Linking the Malawian Diaspora to the Development of Malawi”
Malawi
Malawi (/məˈlɔːwi,məˈlɑːwi/; Chichewa pronunciation:[maláβi]; Tumbuka: Malaŵi), officially the Republic of Malawi and formerly known as Nyasaland, is a landlocked country in Southeastern Africa. It is bordered by Zambia to the west, Tanzania to the north and northeast, and Mozambique to the east, south and southwest. Malawi spans over 118,484 km2 (45,747 sq mi) and has an estimated population of 19,431,566 (as of January 2021). Malawi’s capital and largest city is Lilongwe. Its second-largest is Blantyre, its third-largest is Mzuzu and its fourth-largest is its former capital, Zomba.
Cserepes – The Beginning of the Beginning (Fonó, 2024)
Károly Cserepes returns with The Beginning of the Beginning, his seventh remix album. This new installment draws on African musical traditions to create nine reimagined tracks.
Africa’s influence is central to the project. As Cserepes notes, the continent holds unmatched depth and diversity in folk music. Unlike the strophic forms typical in European traditions, African music often emphasizes repetition, melodic development, and cyclical structures. These features, along with polyrhythmic layering and call-and-response vocals, form the foundation of Cserepes’s reinterpretations.
The rediscovery of African folk music in Europe began in the 1950s and ’60s, aided by portable tape recorders like the Nagra and Uher. These tools enabled researchers to capture high-quality field recordings, which later fueled archives and publications that remain accessible today. These recordings, once niche, went on to inspire minimalist composers such as Terry Riley, Steve Reich, and Philip Glass. In Hungary, the 180 Group carried the torch of this repetitive aesthetic, while African-American jazz, rooted in similar traditions, shaped 20th-century classical composers like Stravinsky and Gershwin.
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Despite this legacy, the intrusion of Western technology and ethnographic interest typically triggered the erosion of the very traditions they sought to preserve. Cserepes’s album thus functions not only as a remix but also as a reminder: these are endangered musical artifacts, worthy of both reinterpretation and respect.
Track titles reference a variety of African cultural terms and groups:
Ngoni – An ethnic group across southern Malawi, Mozambique, Tanzania, Zimbabwe, and Zambia.
Banda-Linda – A dialect of the Banda people in the Central African Republic.
Iboga – A hallucinogenic plant used in West African rituals.
Nganga – A spiritual healer or diviner in Central African religious practices.
Nyankanga – A significant gold deposit in northern Tanzania.
Dikoboda Sombe – A pygmy children’s song, cited as a nod to early oral traditions.
Strangely, The Beginning of the Beginning seems to be available only from Apple Music.
Author: Angel Romero
Angel Romero y Ruiz has dedicated his life to musical exploration. His efforts included the creation of two online portals, worldmusiccentral.org and musicasdelmundo.com. In addition, Angel is the co-founder of the Transglobal World Music Chart, a panel of world music DJs and writers that celebrates global sounds. Furthermore, he delved into the record business, producing world music studio albums and compilations. His works have appeared on Alula Records, Ellipsis Arts, Indígena Records and Music of the World.
Effective communication is significantly important in the present healthcare landscape, as inadequacy may lead to conflicts among healthcare providers.1 The implementation of health information system (HIS) enhances community welfare by improving quality health services, the performance of health professionals, and reducing potential treatment errors.2 Due to the intrinsic connection with communication processes, the effective use of HIS necessitates healthcare professionals communicating effectively through system, understanding updates and protocols, as well as providing feedback on experiences.3–5 In the past era of paper records, data has become difficult to interpret, illegible, lost, or incomplete, resulting in limited analysis and insights.6 HIS is a structured framework that integrates data collection, processing, and reporting to support decision-making, enhance service quality, ensure patient safety, control healthcare financing, improve the overall effectiveness and efficiency of health services.7–9 The digitization of healthcare data has significantly transformed the responsibilities and tasks of health professionals, leading to increased engagement in technical roles.10 In principle, good health services require the support of HIS infrastructure.11 Information system is a fundamental enabler of knowledge management for health services.12
Various types of HIS widely used in healthcare settings include Electronic Medical Record (EMR), Computerized Physician Order Electronic (CPOE), management, immunization information, institutional information, disease management, clinical documentation, and health information exchange networks.2,13 The benefits of these HIS, such as improved care coordination14 and enhanced decision-making,15 are heavily reliant on effective communication facilitated by systems and the communication surrounding use. However, practical use entails both benefits and challenges. The benefits comprise increased efficiency, improved care coordination, and enhanced decision-making.16,17 Previous systematic reviews showed that all seven quantitative studies focusing on process evaluation signified patient satisfaction with the use of digital health technology in pharmaceutical care delivered by pharmacists.18 It is important to acknowledge and tackle associated challenges, such as the privacy and security of patient data. Resistance to change among healthcare professionals can also hinder the use and integration of HIS technology into existing workflows.10,16
A comprehensive understanding of facilitator and barrier in HIS is essential. This provides benefits, such as enhancing clinical outcomes, streamlining care coordination, optimizing practice efficiencies, and effectively monitoring data over time.19 On the other hand, awareness of barrier allows organizations to proactively address and mitigate the factors. Digital health technology interventions have proved effective, but the impact on clinical outcomes varies, signifying the need for personalized feedback to ensure consistent and beneficial effects.20 Important factors affecting system acceptance by users include attitudes, behavioral control, transition costs, service coordination, information management, and the ability to track healthcare outcomes, all of which are facilitator.21 Meanwhile, financial issues, resistance to change, and IT problems during implementation were commonly mentioned as barrier to the use of Electronic Health Records (EHR) and Health Information Exchanges (HIE).22
Understanding the multifaceted challenges associated with HIS implementation is crucial for overall success. Although these challenges include significant barrier encountered by patients in adopting and effectively using systems, concerns regarding the privacy and security of health information,23 limitations in access to patient portals24 as well as other digital health interfaces, the perspectives of healthcare professionals are equally critical. Health professionals are the primary users and implementers of HIS in daily practice.25 Acceptance, effective use, and identification of facilitator and barrier directly impact the successful integration of HIS into clinical workflows,26,27 ultimately affecting patient care and safety.19,28
Barrier and facilitator related to HIS use, as well as the impact on the on-user engagement and satisfaction need to be discussed. Understanding the broader context in which the system is implemented is essential while developing strategies to overcome challenges. Previous systematic reviews have focused only on a single country,29 a specific region,30 or emphasized the exploration of acceptance theory.31 A review from the perspective of healthcare professionals regarding facilitator and barrier, without being limited to a specific region, is needed. In general, scoping reviews are designed to map key concepts and examine studies in an area to provide an overview of the extent and nature of the current literature.32–34 Therefore, this scoping review aimed to provide thematic summary information on facilitator or barrier to HIS use from the perspective of healthcare professionals, making the scoping review methodology well-suited to explore the available evidence without imposing strict inclusion criteria.
