries such as Ethiopia. However, the limitation of frameworks on telemedicine-based healthcare inequality reduction is a challenge for developing countries. In Ethiopia there are four telemedicine projects; however, there is no evidence that any of these projects have been evaluated by considering contextual issues. This academic research explored telehealth practices in Ethiopia with the aim of developing a comprehensive telehealth evaluation framework for developing countries. Such a conceptual framework could be used to inform health institutes and governmental policy makers and in so doing create a vehicle for the implementation of improved health practices in Ethiopia. A grounded theory approach is used to qualitatively explore the usefulness of telemedicine practices in Ethiopia, in mitigating healthcare inequality. Grounded theory makes use of emerging insights in order to contribute to new knowledge. From the inductive analysis of the study, themes such as barrier removal, service quality, synergetic effect, localization, technical setup, resource utilization and managerial readiness emerged to formulate a framework for evaluating telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia. This study contributes to the understanding of the question of how telemedicine practices can be evaluated, to support the healthcare service and reduce the healthcare inequalities in resource constrained communities in Ethiopia. Moreover, the framework could be used during evaluation of telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia.School of ComputingPh.D. (Information Systems

Neurotrauma care in Ethiopia: Building for the future

Bakgrunn: Nevrotraumer er et stort folkehelseproblem i Etiopia, og hovedmålet med denne oppgaven var å studere behandlingen av nevrotraumepasienter i landet. Materiale og metoder: Vi brukte prospektive (artikkel I, II og IV) og retrospektive (artikkel III) studiedesign og inkluderte pasienter fra 2012 til 2017. I artikkel I og II studerte vi 1087 opererte hodeskadepasienter i Etiopia. I artikkel III sammenlignet vi 314 etiopiske og 284 norske pasienter operert for kronisk subduralt hematom (KSDH). I artikkel IV studerte vi 117 sykehusbehandlede og 51 rettsmedisinsk undersøkte fallofre med hodeskade eller ryggmargsskade i Etiopia. Resultater: I artikkel I fant vi at den vanligste årsaken til hodeskade var overfall, mens impresjonsbrudd og epiduralblødning var de hyppigste skadene. Mange pasienter opplevde store forsinkelser, og det var en invers sammenheng mellom skadens alvorlighet og tid til innleggelse. I artikkel II viste vi at de hyppigste operasjonene var elevasjon av impresjonsbrudd og kraniotomi for epiduralblødning. Komplikasjonsraten var 17 % og 3 % av pasientene ble reoperert. I artikkel III fant vi at kirurgisk praksis var lik i Etiopia og Norge, men etiopiske pasienter med KSDH var yngre, hadde mindre komorbiditet, brukte sjelden antikoagulasjon/platehemmer, fikk sjelden postoperativ bildediagnostikk og hadde færre reoperasjoner og medisinske komplikasjoner. I artikkel IV viste vi at de fleste fallofrene ble skadet på byggeplasser, og få brukte verneutstyr. Komplett ryggmargsskade var vanlig blant de innlagte pasientene og få pasienter med ryggmargskade ble operert. Hodeskade var den vanligste dødsårsaken blant rettsmedisinsk undersøkte fallofre og de fleste pasientene døde på ulykkesstedet. Konklusjoner: Behandling av nevrotraumer i Etiopia er assosiert med betydelige ressursbegrensninger og stor pasientseleksjon både før og etter sykehusinnleggelse. Mange pasienter har imidlertid hatt nytte av utviklingen av nevrokirurgi i Etiopia, og våre studier kan bidra til å forbedre kvaliteten på omsorgen ytterligere, utvikle kostnadseffektive helsetjenester, identifisere fokusområder for forebyggende innsats og veilede lovgivningsprogrammer.Background: Neurotrauma is a major public health problem in Ethiopia, and the main aim of this thesis was to study the management of neurotrauma patients in the country. Material and methods: We used prospective (paper I, II, and IV) and retrospective (paper III) study designs and included patients from 2012 to 2017. In papers I and II, we studied 1087 surgically treated traumatic brain injury (TBI) patients in Ethiopia. In paper III, we compared 314 Ethiopian and 284 Norwegian patients operated for chronic subdural hematoma (CSDH). In paper IV, we studied 117 hospital-treated and 51 forensically examined fall victims with TBI or spinal cord injury (SCI) in Ethiopia. Results: In paper I, we found that the most common cause of TBI was assault, while depressed skull fracture (DSF) and epidural hematoma (EDH) were the leading injuries. Many patients suffered significant time delays, and injury severity and time to admission were inversely related. In paper II, we showed that the most frequent operations were DSF elevation and craniotomy for EDH. The complication rate was 17% and 3% of the patients were reoperated. In paper III, we found similar surgical routines in Ethiopia and Norway, but Ethiopian CSDH patients were younger, had fewer comorbidities, rarely used anticoagulants/antiplatelets, infrequently underwent postoperative imaging, and had less reoperations and medical complications. In paper IV, we found that most fall victims were injured at construction sites, and few used protective equipment. Complete SCI was common among hospitalized patients and few SCI patients were operated. TBI was the most common cause of death among forensically examined patients and most patients died at the accident scene. Conclusions: The management of neurotrauma in Ethiopia was associated with significant resource limitations and substantial patient selection both before and after hospital admission. Many patients have however benefitted from the development of neurosurgical services in Ethiopia, and our studies might help to further improve the quality of care, develop cost-effective health services, identify focus areas for preventive efforts, and guide legislative programs.Doktorgradsavhandlin

