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Introduction: Keeping HIV-infected adults away from the health care system during the COVID-19 travel restrictions, presents a challenge to HIV treatment adherence. Methods: This study focused on the initial two phases where Phase 1 designed a Makerere College of Health Sciences (MakCHS) Unstructured Supplementary Service Data (USSD)-based application; and Phase 2 piloted patient enrolment onto the application and determined the feasibility of remote follow-up of patients receiving long-term antiretroviral therapy (ART). Results: A off/online user application, MakCHS Health app, was developed. Overall, 112 patients [(66(59%) female] receiving ART at Mulago ISS clinic, Kampala, were enrolled onto the MakCHS Health app. Up to 89 (80%) utilized the app to access medical help. Patients’ medical queries included needs for drug refills, missed taking HIV medication, medical illnesses, access to COVID-19 vaccination and other personal needs that required clinicians’ attention. Conclusion: Piloting a MakCHS Health application for patient follow-up was feasible and well-received by HIV treatment providers and patients receiving ART. We recommend scale up of the application to enroll all patients receiving long-term treatment for HIV/AIDS, and subsequently expand to. other HIV treatment programs in similar settings. Keywords: M-Health; patient follow up; Chronic HIV treatment; Antiretroviral therapy.

Food security (FS) challenges exist in both the developed and the developing countries, the difference being the severity and the proportion of the population affected. Previous studies maintain that chronic food insecurity at subsistence farming level has persisted due to a number of factors including unsustainable subsistence agriculture and livelihood policies, lack of inputs, poor conservation methods, weak extension services, unregulated markets, limited land among others. This article investigates FS challenges at subsistence farming level using system dynamics tools. The emerging system dynamics model is conceptualised into four sectors; food production, sales, income and food consumption, representing a real-life food security system. The model is used to evaluate policies for better livelihoods as well as explore strategies for profitable subsistence farming and food security.

Food security concepts are extensively used in households as a measure of welfare, to conceptualise operational usefulness in the design, implementation, and evaluation of policies. Most research is focused on improving food security and sustainability and the patterns still remain tenuous. This article explores food security indicators for sustainability by using system dynamics to understand the interconnectedness of the food security system. This is done by analysing quantitative and qualitative concepts of food security indicators. The simulation result shows dynamics of cropland decreasing with increasing population as they need food, energy and space to survive.

Food security (FS) challenges exist in both the developed and the developing countries, the difference being the severity and the proportion of the population affected. Previous studies maintain that chronic food insecurity at subsistence farming level has persisted due to a number of factors including unsustainable subsistence agriculture and livelihood policies, lack of inputs, poor conservation methods, weak extension services, unregulated markets, limited land among others. This article investigates FS challenges at subsistence farming level using system dynamics tools. The emerging system dynamics model is conceptualised into four sectors; food production, sales, income and food consumption, representing a real-life food security system. The model is used to evaluate policies for better livelihoods as well as explore strategies for profitable subsistence farming and food security.

Food security concepts are extensively used in households as a measure of welfare, to conceptualise operational usefulness in the design, implementation, and evaluation of policies. Most research is focused on improving food security and sustainability and the patterns still remain tenuous. This article explores food security indicators for sustainability by using system dynamics to understand the interconnectedness of the food security system. This is done by analysing quantitative and qualitative concepts of food security indicators. The simulation result shows dynamics of cropland decreasing with increasing population as they need food, energy and space to survive.

Health Information Systems (HIS) in Uganda always fail to achieve the organizational objectives and yet little research has been conducted to study the strategic alignment of HIS in the country. This study therefore set out to examine the antecedents and dynamics that influence strategic alignment of HIS in Uganda with the aim of adequately addressing the complex IS design issues a total of 296 respondents were purposively selected from 39 health facilities across the country to participate in the survey. Data was analyzed using descriptive statistics. Findings from the study revealed that HIS are used to locate substitute sources for medical commodities, reduce costs of handling orders as well as minimize uncertainty in ordering lead time. In addition, HIS provide information to clients, add value to existing health services and are used to target health service needs with accuracy as well as identify groups of clients whose needs are not being met. HIS are used to minimize the cost of designing services, adding features to existing services and population grouping services at the health unit level. In the area of internal health facility efficiency, HIS help in ensuring efficiency and enable informed decision making, provide efficiency in internal meetings and discussions, co-ordination among facility departments, and provide good evaluation on annual budget. Further, HIS are used by health workers to provide evaluation on capital, maximize organizational performance, population coverage and strategic planning efficiency. Despite the above, the study revealed that health units do not have standards, frameworks and policies for the strategic alignment of HIS and the funding to support them. For better alignment of HIS, there should be proper planning and training of health workers on the importance of strategic alignment of HIS. Further, health facilities should be encouraged to adopt electronic information systems to improve their efficiency and effectiveness. There should also be policies, frameworks and or standards for guiding strategic alignment of Health Information Systems in health facilities. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

