Discussion
This review shows that with the exception of
PDA-based data collection, there are still few
scientifically rigorous data on the effectiveness
and cost-effectiveness of e-health systems in developing
countries. Further, the evaluations
have mostly been performed by organizations
connected to academic settings and not by other,
larger recipients of donor funding.When looking
at the software systems included in the U.S. President’s
Emergency Plan for AIDS Relief (PEPFAR)
Anti-Retroviral Therapy (ART) Software
Inventory Report5 and EngenderHealth–Open-
Society software tools38 comparison, only three
systems, the Partners in Health—Electronic
Medical Record/HIV—Electronic Medical Record
in Kenya, Mosoriot Medical Record System
in Kenya, and Vista in the U.S. Indian Health
Service, have had any evaluations performed.
Although a few studies have been commissioned
by the U.S. Centers for Disease Control and Prevention
(CDC), it is particularly important that
large funders such as the U.S. Agency for International
Development or PEPFAR include resources
for the evaluation of e-health systems
developed and deployed in developing countries
and perhaps make them a requirement for continued
funding. This could include
standard designs for studies that
are suitable for resource-poor environments,
that minimize biases,
and that are easily comparable to
the results from other projects.
The overall pattern of e-health
evaluations in developed countries
reflects an initial focus on qualita-