Implementation effectiveness of mHealth interventions for communicable diseases surveillance in the context of sub-Saharan Africa : the case of eIDSR in Tanzania

The adoption of mobile and wireless technologies for health (mHealth) interventions for national disease surveillance functions in sub-Sahara Africa (SSA) countries is increasing, but implementation processes and outcomes are rarely reported or unreported. Reported interventions are not effectively implemented because they are often rushed, donor driven, focus on the technology, and are not scaled up or evaluated. This thesis investigated the effectiveness of an integrated mHealth intervention that was implemented for disease surveillance in Tanzania, called eIDSR, by examining how it was adopted and being implemented, the quality of the targeted clinical data, and the value it adds to the availability, quality and use of surveillance data. A mixed-methods design was employed to retrospectively explore the first four years of eIDSR implementation, from the organisational change perspective. Although eIDSR implementation is supported by a relatively positive implementation climate and had been expeditiously implemented in 50% of all health facilities within the first two years, the results indicate that it had not been implemented effectively. The use of eIDSR to submit data was poor, declining with time, and it was not prioritised to notify outbreaks or inform response activities. This was attributed to the uninformed and non-participatory implementation process that was not supported by evidence of good results, the poor information culture, donors' influence, the focus on the technology and its presumed benefits, the lack of leadership capabilities and technical support, and the effect of the per diem culture. In order to effectively implement eIDSRs, the thesis proposes an organisation-wide implementation framework emphasising a change management process, which includes improving clinical practices, implementation climate, evidence-based practices, and information culture; identifying and addressing explicit and implicit organisational forces affecting implementation decisions, and integrating eIDSR design and practices in flexible health system digital infrastructures to optimise the utilisation of scarce implementation resources.