Contextual Barriers to Health Information Systems Optimization in Underserved Communities in Kenya: Qualitative Study Informed by Frugal Innovation and Information and Communication Technologies for Development.

Background: Health information systems (HISs) are essential for strengthening health systems in underserved areas. However, many HISs in Africa are still in the early stages of implementation, and existing systems often suffer from imbalances in data availability. Their optimization is faced with various challenges, including limited resources, which restricts their scalability. Objective: The aim of this study is to identify contextual barriers that hinder the optimization of HIS in African underserved settings. Specifically, the study adopts the lens of frugal innovation (FI) and information and communication technologies for development (ICT4D) to explore ways to enhance the quality of health care delivery for low-income populations. Methods: A qualitative research approach involving 32 participants was used. The study was guided by the central theme: contextual barriers and challenges hindering the optimization of HISs. Results: Four major thematic categories emerged from the data: HIS contextualization, health system factors, service provider issues, and HIS integration. The findings offer valuable insights that can contribute to transforming HISs in underserved settings and improving health care quality. Conclusions: The findings reflect stakeholder experiences in underserved communities in Nairobi, Kenya, and may be transferable to similar settings, subject to local governance, resources, and workflows. Despite the transformative potential of HISs in low- and middle-income countries, progress remains limited due to poor digital infrastructure and contextual barriers resulting in minimal impact from capital-intensive digital health investments and persistent data challenges. Using FI and ICT4D lenses, 4 key barriers were identified: health system, HIS contextualization, HIS integration, and HIS service provider. Rethinking HIS strategies through FI and ICT4D can enable affordable and sustainable, user-centered solutions. Future research should test scalability, sustainability, and interoperability impact in diverse settings.