Method
The review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines35 (Supplementary Material 1):
Information Sources and Search Strategy
The literature search for this scoping review was conducted on two electronic databases including Scopus, a comprehensive multidisciplinary database with scientific, technical, medical, and social sciences literature as well as MEDLINE through PubMed, a premier source for biomedical and health-related studies. These two databases were selected to provide broad and focused coverage of the relevant literature. To minimize potential bias in the search strategy, several steps were taken. Firstly, the PCC (Population, Concept, Context) framework was applied to define the scope of the search, ensuring that all relevant facets of the study question were considered. The participants (P) consisted of healthcare professionals including, but not limited to, physicians, nurses, pharmacists, and allied health staff, who use HIS. The concept (C) focused on facilitator and barrier affecting the adoption and use. The context (C) comprises various healthcare settings, including hospitals, clinics, community health centers, and other relevant environments where these systems are implemented.
Secondly, the search strategy was developed by translating the PCC components into relevant keywords and MeSH terms. For example, ‘healthcare professionals’ and related terms were used to represent the Population, ‘acceptance and barrier’ represented the Concept, while “hospital”, “clinic”, and ‘community health’ represented the Context, with ‘health information systems’ as the primary topic of focus.
Thirdly, the search terms were combined using Boolean operators (AND, OR) to refine the search and retrieve the most relevant studies. The combination strategies were carefully considered to capture the most relevant studies and minimize irrelevant studies. The full strategy using a combination of medical subject heading terms and text words is presented in Table 1. A scoping review methodology was selected due to the broad and heterogeneous nature of the study question. Given the wide range of HIS, technologies, and healthcare settings, a scoping review allowed effective mapping of the existing evidence and identifying key concepts, rather than focusing on a specific intervention or outcome, as in a systematic review. This approach was suitable for exploring the overall landscape of facilitator and barrier in the field.33
Table 1 Literature Search Strategy
Eligibility Criteria
To minimize potential bias in the selection of studies for this scoping review, clear and objective eligibility criteria were established in line with the PCC framework. The scoping review included original observational or experimental that met the following criteria:
Healthcare professionals directly engaged with HIS, including but not limited to physicians, nurses, midwives, pharmacists. This criterion ensured that the perspectives and experiences captured are from individuals who directly interact with HIS in professional roles, providing relevant insights into facilitator and barrier.
Focused on the assessment of HIS, defined as an integrated and interoperable system designed to manage healthcare data, including various functions namely collecting, storing, managing, and transmitting data of patients, operational management of hospitals, and supporting healthcare policy decision.36 This provides a clear and consistent definition of the core concept under investigation, ensuring that the included literature focuses on comprehensive HIS rather than isolated technologies or systems with limited functionality.
Identify facilitator or barrier to HIS use by healthcare professionals.37 This criterion directly addresses the question of the scoping review, ensuring that the included studies provide data relevant to understanding the factors influencing HIS use.
Studies conducted within healthcare setting (eg, hospitals, clinics, community health centers). This ensures that the results are relevant to real-world healthcare environments where HIS is implemented and used, enhancing the applicability of the review results to practice.
Availability of full text in English. Limiting inclusion to English language studies allows for a comprehensive understanding and accurate synthesis of the evidence, mitigating potential misinterpretations due to translation limitations.
Published between 2013 and 2023. This timeframe was selected to capture the contemporary landscape of HIS adoption and use. The starting year of 2013 was selected to focus on more recent developments and challenges in the field, considering the rapid evolution of health information technology in the past decade. The end year of 2023 ensures the inclusion of the most up-to-date studies available at the time of the search.
Exclusions criteria comprised:
Studies lacking full-text availability. The exclusion of these studies ensures that a thorough assessment of the methodology and results can be conducted, as crucial information may be missing from abstracts or other limited-access formats.
Conference proceedings, letters, editorials, commentaries, posters, reviews, and presentations. These publication types generally provide preliminary results, opinions, or summaries rather than in-depth analyses of original study. Focusing on original observational or experimental studies ensures a more robust and detailed evidence base for the scoping review.
