Liberya'nın EHS Uygulamaları İçin Hibrit Bir Çerçeve Önerisi

Özet (abstract)

Liberia, like other fragile post-conflict health systems, still relies mainly on paper patient records, and electronic health record (EHR) initiatives have repeatedly failed to reach routine use or national scale. The literature documents the barriers but explains less well why they persist. This conceptual paper proposes three candidate mechanisms and a phased framework, the Hybrid Incremental Digital Transition Framework (HIDTF), for the transition from paper to interoperable EHRs in Liberia. Conceptual synthesis and framework development. Peer-reviewed and grey literature on Liberia and comparable low- and middle-income settings was identified through purposive, iterative searching (PubMed, Europe PMC, Google Scholar) and synthesised narratively by a single author. The corpus is illustrative, not comprehensive, and no quality appraisal or independent screening was done. Constructs from established implementation science frameworks, sociotechnical systems theory and resilience theory, with a political economy lens, were used to derive mechanisms and design requirements. Additional file 1 lists all cited sources and codes the support for each element as a documented finding, a source-author interpretation or an inference by the author. Three candidate mechanisms were proposed. Recursive implementation failure: each abandoned attempt may deplete absorptive capacity and deepen scepticism, lowering the odds of the next attempt. Reliability asymmetry: where power and connectivity are unreliable, reversion to paper can be a rational professional response rather than resistance. Incentive misalignment: donor accountability structures can reward deployment outputs over sustained use. HIDTF proposes five phases and readiness gates (a coordination mechanism and an agreed interoperability approach; minimum infrastructure with offline capability; a trained local cadre) to be met before a site or county digitises. Hybrid paper-digital workflows would be governed as a designed arrangement, and domestic financing would be planned from the outset. No durations or numerical targets are proposed, and four testable propositions are stated. HIDTF is a theory-informed proposal built on secondary evidence from Liberia and comparable settings. The evidence on sequencing is mixed, since one cited source recommends concurrent development, and transferability beyond Liberia is a hypothesis. A Liberian initiative chronology, stakeholder consultation and prospective pilot evaluation are needed before adoption. Not applicable.

Yazarların özeti; kaynağından alınmıştır. BMC Health Services Research, 2026 · DOI ↗