Appraising eHealth Investment for Africa: Scoping Review and Development of a Framework

Area of Science:

• Health Informatics
• Health Economics
• Health Systems Strengthening

Background:

• Growing opportunities for resource-constrained countries to leverage digital health (eHealth) for health system improvement.
• Challenges in conducting economic appraisals for eHealth investments due to limited economic expertise and data in low- and middle-income countries.
• Need for a suitable framework to guide eHealth investment decisions in these settings.

Purpose of the Study:

• To identify and, if necessary, develop a framework for performing eHealth investment appraisals.
• To address the constraints of limited economic expertise and data in resource-limited environments.
• To support effective and wise eHealth investments in low- and middle-income countries.

Main Methods:

• Conducted a scoping review to identify and chart relevant investment appraisal frameworks.
• Identified required framework attributes from published checklists.
• Analyzed frameworks using deductive and inductive iterations to refine attributes and develop a new framework if needed.

Main Results:

• Identified 24 candidate investment appraisal attributes, refined to 23 final attributes.
• Reviewed seven relevant frameworks, finding no single framework adequately addressed all attributes.
• Developed a new, evidence-based framework that incorporates all 23 identified attributes.

Conclusions:

• A novel investment appraisal framework has been developed specifically for eHealth.
• The framework is practical and business-case focused, designed for resource-constrained African settings.
• Provides a tool to overcome limitations in economic expertise and data for eHealth investment appraisal.