Studies focusing on mobile phone devices. While mobile health (mHealth) is relevant, the focus of this review is on integrated and interoperable HIS. Excluding studies solely on individual mobile phone applications helps to maintain the scope on more comprehensive healthcare data management systems.
Study Selection
Relevant studies identified through title and abstract screening were independently evaluated by two authors (NY, QAK). Subsequently, a thorough evaluation of the full-text versions was independently conducted against the eligibility criteria. This dual review further minimized the risk of selection bias by ensuring that the final inclusion of studies was based on a consistent and agreed-upon application of the criteria. In cases of disagreements that could not be resolved, the other three authors (SDA, AAS, and RA) were available to act as adjudicators. Consensus was adopted for final resolution in all cases of disagreement. This multi-reviewer approach with a clear mechanism for resolving conflicts reduced the potential for subjective bias in the final selection of studies.
Extraction and Management Data
The data extraction process was primarily undertaken by NY and QAK, while SDA checked and verified the data extraction process. This independent verification step further minimized the risk of extraction errors, ensuring the accuracy and completeness of the extracted data. Any discrepancies or doubts identified during this verification process were discussed and resolved through consensus among all three authors. Data were extracted using predefined extraction tables and manually recorded in Microsoft Excel 2010. The use of predefined tables ensured that all relevant data points were systematically collected across all included studies, reducing the potential for information bias due to inconsistent extraction. The characteristics of each extracted article included general information (author, year of publication, study location), objectives, type of HIS, methods (study design, population, sample size, data collection methods), key results (facilitator and barrier), and funding.
Data Analysis and Synthesis
Based on the heterogeneity of the data concerning population, type of HIS examined, and methodological approaches, a qualitative narrative synthesis was undertaken to address the broad study question of this scoping review. The primary method of data analysis included a thematic content analysis of the extracted facilitator and barrier to HIS adoption and use by two authors (NY and QAK) independently. In this process, each extracted facilitator and barrier was subjected to content analysis through the coding of relevant keywords. The process allowed for cross-verification of emerging themes and reduced the risk of individual bias influencing the categorization of results. Disagreements in coding or theme assignment were resolved through discussion and consensus among the two primary authors. Following the independent coding, the identified keywords were categorized into four themes based on previous studies.30,38 These categories provided facilitator and barrier of HIS for understanding the key contextual domains, including colleague and social context, organizational, individual, as well as technological and technical. Colleague and social context were defined as the role of co-workers and leaders who have a good understanding and knowledge of digital system in creating a shared awareness to motivate users toward increasing acceptance and intention to adopt technology in the workplace.39 Organizational context refers to readiness of policymakers in preparing infrastructure and resources (finance and human resources with the potential to master information technology).40 Individual context is defined as capacity in the implementation of system, including experience, age, attitudes and behavior towards technology, ability to be trained/learned, intention to use, perceptions, expectations of system, knowledge, and awareness of system/technology.41 Technological context of the study was described as the capacity and availability of information technology with technical support to increase acceptance and use of the system.17 Additionally, each facilitator and barrier was analyzed through the lens of the 2023 World Bank classification settings, annually updated by July 1 based on Gross National Income (GNI) per capita from the preceding calendar year.42 The specific GNI per capita thresholds for each income group served as crucial benchmarks. These include low-income country (LIC), lower middle-income country (LMIC), upper middle-income country (UMIC), and high-income country (HIC), with GNI per capita of $1135 or less in 2022, between $1136 to $4465, $4466 to $13,845, and $13,846 or more, respectively.
Quality Assessment
QAK conducted the evaluation of included studies to determine methodological quality assessment, with additional independent verification performed by SDA. Any discrepancies between the reviewers (QAK and SDA) were resolved through consensus. This step ensured that judgments were not solely reliant on a single individual interpretation, thereby reducing the risk of subjective bias. The quality assessment process for the included studies was based on the method adopted. Studies using qualitative method were assessed using JBI Critical Appraisal Checklist for Qualitative Research.43 Similarly, those that applied the cross-sectional method were subjected to the JBI Critical Appraisal Checklist for Cross-Sectional Research.44 Studies using mixed method were assessed using the Mixed Methods Appraisal Tool.45 These checklists incorporate specific criteria designed to evaluate various aspects of study quality, thereby minimizing bias arising from a lack of clear assessment criteria. Studies scoring higher than 70%, between 50% and 70%, and less than 50%, were categorized as high, medium quality, and low quality, respectively. The pre-defined categorization of quality scores (high, medium, and low) based on established thresholds provided a consistent and transparent approach to interpreting the assessment results, reducing potential bias in the overall quality rating of the included studies.
Result
Study Selection
The PRISMA flowchart showing the literature selection steps is presented in Figure 1. A comprehensive search across Scopus and MEDLINE through PubMeddatabases resulted in 676 references potentially meeting the inclusion criteria. Following a selection process, comprising duplicate removal as well as titles and abstracts evaluation, 148 studies were reviewed for full-text eligibility assessment. Finally, 79 that met the inclusion criteria were included in the review.
Figure 1 PRISMA Flowchart of Study Selection Process. Adapted from Page M J et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; n71 10.1136/bmj.n71. Creative Commons.46
The review explored facilitator and barrier across various contextual perspectives (Supplementary Material 3). Organizational context showed facilitating conditions regarding HIS use as the most frequent facilitator, as shown by the results from 11 studies. HIC and LMIC were the focus of the most discussions (4 studies each), as presented in Figure 2. However, the lack of consensus responsibility was identified as a significant barrier, with results from 13 studies outlining the impact. HIC had the highest number of discussions, while no LMIC addressed the issue. From an individual context perspective, positive behavior and attitude were outlined as the primary facilitator for HIS use, according to the results from 27 studies. Negative perception was identified to be a prominent barrier, as signified by 10 studies. In the technological context, the usefulness and daily task-simplifying of HIS were identified as the most substantial facilitator, with evidence from 22 studies supporting this observation. Conversely, the lack of technical support was identified as a significant barrier, with 19 studies identifying the impact. In the social context, support from experienced friends was identified as an influential facilitator, judging by the results from 11 studies. Lack of leadership role was recognized to be a significant barrier, based on evidence from 12 studies.
