Why Sub-Saharan Africa Lags in Electronic Health Record (EHR) Adoption and Possible Strategies to Increase EHR Adoption in this Region

  • Raphael Oluseun Odekunle Bronx-Lebanon Hospital Center


Poor health information system has been identified as a major challenge in healthcare in many developing countries including sub-Saharan African countries. EHR has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. Therefore, this study seeks to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region.  A literature review was conducted using one of the second generation approaches, mixed synthesis. A comprehensive literature search was conducted on two electronic databases: PubMed and Medline. The available evidence indicates that there are many factors that hinder widespread adoption of an EHR in sub-Saharan Africa. These include high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and  internet connectivity, and primary user's limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than we think because of the current poor level of technological development, lack of required computer skills, and limited resources.






Download data is not yet available.



World Health Organization. Core Health Indicators 2008; Available on http://apps.who.int/whosis/database/core/core_select_process.cfm accessed on 2nd September, 2015.

Chaplin B, Meloni S, Eisen G, Jolayemi T, Banigbe B, Adeola J, Wen C, Nieva HR, Chang C, Okonkwo P, Kanki P. Scale-up of networked HIV treatment in Nigeria: Creation of an integrated electronic medical records system. International journal of medical informatics. 2015;84:58-68.

Ajiboye BA, Adekoya AJ, Alawiye MK, Oyedipe WK. Knowledge and utilization of health information and communication technologies (HICTs) by health workers of the North-Eastern health zone of Ogun State, Nigeria. Informatics for Health and Social Care. 2014;39:104-23.

Cline GB, Luiz JM. Information technology systems in public sector health facilities in developing countries: the case of South Africa. BMC medical informatics and decision making. 2013;13:13.

Fraser H, Biondich P, Moodley D, Choi S, Mamlin B, Szolovits P. Implementing electronic medical record systems in developing countries. Journal of Innovation in Health Informatics. 2005;13(2):83-95.

Williams F, Boren SA. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Informatics in primary care. 2008;16:139-45.

Pantuvo JS, Naguib R, Wickramasinghe N. Towards implementing a nationwide electronic health record system in Nigeria. International Journal of Healthcare Delivery Reform Initiatives. 2011;3:39-55.

Simba DO. PRACTICE POINTS Application of ICT in strengthening health information systems in developing countries in the wake of globalisation. African health sciences. 2004;4:194-198.

Monda J, Keipeer J, Were MC. Data integrity module for data quality assurance within an e-health system in sub-Saharan Africa. Telemedicine and e-Health. 2012;18:5-10.

International Organization for Standardization ISO/DTC 20514. Health Informatics-Electronic Health Record-Defination, Scope, and Context 2005. Available on https://www.iso.org/obp/ui/#iso:std:39525:en accessed on 3rd April, 2015).

Williams F, Boren SA. The role of electronic medical record in care delivery in developing countries. International Journal of Information Management. 2008;28:503-7.

Blaya JA, Fraser HS, Holt B. E-health technologies show promise in developing countries. Health Affairs. 2010;29:244-51.

Castelnuovo B, Kiragga A, Afayo V, Ncube M, Orama R, Magero S, Okwi P, Manabe YC, Kambugu A. Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa. PLoS ONE. 2012; 7: e51631

Shortliffe EH, Cimino JJ. Biomedical Informatics: Computer Applications in Healthcare and Biomedicine. New York, NY: Springer 2014: 1-43.

Institute of Medicine. Key Capabilities of an Electronic Health Record System: Letter Report. Washington, DC: The National Academies Press. 2003: 1-36.

Oluoch T, Santas X, Kwaro D, Were M, Biondich P, Bailey C, Abu-Hanna A, de Keizer N. The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: A systematic review. International journal of medical informatics. 2012;81(10) 83-92.

Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs. 2005 ;24(5):1103-1117.

Akanbi MO, Ocheke AN, Agaba PA, Daniyam CA, Agaba EI, Okeke EN, Ukoli CO. Use of electronic health records in sub-Saharan Africa: progress and challenges. Journal of medicine in the tropics. 2012;14(1):1-6.

Pope C, Mays N, Popay J. Synthesising Qualitative and Quantitative Health Evidence: A Guide to Methods: A Guide to Methods. McGraw-Hill Education (UK); 2007

Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, Hsu R, Katbamna S, Olsen R, Smith L, Riley R. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC medical research methodology. 2006;6;6(1):35.

Awokola BI, Abioye-Kuteyi EA, Otoru OO, Oyegbade OO, Awokola EO, Awokola OA, Ezeoma IT. Practical challenges of setting up an electronic medical record system in a Nigerian tertiary hospital: The Wesley Guild Hospital experience. Middle East Journal of Family Medicine. 2012 ;7(10): 37-42

Awokola BI, Abioye-Kuteyi EA, Ogundele OA, Awokola EO. Computer and Internet Use by Doctors in a Nigerian Teaching Hospital: A Survey of the Wesley Guild Unit of Obafemi Awolowo University Teaching Hospitals Complex. Middle East Journal of Family Medicine. 2011;9(9):17-21.

Ameh N, Kene TS, Ameh ES. Computer knowledge amongst clinical year medical students in a resource poor setting. African health sciences. 2008 10;8:40-43.

Daini OA, Korpela M, Ojo JO, Soriyan HA. The computer in a Nigerian teaching hospital: First-year experiences. MEDINFO. 1992;92:230-235.

Jimoh L, Pate MA, Lin L, Schulman KA. A model for the adoption of ICT by health workers in Africa. International journal of medical informatics. 2012;81:773-781.

Kamadjeu RM, Tapang EM, Moluh RN. Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: a case study from Cameroon. Informatics in primary care. 2005;13:179-86.

Fraser HS, Blaya J. Implementing medical information systems in developing countries, what works and what doesn’t. In AMIA Annual Symposium Proceedings 2010:232-236.

Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N, Mamlin BW, Mamlin JJ, Einterz RM, Tierney WM. Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. Journal of the American Medical Informatics Association. 2003;10(4):295-303.

Abramson EL, McGinnis S, Moore J, Kaushal R. A statewide assessment of electronic health record adoption and health information exchange among nursing homes. Health services research. 2014;49(1pt2):361-372.

How to Cite
Odekunle, F. F., Srinivasan, S., & Odekunle, R. O. (2018). Why Sub-Saharan Africa Lags in Electronic Health Record (EHR) Adoption and Possible Strategies to Increase EHR Adoption in this Region. Journal of Health Informatics in Africa, 5(1), 8-15. https://doi.org/10.12856/JHIA-2018-v5-i1-147
Research article