Smart Paper Technology for maternal and newborn health data in The Gambia: A qualitative study of early implementation
8 affiliations
- 1Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
- 2Charité Centre for Global Health and Institute for International Health, Charité Universitatsmedizin, Berlin, Germany.
- 3London School of Hygiene & Tropical Medicine, London, United Kingdom.
- 4Reproductive, Maternal, Newborn Child and Adolescent Health Programme, Ministry of Health, The Gambia.
- 5Directorate of Planning and Information, Ministry of Health, Kotu, The Gambia.
- 6Expanded Programme on Immunisation, Ministry of Health, Kotu, The Gambia.
- 7Bundung Maternal and Child Health Hospital, Kanifing, The Gambia.
- 8Directorate of Health Research, Ministry of Health, Kairaba Avenue, The Gambia.
Abstract
Many low- and middle-income countries rely on paper-based maternal and child health records that are often incomplete, fragmented, and difficult to use for continuity of care and decision-making. Smart Paper Technology (SPT), a hybrid paper–digital documentation system, has been proposed as a practical alternative to fully electronic medical records in resource-constrained settings. This study explored the early implementation of SPT in maternal and infant health services in The Gambia, focusing on feasibility and acceptability. We conducted a qualitative descriptive implementation evaluation guided by Rapid Assessment Procedures (RAP) in two pilot facilities in the Western Region of The Gambia between September and December 2024. Data were collected through 30 semi-structured interviews; four focus group discussions with 30 participants spanning facility-level clinical, management, and administrative staff, Ministry of Health staff, and technical and implementing partners; and non-participant observations across key service delivery areas. Data were analysed thematically using NVivo 14. Participants described SPT as feasible and broadly acceptable because it built on familiar paper-based workflows, was introduced through a participatory process, and offered advantages in reporting, information retrieval, and maternal–infant record linkage. However, these benefits were contingent on the implementation context. Key challenges included uneven training coverage, dual documentation, limited internet connectivity, scanning and data capture errors, storage constraints, and concerns about data governance. Staff adapted through peer mentoring, remote troubleshooting, and local workarounds. Participants emphasised that successful scale-up would require sustained training, clear governance arrangements, adequate human and technical resources, and a phased transition to government ownership. SPT offers a practical pathway towards digitisation in maternal and infant health services in LMICs, but its success depends on strong organisational systems, workforce support, and implementation processes that are responsive to routine service realities.
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BibTeX
@article{nkereuwem2026smart,
title = {{Smart Paper Technology for maternal and newborn health data in The Gambia: A qualitative study of early implementation}},
author = {Oluwatosin Nkereuwem and Jana Prauseová and Rachel Ford and Alpha Omar Jallow and Musa Marena and Gibril Jarju and Sidat Fofana and Mamady Cham and Buba Manjang and Beate Kampmann and Joanna Busza},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0006244},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006244},
note = {CC BY},
}
RIS
TY - JOUR
TI - Smart Paper Technology for maternal and newborn health data in The Gambia: A qualitative study of early implementation
AU - Oluwatosin Nkereuwem
AU - Jana Prauseová
AU - Rachel Ford
AU - Alpha Omar Jallow
AU - Musa Marena
AU - Gibril Jarju
AU - Sidat Fofana
AU - Mamady Cham
AU - Buba Manjang
AU - Beate Kampmann
AU - Joanna Busza
PY - 2026
DA - 2026/10/23
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0006244
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006244
AB - Many low- and middle-income countries rely on paper-based maternal and child health records that are often incomplete, fragmented, and difficult to use for continuity of care and decision-making. Smart Paper Technology (SPT), a hybrid paper–digital documentation system, has been proposed as a practical alternative to fully electronic medical records in resource-constrained settings. This study explored the early implementation of SPT in maternal and infant health services in The Gambia, focusing on feasibility and acceptability. We conducted a qualitative descriptive implementation evaluation guided by Rapid Assessment Procedures (RAP) in two pilot facilities in the Western Region of The Gambia between September and December 2024. Data were collected through 30 semi-structured interviews; four focus group discussions with 30 participants spanning facility-level clinical, management, and administrative staff, Ministry of Health staff, and technical and implementing partners; and non-participant observations across key service delivery areas. Data were analysed thematically using NVivo 14. Participants described SPT as feasible and broadly acceptable because it built on familiar paper-based workflows, was introduced through a participatory process, and offered advantages in reporting, information retrieval, and maternal–infant record linkage. However, these benefits were contingent on the implementation context. Key challenges included uneven training coverage, dual documentation, limited internet connectivity, scanning and data capture errors, storage constraints, and concerns about data governance. Staff adapted through peer mentoring, remote troubleshooting, and local workarounds. Participants emphasised that successful scale-up would require sustained training, clear governance arrangements, adequate human and technical resources, and a phased transition to government ownership. SPT offers a practical pathway towards digitisation in maternal and infant health services in LMICs, but its success depends on strong organisational systems, workforce support, and implementation processes that are responsive to routine service realities.
SN - 2767-3375
ER -