Figure 2 Facilitator and Barrier of Utilization of HIS.
Quality Assessment
A quality assessment was conducted, and the results showed that there were no low-quality identified in the qualitative and mixed-method studies (Supplementary Material 4). Among the qualitative studies, 13 and 5 were categorized under high and moderate quality, respectively. Similarly, in the mixed method, 11 and 2 were classified under high and moderate quality. Regarding the cross-sectional studies, the majority of 36 studies were determined to be of high quality, with 9 classified under moderate quality. Meanwhile, only 2 studies were considered to be of low quality, as both lacked clear descriptions of inclusion criteria, subject and setting explanations, standard criteria for the measured conditions, and details of the statistical analysis adopted.
Discussion
This review outlined the multifaceted nature of facilitator and barrier toward the implementation and use of information system and technology by healthcare professionals, ranging from individual, technological, organizational, and social contexts. This classification provided a comprehensive understanding of the diverse factors. By organizing these facilitator and barrier into specific categories, a deeper insight into the multifaceted nature of the challenges and opportunities associated with HIS use was acquired.
Individual Context
In LIC, the identified facilitator in individual contexts was limited to positive attitude and behavior,68,93,103 alongside possessing good IT knowledge.93,103 A positive attitude and behavior, comprise maintaining an optimistic outlook on life, expecting improvement and success, as well as viewing the bright side of challenging situations.124 HIC, UMIC, and LMIC recognized a broader spectrum of facilitator in individual contexts, including previous IT experience, positive attitude and behavior, intention to use, positive perception, and good knowledge. Studies showed that subjects with a positive perception of HIS usefulness, often due to good IT knowledge or experience, tend to have a more positive attitude towards the application in work, perceiving it as facilitator rather than barrier.125 Furthermore, the intention to use HIS significantly strengthened this relationship, specifically when users believe in the positive impact towards HIS.125 This implies that the effective adoption of HIS could be significantly improved by training initiatives to enhance health workers confidence in using system and by clearly communicating the benefits to increase motivation.
The most prevalent barrier in the individual context across HIC, UMIC, LMIC, and LIC was negative perception towards the use of new technology in the implementation of HIS. Barrier in individual contexts was nearly the same in all categories of countries, signifying a shared struggle in addressing barrier toward HIS implementation. To overcome negative perceptions, there is a need to actively acquire positive information and experiences. This enables healthcare professionals to effectively handle the inevitable challenges faced in demanding healthcare settings.126 Negative perceptions often arise from a natural tendency to focus more on negative information. Consciously combating this bias by identifying positive aspects can be instrumental in reshaping perceptions.127 However, lack of IT experience was not mentioned as barrier in LIC, which can be attributed to limited exposure to complex system and a greater emphasis on addressing resource constraints.128 A combination of technological enhancements, capacity-building activities, and data quality assessment with a feedback system has proven to be effective in enhancing IT experience.129
Evidence increasingly shows the challenges arising from a lack of human-centered design in HIS, directly impacting performance in healthcare settings. For example, inadequate HIS planning, lack of training for professionals, and inadequate preparation for unplanned system disruptions can all lead to compromised healthcare quality and increased risks to patient safety.130 Additionally, studies show systemic issues within HIS that can be partly attributed to a lack of proper consideration for human capabilities and limitations during the design and implementation stages.131,132 To optimize performance and ensure patient safety, a complete understanding of the cognitive, physical, and organizational dimensions of healthcare professionals interaction with these technologies must be achieved through user usability testing.133
Technology Context
The most prominent facilitator across diverse economic settings was the ability to be useful and simplify daily tasks. This suggests that regardless of the economic context, health professionals value technology known to demonstrably ease workload, streamline routines, and ultimately improve efficiency in daily operations. This is consistent with the understanding that the core value proposition of HIS lies in the ability to optimize workflows and reduce administrative burdens.134 Similarly, ease of use and a user-friendly interface were mentioned, showing that when technology is easy to navigate, it reduces resistance towards change and enhances user satisfaction, ultimately contributing to better integration and utilization.
