© Schattauer 2017 Methods Inf Med 2/2017 1 Review Articles Assessing the Coverage of E-Health Services in Sub-Saharan Africa A Systematic Review and Analysis Davies Adeloye 1,2 ; Taiwo Adigun 3 ; Sanjay Misra 3,4 ; Nicholas Omoregbe 3 1 Demography and Social Statistics, and the e-Health Research Cluster, Covenant University, Ota, Nigeria; 2 Centre for Global Health Research, University of Edinburgh Medical School, Usher Institute, Edinburgh, UK; 3 Department of Computer and Information Sciences, Covenant University, Ota, Nigeria; 4 Department of Computer Engineering, Atilim University, Ankara, Turkey Keywords E-health, telemedicine, mhealth, sub-saha- ran, africa Summary Background: E-Health has attracted grow- ing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. Objectives: To review publicly available lit- erature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. Methods: Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. Results: Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002–2014. Six types of e-Health interven- tions were reported, with 17 studies (65 %) based on telemedicine, followed by mHealth with 5 studies (19 %). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19 %), pathology (12 %) and radiology (8 %). Successes were ‘widely re- ported’ (representing 50 % overall accept- ance or positive feedbacks in a study) in 10 studies (38 %). The prominent challenges re- ported were technical problems, poor inter- net and connectivity, participants’ selection biases, contextual issues, and lack of funds. Conclusion: E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contex- tually feasible, acceptable, and sustainable. Correspondence to: Dr. Davies Adeloye Demography and Social Statistics, and the e-Health Research Cluster Covenant University Ota Nigeria E-mail: Davies.Adeloye@covenantuniversity.edu.ng Methods Inf Med 2017; 56: ■■–■■ https://doi.org/10.3414/ME16-05-0012 received: November 9, 2016 accepted: January 7, 2017 epub ahead of print: ■■■ 1. Introduction Over the last two decades, increasing ef- forts to effectively deploy information and communication technologies (ICTs) in health service delivery have been observed, and attracted varying interests globally [1, 2]. A 2009 forecast suggested that e-Health service, including digitalization of health records and cloud applications, may in- crease from 71 million to about 1 billion subscribers in 2014 [3]. The European Net- work and Information Security Agency (ENISA) reported that ICT, incorporating health records, data science and cloud computing, was set to attract massive glo- bal investment, with expenditure estimated at US $44 billion in 2013 [4]. This has relatively increased expectations of im- proved quality, efficiency and effectiveness of health information systems and health care delivery in developing countries [5]. Health experts have emphasized the growing importance of a comprehensive e-Health system among the top needed measures towards improving national health systems [6]. This has further raised awareness on the ‘big data’ approach to col- lation and analysis of health data across world countries, as a measure to bridge gap between health care delivery, policy re- sponse and population health outcomes [1, 7]. The introduction of e-Health services has reportedly reduced health care costs and increased efficiency of health service delivery in many low- and middle-income countries (LMICs), where weak govern- ance, poor funding, and recurrent health workforce crisis, among others, have been major health system challenges [2]. Ac- cording to Kgasi and Kalema, e-Health has also relatively addressed prevailing in- equalities in health care provision across many LMICs, bridging the ‘urban versus rural’, and ‘rich versus poor’ gaps, respect- ively [8]. Following the 2005 World Health Assembly (WHA) 58 resolution to imple- ment e-Health systems globally, the World Health Organization (WHO) has provided technical support to member states, es- pecially in the WHO African region, to as- sist in the full implementation of e-Health