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

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.