Emphasis on top-notch performance and having strong security protection was predominantly articulated by HIC only. The pursuit of top-notch performance was in line with the importance of ensuring seamless and efficient functioning of HIS technology, thereby optimizing healthcare delivery and administrative processes.135 The emphasis on these aspects was driven by the crucial need to maintain the highest levels of data privacy and security, particularly due to the sensitive nature of healthcare information.136 This signified that HIC was proactive in recognizing the security risk threat to technology use and having good awareness of the potential threats posed by security vulnerabilities. The vulnerability to security breaches, data theft, and unauthorized access presents a universal challenge transcending economic distinctions.137,138
The fact that LMIC and LIC specifically mentioned “Availability of Technical Support” as facilitator, but not “Top-Notch Performance” or “Strong Security”, suggests HIS adoption is likely in an early stage where basic functionality and support are the main needs. Therefore, both may not be focused on the more complex demands of strong security and high-level performance that become more critical with advanced HIS integration. HIC did not cite “Availability of Technical Support” as facilitator, probably due to the perception as a bare minimum. Reliable technical support is a given and not a key driver for HIS use, likely focused on more advanced features of the technology. Although HIC may have greater resources for addressing security risks, it is essential for UMIC, LMIC, and LIC to also prioritize strong security measures to safeguard sensitive health information.136 Acknowledging and addressing this shared concern present the commitment to mitigating risks and promoting a secure environment for health information management.139 In the modern world, a diverse set of technologies including the Internet of Things, blockchain, mobile health apps, cloud platforms, and integrated forms, are being leveraged to strengthen the security and privacy of healthcare information.140
The predominant barrier often cited is the lack of technical issues. However, the nature of technical issues experienced by LIC and LMIC differs significantly from those encountered by HIC and UMIC. LIC and LMIC frequently face perceived technical problems such as poor internet access leading to slow system performance, inadequate computer infrastructure limiting efficient HIS use, and unreliable power supply leading to data loss due to lack of automatic saving.93,103 However, HIC and UMIC encounter minor technical issues, such as frequent and disruptive bubble messages, the absence of a “help” button for immediate assistance with technical problems, and other relatively minor technical matters.57,110,113,116,119
The complexity of technology, lack of essential features, and non-feasible user interface collectively pose significant barrier to effective HIS use. The intricate nature of modern technology often results in HIS platforms being overly complex, making it challenging for effective navigation and use by healthcare professionals.141 Additionally, the absence of crucial features in system hinders the ability to meet the diverse needs of healthcare providers and organizations, leading to suboptimal functionality.142 The presence of a non-feasible user interface further elevates the usability issues, diminishing user experience and making it arduous for individuals to interact with the system.143,144 These barrier significantly impede the integration and effective HIS use in healthcare technology landscape, thereby impacting the delivery of quality patient care and the overall efficiency of healthcare processes.
Technology barrier in HIS is a direct consequence and deeply intertwined with human performance.145 The capacity of healthcare professionals to work efficiently and effectively is directly limited by poorly designed HIS that often ignore human-centered design principles.146 Systems with technical problems, difficult-to-use interfaces, or unreliable performance led to increased mental effort, a higher risk of errors, and interruptions in established clinical workflows.147 The mismatch between health IT design and how humans think and work reduces productivity while also endangering patient safety.130 The frustration and mental overload caused by poorly designed or difficult technology can result in workarounds, lower user satisfaction, and the failure to realize the intended benefits of HIS.148 This emphasizes the critical importance of putting human-centered design principles first in the development and implementation of HIS to maximize both system effectiveness and human performance in healthcare.
Organizational Context
Facilitating conditions appear as a relevant facilitator across all income levels. These conditions comprised a range of crucial elements such as conducive policy frameworks,60,62,80,82,96,121 robust infrastructure,53,64,72,73,78,79,82,90,98,104,115,149 and proficient human resources,110,112 collectively creating a conducive environment. The prevalence of mentions across diverse income levels presented the universal recognition of the crucial role played by facilitating conditions in driving the effective use of technology.150,151 Since each country aims to improve healthcare system, recognizing facilitating conditions remains a key factor.
Availability of training and education was recognized as a crucial facilitator for successful HIS use, particularly in HIC.72,102,109,110,112,114 In well-resourced settings such as HIC, organizations are likely to invest more in comprehensive training programs to ensure proper system adoption and maximize the benefits of HIS. This facilitator being predominantly conveyed reflected an effort to prioritize continuous learning and skill development in leveraging technological advancements in healthcare system.152 The implementation of new technology, such as HIS, requires comprehensive training for effective use, supporting the growth of both the individual and the organization.153 Therefore, training plays a crucial role in enhancing individual skills as well as driving organizational growth and success. The training programs are crucial for ensuring the desired outcomes of implementation are defined and measured.154
HIC, UMIC, and LMIC recognized the importance of substantial budget allocations for the implementation and sustainability of HIS. This collective awareness is grounded in the understanding that adequate financial resources are essential for the successful deployment and long-term viability of HIS in healthcare system.155 LIC did not consistently elaborate the availability of budgetary allocations as facilitator. This disparity can be attributed to several factors, including limited financial resources, competing healthcare priorities, challenges in budget transparency and allocation, as well as a lack of comprehensive strategic planning.156 In LIC, the perception that budget availability is not facilitator might point to it being a more fundamental limitation requiring urgent attention to be addressed. The infrequent mention of budget availability suggests that while financial commitment is essential for HIS implementation, it is likely that having a budget is considered a basic necessity rather than a frequently recognized positive facilitator.
HIC mentioned financial issues as barrier, while LICs did not, suggesting the need for closer examination. This discrepancy in acknowledgment may be attributed to the varying financial,157,158 resources availability, and educational landscapes between the two categories of countries.159 In HIC, financial constraints might relate to the high costs of implementing and maintaining sophisticated, integrated HIS, including advanced security features, interoperability solutions, and continuous upgrades.160 These countries might face budgetary competition for cutting-edge technologies and encounter challenges in justifying the return on investment for complex HIS implementations.161 On the other hand, LIC might focus on the more fundamental matters that need to be in place before money problems for specific HIS including no electricity or internet, not enough trained people, or no existing systems. In these situations, not having significant money for investment in HIS might be assumed and not specifically pointed out as barrier.162
The lack of consensus regarding responsibility was the most commonly cited barrier to effective HIS use across diverse healthcare landscapes. The absence of clearly defined roles and responsibilities results in an impaired collaboration between practitioners,49,51,67 diminished trust in information from other healthcare providers,48,51,56,61,71,99,108,109,111,112,123 and uncertainty surrounding documentation duties.78,93,109 These challenges arise due to ambiguous accountability, with practitioners uncertain of who is responsible for key tasks such as result follow-up, order entry, and record updates.127,163 Irrespective of income status, all countries struggle with this barrier, experiencing limited information flow, disjointed care, and compromised patient outcomes due to nebulous governance in health information management.164 Therefore, responsibility consensus should be established as a universal priority to facilitate optimal HIS use.