PurposeThe purpose of this paper is to develop a framework for designing sustainable telemedicine information systems in developing countries.Design/methodology/approachBoth quantitative and qualitative research methods were used. Primary data were collected from two hospitals in Uganda using a self‐administered questionnaire and an interview guide. Descriptive statistics were used to analyze survey data, while content analysis method was used to analyze interview responses. The framework was developed based on Hevner et al.'s design science framework.FindingsThe key requirements for designing sustainable telemedicine information systems in developing countries were identified as the need for speed, ease of use and affordability.Research limitations/implicationsThis study was theoretical in nature. Although primary data were used, the researchers were unable to carry out a series of practical tests of this framework with prototype systems on a cross‐section of users.Practical implicationsDesign and sustainability of telemedicine information systems is still a big challenge to most developing countries, despite its wide usage in the developed countries. While various telemedicine frameworks exist, not much has been done to adequately address the issue of design for sustainability. This paper proposes an appropriate framework that will guide telemedicine information systems designers on designing telemedicine systems that are sustainable in local conditions of developing countries.Originality/valueThe main contribution of this paper is in the area of information systems design for sustainability, from a developing country perspective. The paper also extends on the constructs of design science research theory and shows how they can be applied in information systems design and evaluation.

Alignment of Information Systems with organizational objectives and strategy is a key factor for the success of information systems. However, most health facilities have not aligned their Health Information Systems to organizational-wide strategic goals and objectives. This has led to challenges such us poor planning, lack of resources and above all the lack of direction by top management in implementing and using Health Information Systems. This research involved an assessment of the requirements for strategic alignment of health information systems in health facilities, development and validation of a strategic alignment model using selected health facilities.A multi-method research approach involving the use of quantitative and qualitative methods was used. The quantitative approach provided quantitative data that was used to generate requirements for the development of the model, as well as validating and testing of the system dynamics model. A sample of 408 respondents was taken from 39 health facilities in Uganda to participate in the study. Data was analyzed using descriptive statistics and presented in tables and graphs. The requirements for strategic alignment of Health Information Systems were identified as proper planning, establishment of policies, frameworks and standards, resource mobilization, establishment of work processes, training and sensitization of staff members about Health Information Systems work processes. Further, there is need to minimize time lag between HIS and other integrated organization information systems, improve on useful features and functions of HIS and also ensure the system covers all functions of the health facility. The study proposes a model, which when well used can help to improve the strategic alignment of Health Information Systems in health facilities.

Background: Of the three million newborns that die each year, Uganda ranks fifth highest in neonatal mortality rates, with 43,000 neonatal deaths each year. Despite child survival and safe motherhood programmes towards reducing child mortality, insufficient attention has been given to this critical first month of life. There is urgent need to innovatively employ alternative solutions that take into account the intricate complexities of neonatal health and the health systems. In this paper, we set out to empirically contribute to understanding the causes of the stagnating neonatal mortality by applying a systems thinking approach to explore the dynamics arising from the neonatal health complexity and non-linearity and its interplay with health systems factors, using Uganda as a case study. Methods: Literature reviews and interviews were conducted in two divisions of Kampala district with high neonatal mortality rates with mothers at antenatal clinics and at home, village health workers, community leaders, healthcare decision and policy makers, and frontline health workers from both public and private health facilities. Data analysis and brainstorming sessions were used to develop causal loop diagrams (CLDs) depicting the causes of neonatal mortality, which were validated by local and international stakeholders. Results: We developed two CLDs for demand and supply side issues, depicting the range of factors associated with neonatal mortality such as maternal health, level of awareness of maternal and newborn health, and availability and quality of health services, among others. Further, the reinforcing and balancing feedback loops that resulted from this complexity were also examined. The potential high leverage points include special gender considerations to ensure that girls receive essential education, thereby increasing maternal literacy rates, improved socioeconomic status enabling mothers to keep healthy and utilise health services, improved supervision, and internal audits at the health facilities as well as addressing the gaps in resources (human, logistics, and drugs). Conclusions: Synthesis of theoretical concepts through CLDs facilitated our understanding and interpretation of the interactions and feedback loops that contributed to the stagnant neonatal mortality rates in Uganda, which is the first step towards discussing and exploring the potential strategies and their likely impact.

This article critically examines the challenges associated with demand for immunization, including the interplay of political, social, economic and technological forces that influence the level of immunization coverage. The article suggests a framework to capture the complex and dynamic nature of the immunization process and tests its effectiveness using a case study of Ugandan healthcare provision. Field study research methods and qualitative system dynamics, a feedback and control theory based modelling approach, are used to capture the complexity and dynamic nature of the immunization process, to enhance a deeper understanding of the immunization organizational environment. A model showing the dynamic influences associated with demand and provision of immunization services, with the aim of facilitating the decision making process as well as healthcare policy interventions, is presented.

This paper demonstrates how qualitative System Dynamics methodology can be used to provide a better understanding of health systems thus facilitating better development and design of computer-based health information systems. In an earlier paper by the same authors, system dynamics modeling and field study research methods are used to capture the complex and dynamic nature of the immunization process, to enhance the understanding of the immunization health care problems and to generate insights that may increase the immunization coverage effectiveness. Through qualitative modeling, causal loop diagrams which are used to show the key issues that need to be addressed when developing health information systems are drawn with the aim of improving the immunization services. The paper shows the benefits of using System Dynamics to understand systems with complex interactions thus facilitating the development of information systems that meet the stakeholder requirements.