Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study

Emeka Chukwu; Lalit Garg; Edward Foday; Abdul Konomanyi; Royston Wright; Francis Smart

doi:10.2196/30040

Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study

JMIR Med Inform. 2022 Feb 3;10(2):e30040. doi: 10.2196/30040.

Authors

Emeka Chukwu¹, Lalit Garg¹, Edward Foday², Abdul Konomanyi³, Royston Wright⁴, Francis Smart²

Affiliations

¹ Department of Computer Information Systems, Faculty of Information Communications Technology, University of Malta, Msida, Malta.
² Directorate of Policy, Planning, and Information, Ministry of Health and Sanitation, Freetown, Sierra Leone.
³ Directorate of eGovernment, Ministry of Information and Communication, Freetown, Sierra Leone.
⁴ Monitoring and Evaluation Unit, Health and Nutrition, United Nations Children's Fund, Freetown, Sierra Leone.

PMID: 35113026
PMCID: PMC8855303
DOI: 10.2196/30040

Abstract

Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility-based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions.

Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample.

Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period.

Results: Among the 72 surveyed health facilities, 59 (82%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60%) use solar energy as their only electricity source and the other 6 (40%) have no electricity source. Similarly, among the 13 hospitals, 5 (38%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3%) PHUs have one computer each, and 37 (63%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95% confidence level within an 11% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22%) of the 72 respondents stated that device theft is a primary hindrance to digitization.

Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone.

Keywords: Sierra Leone; SpaceX; connectivity; digital health; eHealth infrastructure; health ICT; internet; mHealth; rural areas; rural-urban divide.

©Emeka Chukwu, Lalit Garg, Edward Foday, Abdul Konomanyi, Royston Wright, Francis Smart. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 03.02.2022.