Awareness regarding the lack of policy on risk security is predominantly evident in HIC120 and UMIC,122 while it should logically be a universal concern across all countries, regardless of income level.165 The relative silence from LIC might not necessarily show the absence of such risks, but rather a potential lack of resources, expertise, or prioritization in identifying and articulating these concerns.166 Since HIC and UMIC show an absence of robust risk security policies, there is a need for a more concentrated effort to address this critical aspect of HIS implementation.165 This necessitates the development and dissemination of best practices, the provision of technical assistance, and fostering international collaboration to establish universal standards and guidelines for HIS risk security policy.
The adoption of HIS is significantly influenced by the basic contrasts in policy and funding structures between high-income and low-income settings. HIC often benefits from substantial public and private investment in digital infrastructure, coupled with supportive national policies that mandate or incentivize HIS implementation, promote interoperability, and ensure data security.167 This conducive environment fosters widespread adoption and sophisticated system development. Conversely, LICs frequently face significant hurdles due to limited financial resources, fragmented or non-existent national digital health strategies, and competing priorities for healthcare spending.156 Consequently, HIS adoption in these settings is often piecemeal, underfunded, and struggles with infrastructural limitations and a lack of cohesive policy frameworks, leading to a digital divide in healthcare capabilities.
Social Context
Support from peers and the influential role of leadership were widely acknowledged as key facilitator in effective HIS use. The crucial role of peer networks includes sharing best practices, knowledge exchange, and mutual encouragement, all of which contributed to successful implementation.168 These results are in line with social learning theory, positing that individuals learn and adopt new behaviors by observing and interacting with others within social network.169 Furthermore, effective leadership plays a crucial role in championing technological advancements, fostering a culture of innovation, and garnering support for change initiatives.170 With social support being strongly emphasized, it appears that efforts focused on enabling peer learning and mentorship programs could be particularly impactful in advancing successful HIS adoption, specifically in settings facing resource limitations.171
The absence of effective leadership and an environment characterized by individualism presented significant barrier to successful HIS use in healthcare settings. Inadequate leadership could hinder the development and implementation of cohesive strategies for integration, leading to fragmented efforts and a lack of organizational buy-in.172,173 A leader’s absence or lack of engagement can cause healthcare workers to feel unsure, resist change, and not commit to new HIS, obstructing the implementation. Meanwhile, a leader who models autonomy, accountability, teamwork, and patient-focused improvement can prevent these barrier.174 HIC often identified individualism to be a prominent barrier, as the emphasis on self-reliance and autonomy may impede the collective efforts required for comprehensive implementation and use.175 Addressing these barrier necessitates effective leadership to drive cohesive strategies and a shift towards a collaborative culture that prioritizes the collective benefit of HIS in healthcare system.176 This result implies that addressing systemic issues related to leadership and organizational culture may be more critical than focusing solely on individual attitudes when seeking to promote effective HIS implementation.
Public Health Implication
Comparing successful and failed HIS adoptions provides valuable insights, allowing the identification of key facilitator and barrier by studying instances of significant improvements and critical shortcomings in healthcare delivery and efficiency. For example, successful implementations often show strong leadership support, comprehensive user training, robust technical infrastructure, and a user-centered design approach consistent with existing workflows. Conversely, unsuccessful cases show barrier such as inadequate stakeholder engagement, insufficient funding, poor system usability, lack of interoperability, and resistance to change. Understanding these differentiating factors offers valuable lessons for policymakers, healthcare administrators, and implementers aiming to maximize successful HIS adoption and avoid common mistakes.
Facilitator identified in this scoping review show key elements supporting successful HIS implementation, ultimately improving patient care through better information access and decision-making. These facilitator will enhance healthcare system efficiency through streamlined workflows and resource management. Equally, barrier underscore the challenges requiring attention for effective adoption and the realization of these benefits. This review of facilitator and barrier provides a foundation for informed decision-making by policymakers and healthcare professionals to enhance HIS acceptance.
The adoption of HIS is significantly shaped by overarching policy landscapes. Facilitator and barrier identified in this review offer valuable insights for policymakers aiming to optimize HIS adoption and effectiveness.177 This understanding can contribute to targeted interventions and policies that address barrier and leverage facilitator to optimize information system use in healthcare, ultimately leading to improved delivery, better patient outcomes, and a positive impact on public health. To reduce resistance and foster greater acceptance, policymakers should prioritize early and continuous engagement of healthcare professionals,178 invest in comprehensive training and support,179 clearly articulate the benefits of HIS for patient care and workflow efficiency,180 establish and enforce stringent data security and privacy policies,181 adopt a user-centered design approach,130 as well as establish robust communication channels for feedback.178 Drawing upon global best practices, policymakers should also consider investing in interoperable infrastructure, establishing clear national standards (including for data security and privacy), prioritizing user participation in system design, ensuring adequate and sustainable funding, as well as promoting collaboration across healthcare organizations.179 By strategically addressing these areas with a strong emphasis on data security and privacy, policymakers can create an enabling environment for successful HIS adoption, contributing to a more efficient, patient-centered, and secure healthcare system.
