Systematic review: Decentralised health information systems implementation in sub-Saharan Africa

Globally the health space is being revolutionised by rapid digital transformation to support care activities, promote healthier lifestyles and ensure informed decision making to improve service delivery. However, many health systems in sub-Saharan Africa are yet to realise the full potential of health information systems (HIS) as a digital transformation initiative. The objective of this article is to establish how the sociotechnical challenges in Africa's health systems can be addressed by recommending a fitting approach to implement HIS relevant to the context of the continent. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique was applied to search, identify and filter articles over a 10-year period by applying inclusion and exclusion criteria accordingly. Only 42 articles satisfied the objective of this article. The emergent themes include contextual factors, coordination and collaboration, data complexity, organisation structure, accountability and stakeholders' perspectives. The results indicated that less attention has been given to how the implementation approach could impact the output of health systems. In conclusion, the authors argue that a decentralised approach to the implementation of HIS is more appropriate for Africa's health systems. The premise of the authors' argument is informed by the tiered structure of health systems, varying levels of infrastructural development and use of large volumes of health-related data for resources allocation at the national level. Future studies should investigate the processes for formulation and evaluation of health policies to actively redress the administrative issues associated with the current functional HIS in each African country. Transdisciplinarity Contribution: The paper contributes to the practical implications of implementing HIS in sub-Saharan African health systems by highlighting the contextual realities and data governance complexities that support a decentralised approach towards ensuring resilience and health security.