Examining the current adoption of digital health innovations in Kenyan hospitals and exploring their potential for improving services and patient care.

Project Overview

We use the term digital health to encompass health services and information delivered or enhanced through the internet and related technologies. It is recognised as one of the most rapidly growing areas in health today, encompasses the more specific mHealth field, and is anticipated to make a major contribution to achieving universal coverage. Much of the activity in the field is focused on the primary development of specific solutions to problems framed as a technocentric challenge in healthcare management (eg. information systems that streamline management functions) or care (eg. the many mHealth decision tools or job aides). Less work has been conducted on the absorptive capacity of health care contexts and the formal and informal process of assimilation of digital health at specific levels of health system organisation.

Thus while it is expected that digital health will transform the shape of healthcare provision (including by disrupting existing models of care) based on the opportunities it provides for knowledge sharing, learning, standardising care, reducing errors, task-shifting and performance monitoring (amongst others) little attention seems currently to be paid to the contexts that might be transformed in LMIC. Large and smaller district hospitals in many LMIC are expected to offer a set of services that cannot be provided at lower levels of the health system. Such services are traditionally based on the notion that skills or resources need to be concentrated in one location because of scarcity and to promote efficiency. These hospitals are therefore, expected to contribute to the system of primary care by providing, for example, more advanced diagnostic services, care for acute severe illness, a set of more sophisticated interventions, surgical care and the coordinating expertise to manage chronic conditions. As organisations these hospitals represent a complex ecosystem into which digital health solutions might be integrated. Yet, this organisational environment is, from an digital health perspective, poorly understood.

The proposed DPhil will begin to explore the district hospital as an organisational form with a view to examining any current use of digital health tools supporting knowledge sharing, learning, standardisation of care (eg. through disseminating guidelines), reducing errors (eg. through prescribing guides) and, task-shifting (eg. tools that support continuity of care across providers or patient engagement in care). This work will focus on the use of digital health by frontline healthworkers in their day to day work, aim to analyse what challenge identified tools address, their stage of adoption and why they are being adopted. Work will further examine whether these digital health tools are being adopted by individuals themselves or whether they are assimilated formally into the hospital’s systems of organising or providing care or are linked to any wider health information system. In linked work the DPhil will encompass work exploring, from frontline worker perspectives, where eHealth solutions might meet needs for knowledge sharing, learning, standardisation of care, error reduction or task-shifting.

To address the questions outlined above the student will initially spend time identifying useful literature and develop a solid theoretical basis for subsequent empiric work. It is anticipated that literature from areas spanning dissemination of innovations, implementation science, organisational science and information sciences may be explored (see footnotes for examples).  Drawing on this literature the student will develop a proposal for empiric work to be conducted in Kenya where there is a substantial existing programme of work that engages with county (district) hospitals. Empiric work will likely employ qualitative methodologies spanning interviews, group discussions and field observations. Use may also be made of participatory group meetings drawing on human centred design approaches to explore with health workers needs and opportunities for eHealth tools. 

Background references:

What is e-health? G Eysenbach. J Med Internet Res 2001;3(2):e20doi:10.2196/jmir.3.2.e20

  1. Report of the third global survey on eHealth Global Observatory for eHealth - Global diffusion of eHealth http://apps.who.int/iris/bitstream/10665/252529/1/9789241511780-eng.pdf?ua=1
  2. English M, et al. (2006). The District Hospital. Disease Control Priorities in Developing Countries - 2nd Edition. D. Jamison, G. Alleyne, J. Breman et al. Washington DC, World Bank: 1211-1228.
  3. Greenhalgh, T., et al. (2004). "Diffusion of innovations in service organizations: systematic review and recommendations." Milbank Q 82(4): 581-629.)
  4. May, C. R., et al. (2016). "Implementation, context and complexity." Implementation Science 11(1): 141.
  5. Kumar, P., et al. (2016). "I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries." Arch Dis Child 101(10): 974-979.
  6. Edgcombe, H., et al. (2016). "Enhancing emergency care in low-income countries using mobile technology-based training tools." Arch Dis Child.

Training Opportunities

Training opportunities: Time will be spent learning and conducting literature reviews and developing conceptual frameworks linked to thinking on digital health implementation, adoption and assimilation. Skills in proposal writing to satisfy the requirements of scientific and ethical review will be developed. Where necessary appropriate training in research methods will be provided (eg. in qualitative data collection and analysis) and there will be opportunities for engaging with a wider body of researchers in Oxford and the Kenya engaged in health systems research and health informatics.  It is anticipated that during the course of the DPhil and primarily linked to the collection of primary data between 6 and 12 months may be spent in Kenya based at the Nairobi offices of the KEMRI-Wellcome Trust Research Programme (www.kemri-wellcome.org).


Tropical Medicine & Global Health


Project reference number: 946

Funding and admissions information


Name Department Institution Country Email
Professor Mike English Tropical Medicine Oxford University, Nairobi KEN menglish@kemri-wellcome.org
Dr Chris Paton Tropical Medicine Oxford University, NDM Research Building GBR chris.paton@ndm.ox.ac.uk
Associate Professor Niall Winters Department of Education Oxford University GBR niall.winters@education.ox.ac.uk

There are no publications listed for this DPhil project.