Strength, Limitation, and Future Study
A key strength of this study lies in the approach, which allows for a broad mapping of the landscape, capturing a diverse range of factors influencing HIS adoption and use as perceived by health professionals. The review helps to inform policymakers of the factors that facilitate or hinder the use of information system or technology by healthcare professionals. Facilitating factors or barrier to the use of information system or information technology have been presented. However, this study also presents a limitation including the literature search conducted using terms that may not have comprised all publications in the databases, no further contact existed with the authors of the papers to validate the content analysis of the review, grey literature was excluded, no risk of bias assessment was performed, results were presented descriptively, and only English language studies were included. Although this scoping review primarily focused on facilitator and barrier to the use of core HIS functionalities from the perspective of daily healthcare professional interaction, the growing influence of Artificial Intelligence (AI) and broader digital health trends on the evolution of these systems must be acknowledged. Studies suggest that AI capacity to revolutionize clinical decision-making and improve health outcomes has potential applications in healthcare,182 presenting significant implications for future HIS design and implementation. By leveraging AI as a preferred method for handling big data in healthcare, analytical algorithms can enhance EHRs through big data analytics, enabling healthcare providers to deliver better clinical services by filtering and categorizing large datasets for enhanced data interpretation.183,184 Future studies should explore how the integration of AI-powered tools and the broader digital health ecosystem impacts facilitator and barrier identified in this review. Moreover, the long-term impact of specific HIS functionalities on measurable patient outcomes should be explored as well as economic evaluation as a basis for information technology system development policy. Understanding these factors remains crucial for stakeholders implicated in the design, implementation, and maintenance of HIS.
Conclusion
In conclusion, these results underscore the critical need for targeted interventions that enhance technical support, address user resistance, and streamline HIS training programs to ensure widespread adoption. Future studies should investigate both the economic evaluation of HIS implementations and long-term impacts on healthcare efficiency and patient outcomes, alongside an exploration of the evolving influence of AI and the broader digital health ecosystem on HIS adoption.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
No funds were provided to the current work.
Disclosure
The authors declare that there are no conflicts of interest in this work.
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Anne Frank, one of the most famous diarists during World War II, went into hiding with her family in Amsterdam on July 6, 1942. The Frank family went into hiding in ‘The Secret Annexe’ in the building that housed her father’s business. Also, on this day in 1957, Althea Gibson etched history by becoming the first African-American woman to win a singles title at Wimbledon
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‘The Diary of a Young Girl’ explores the life of 13-year-old Anne Frank, who went into hiding after the Germans began hunting Jews in the Netherlands. It was on July 6, 1942, that the Frank family went into hiding to escape persecution during World War II.
If you are a history geek who loves to learn about important events from the past, Firstpost Explainers’ ongoing series, History Today, will be your one-stop destination to explore key events.
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On this day in 1957, Althea Gibson became the first African American woman to win the Wimbledon singles title. Her victory at the All England Lawn Tennis and Croquet Club was a monumental achievement, breaking racial barriers in a sport that had long been largely segregated.
Here is all that happened on this day.
Anne Frank went into hiding in Amsterdam
Anne Frank along with her family went into hiding in Amsterdam on July 6, 1942, to escape Nazi persecution of Jews during World War II. The day before, Anne’s older sister Margot had received a call-up notice from the Nazi authorities, ordering her to report for a so-called “labour camp” in Germany. Fearing deportation, the Franks made the immediate decision to move into their prepared hiding place, the Secret Annexe, earlier than planned.
The Secret Annexe was a concealed space behind a movable bookcase in the building of Anne’s father, Otto Frank’s, business. Along with Anne, her sister Margot, parents Otto and Edith Frank and later, the van Pels family and dentist Fritz Pfeffer, eight people in total lived in cramped quarters under constant threat of discovery.
A full-scale replica of the secret annex where Anne Frank penned her famous diary has opened in New York City. File image/AP
Anne took with her the red-checkered diary she had received on her 13th birthday just a few weeks earlier. In it, she began documenting her daily experiences, thoughts, fears, and hopes while in hiding. Her diary would go on to become one of the most powerful firsthand accounts of life under Nazi terror.
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The Franks remained hidden in the annexe for two years, relying on the help of loyal non-Jewish friends and colleagues who provided food, news, and support. Tragically, on August 4, 1944, the hiding place was betrayed, and the occupants were arrested by the Gestapo.
Anne died of typhus in Bergen-Belsen concentration camp in early 1945. Otto, the only surviving member of the group, later published her diary under the title The Diary of a Young Girl.
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First African American woman won Wimbledon
We remember tennis stars like Serena and Venus Williams, who have ruled the court for decades. But, it was Althea Gibson who etched history on this day in 1957 by becoming the first African American woman to win a singles title at Wimbledon, one of tennis’s most prestigious tournaments.
Born in South Carolina in 1927 and raised in New York, Gibson overcame tremendous racial and social barriers. In the 1950s, tennis was largely segregated, with many top tournaments closed to Black players. However, her undeniable talent forced the world to take notice. With the support of tennis allies and civil rights advocates, she broke into elite-level competition, becoming the first Black player to compete at the US Nationals in 1950 and at Wimbledon in 1951.
Tennis icon Althea Gibson was named Female Athlete of the Year in 1957 and1958 by the Associated Press. File image/AP
Her breakthrough year came in 1956 when she became the first African American to win a singles title at the French Championships (now the French Open), where she also secured a doubles title. Her 1957 Wimbledon victory elevated her to global stardom. She was given a ticker-tape parade in New York City and was named the Associated Press Female Athlete of the Year in 1957 and again in 1958, when she won Wimbledon for the second time.