The development of telemedicine programs in Sub-Saharan Africa: Progress and associated challenges

Monitoring the progress of telemedicine use in Sub-Saharan Africa (SSA) countries has received a considerable attention from many health organizations and governmental agencies. This study reviewed the current progress and challenges in relation to the development of telemedicine programs in SSA. The results from reviewing 66 empirical studies revealed an unbalanced progress across SSA countries. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the success of telemedicine development in SSA. This study reported the current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. The outcomes from this study offer a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA

The Need for Public Policy Initiatives to Retain Medical Doctors in Ethiopia

Ethiopia suffers from a medical shortage or brain drainthat has severely affected its already fragile health care system. The country has a very low physician-to-population ratio,whilemany in the medical community continue to leave in great numbers. Aphenomenological approach was used in this study to explore the lived experiences of medical doctors who have left Ethiopia, with contemporary migration theory serving as the conceptual framework. The central research question focused onwhy Ethiopian medical doctors leave their country and what can be done to retain them. Participants were 10 medical doctors of Ethiopian origin who live and practice medicine in the Washington, DC metropolitan area. Participantswere purposively selected, and in-depth interviews and a focus group discussion were used to collect data from them. The study followed Moustakas\u27 recommendations for phenomenological analysis, which representeda modification of the Stevick-Colaizzi-Keen method. The themes that emerged during data analysis have economic, political, professional, and personal dimensions. The findings includelow pay, lack of professional development, poor working conditions, the threat of political persecution, fear of contracting HIV, and inability to participate in health care decision-making. Recommendations accordingly include offering pay raises and fringe benefits, creating opportunities for professional development, improving working conditions, and limiting political interference in the health care system. Implications for positive social change include the fact that stemming the outflow of medical doctors could help save the lives of thousands of Ethiopians threatenedby preventable and curable diseases

Dynamics of Technology Acceptance to the Sustainability of eHealth Systems in Resource Constrained Environments

Healthcare in developing countries is confronted with a shortage of skilled healthcare workforce, medical errors, inequity and inefficient healthcare service delivery. Innovative ways of solving healthcare problems through Information and communication technology (ICT) can improve the efficiency, effectiveness, access and quality of the healthcare system. Despite highly anticipated benefits of eHealth system to improve the efficiency of healthcare delivery, the healthcare had barely begun to take advantage of ICT mainly in a resource-constrained environment. The implementation of eHealth systems in developing countries could not proceed beyond the pilot phase to demonstrate sustainability in a large-scale rollout. The general research problem in this thesis focuses on how factors of eHealth implementation interplay to influence technology and information use to ensure the long-term sustainability of eHealth in resource-constrained settings. Systems thinking and system dynamics modelling method were used to handle complexity in the implementation of eHealth. Moreover, sustainability theory, technology acceptance model (TAM) and IS success models were used to develop a system dynamics model of sustainable eHealth implementation. The socio-technical, techno-organizational and techno-economic factors of sustainable eHealth systems are discussed to address the research objectives. The system dynamics simulation model of sustainable eHealth implementation is developed, verified, validated and tested. This applied research study focused on addressing the problems of sustainable eHealth systems implementation in resource-constrained environments. The model-based theory-building research study followed in this thesis aimed at enhancing the understanding of sustainable eHealth implementation in a resource-constrained environment to maximize the acceptance of eHealth by the end-users. Both the ontological and epistemological assumptions of this research study supported the position of the constructivist research paradigm. Methodologically, this study mainly applies qualitative research methodology which is common in the interpretive approach. Structured and semi-structured questionnaires were used to elicit information from purposefully sampled eHMIS and SmartCare health facilities in Ethiopia. Field notes, document review, interview and focus group discussion data were analysed using ATLAS.ti software. Vensim DSS Version 6.3D was used to model and simulate the system dynamics model. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach was followed in the systematic literature review of techno-economic factors. The simulation results confirmed that the ‘effectiveness of training’ was a dominant factor to improve the ‘acceptance rate’ of eHMIS and SmartCare in the socio-technical dimension of sustainable eHealth implementation. The adequacy of ICT and healthcare workforce within eHealth implementing facility and end-users’ familiarity with digital technology showed a stronger influence on the ‘acceptance rate’ of both eHMIS and SmartCare systems in the techno-organizational dimension. An economic incentive, funding duration, funding amount, funding source and economic benefit are identified as techno-economic factors that influence the long-term sustainability of eHealth projects.Thesis (PhD)--University of Pretoria, 2019.Graduate School of Technology Management (GSTM)PhDUnrestricte

Stakeholder Contradictions in Early Stages of eHealth Efforts

Use of information and communication technology (ICT) in healthcare has increased substantially over the past decades. Implementation of ICT in municipal health services (eHealth) involves a variety of stakeholders, and may lead to changes in the roles of providers and patients. Coordination, communication, early identification and involvement of key stakeholders in eHealth projects have been highlighted as important. However, research often takes a narrow perspective and pays scant attention to conflicting drivers. This study used a qualitative approach to identify and investigate contradictory stakeholder interests in the early phase of a municipal eHealth project. Analysis using Stakeholder Theory (ST) and Dialectic Process Theory revealed two important contradictions; 1) effective service versus efficient service and 2) technology enthusiasm versus reluctance to change. The analysis illustrated the usefulness of combining these theories in eHealth efforts. Implications from our research suggest that stakeholder management should be considered to prevent conflicts in eHealth projects

UNDERSTANDING THE PRESENT TO PREPARE FOR THE FUTURE: A REVIEW OF HEALTH INFORMATION SYSTEMS RESEARCH IN NIGERIA (7)

Health Information Systems (HIS) present many opportunities to address health challenges in developing countries such as Nigeria. However, in order to leverage the potential of HIS, the opportunities and challenges facing implementation must be explored and understood. This paper conducts an archival analysis of the existing literature on HIS in Nigeria published in premier Information Systems (IS) and Health Informatics outlets; in an effort to provide a comprehensive picture of existing literature by identifying trends, discussing findings, and proposing new research opportunities. The 18 articles meeting the inclusion criteria are reviewed. Current trends are discussed using the framework developed by McLeon et al. (2013) for understanding the factors influencing health IS implementation in developing countries. At present, several challenges face IS implementation in Nigeria such as the lack of policy guidance, resistance among end users, and cultural barriers. In addition, existing studies are limited in scope, theory, and level of analysis applied. The paper contributes to the literature by investigating the status quo, presenting new areas ripe for future investigation including the organisational, financial, and technological issues at play, and illuminating important issues which can guide pilot testing and implementation of new health IS initiatives in Nigeria

Ethiopean-Eritrean studies: a bibliography on society and history, 2016-2022

J. Abbink produced a new bibliography on Ethiopian-Eritrean studies in society and history. It is a by- product of research he did on these countries in the past five years and is the ultimate volume in the series. The volume covers the period from 2016  to July 2022 and contains all the crucial references to recent work in history, archaeology, sociology, anthropology, economics, agricultural studies, politics, international relations, environmental studies, religious and cultural studies. Also prominent are themes like the Nile Basin, (regional) conflict, food (in)security, gender relations, demographic developments, urban life, arts & crafts, and pastoral societies.A brief introduction situates the bibliography in the wider field of Ethiopian-Eritrean studies and clarifies the underlying criteria of inclusion and organization of the references. As much as possible, the individual references also contain a link to their digital publication website. The work is concluded with an author name index and is published as an E-book only.ASC – Publicaties niet-programma gebonde