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Althea Gibson paved the way for future generations of African American athletes, including Arthur Ashe, Venus and Serena Williams, and others who have followed in her footsteps. Her courage, excellence, and perseverance shattered long-standing barriers and changed the face of tennis forever.
This Day, That Year
On this day in 1964, Nyasaland broke from British rule and became the independent country of Malawi within the Commonwealth of Nations. The first full-length all-talking motion picture, Lights of New York, premiered in New York City in 1928.
May 25th 2025, Africa and its diaspora paid tribute to those heroes, past and present, whose legacies inspired and continue to inspire the pursuit of genuine African liberation. As the Associate Professor in the Department of Politics and International Relations at the University of Johannesburg, Adeoye O. Akinola, who also heads the African Union Studies Unit, wrote on premiumtimesng.com, “Pan-Africanism must be reclaimed — not as nostalgia, but as a practical and urgent roadmap. It must guide our trade policies, our education systems, our conflict resolution mechanisms, and our global diplomacy. It must be people-driven, not elite-dominated.” Professor Akinole added, “And, most importantly, it must deliver tangible benefits to everyday Africans.”
This years Africa Day, a celebration of the 1963 founding of the Organization of African Unity (OAU), which gave way in 2002, to the African Union (AU), we pay tribute to those founding members of Pan Africanism which helped make African liberation a reality. As one of OAU founding members, President Kwame Nkrumah of Ghana said in 1960, at a Harlem rally, reported the New York Times, “that the 20,000,000 Americans of African ancestry ‘constituted the strongest link between the people of North America and the people of Africa.’” Add to Nkrumah’s weighty words, said Dr. Anthony Monterio, we reflect on the importance of Africa and those in the diaspora that paved the way “for Pan Africanism, a historic movement that originates outside of Africa.”
The Philadelphia based, Dr. Monterio, who has a PhD in sociology, is the founder of the Saturday Free School for Philosophy and Black Liberation, which is now in its 14th year. During the phone interview with Dr. Monterio, from his home in North Philly, he explained, “Pan Africanism is a historic movement that linked the struggle for the freedom of Black folk in the diaspora, especially in the Western hemisphere to the struggle against colonialism on the African continent. It was begun by people who were not Africans as such, but were in the (U.S. and Caribbean) diaspora.”
“In the nearly half century between 1900 and 1945, various political leaders and intellectuals from Europe, North America, (the Caribbean) and Africa met six times to discuss colonial control of Africa and develop strategies for eventual African political liberation,” noted Saheed Yinka Adejumobi an associate Professor in the History Department at Seattle University on the website blackpast.or
The first Pan African Conference, according to Dr. Monterio was in 1900, held in London. Henry Sylvester Williams, a Trinidadian attorney, who formed the “African Association” in London, to encourage Pan-African unity was its principal organizer. Dr. W.E.B. DuBois, who in 1899, published “The Philadelphia Negro,” America’s first sociological study of a Black American neighborhood, also participated in the 1900 conference. While in Europe Dr. DuBois, in addition to attending the conference, while in Paris at the 1900 Paris Exposition, he and his students set up “The American Negro Exhibit,” showing through visualizations, including photographs, maps, and charts “the changing status” of the newly emancipated Black former slaves, noted the book, “Black Lives 1900: W.E.B. DuBois At The Paris Exposition.”
Professor Adejumobi noted, “For the first time, (in 1900) opponents of colonialism and racism gathered for an international meeting. The conference, held in London, attracted global attention, placing the word ‘Pan-African’ in the lexicon of international affairs and making it part of the standard vocabulary of Black intellectuals.” It was not until after World War One that DuBois revived the Pan-African congresses. DuBois, noted Dr. Monterio, later became “the torchbearer of subsequent” Pan African Conferences, or “Congresses” as they were later called. DuBois, added, Dr. Monterio, was the first to frame the problem of the “20th century, is the ‘problem of the color line,’ by which he meant the ongoing oppression of Black people in the United States, and the continuing colonization of Black people in Africa, and in the Caribbean, and in South and Central America.”
According to Dr. Monterio, “DuBois, is the father of what is modern day Pan Africanism, which begins with the first Pan African Congress, held in 1919 and in Paris, at the same time that the Great powers were meeting in Versailles, at the Versailles Palace, just outside of Paris to hammer out a peace deal between the waring parties after World War One. DuBoise’s “worldview,” explained Monterio, was that there could not be peace without the decolonization of Africa.
The small African delegation at the 1927 Congress, explained Professor Adejumobi. “was due in part to travel restrictions that the British and French colonial powers imposed on those interested in attending the congress, in an effort to inhibit further Pan-African gatherings.” The majority of the delegates were Black Americans and many of them were women. The 1927 congress “was primarily financed by Addie W. Hunton and the Women’s International League for Peace and Freedom, an interracial organization that had been founded in 1919 by opponents of World War I. Similar to previous Pan-African congresses, participants discussed the status and conditions of Black people throughout the world.”
Professor Adejumobi noted in his 2008 review of the history of Pan Africanism, “The financial crisis induced by the Great Depression and the military exigency generated by World War Two necessitated the suspension of the Pan-African Congress for a period of eighteen years. In 1945, the organized movement was revived in Manchester, England.” On October 15-21, 1945, in Manchester, George Padmore, the staunch anti-imperialist, played a pivotal role in organizing the 5th Pan-African Congress. Recognizing DuBois’s unequaled contribution to the Pan-African movement, delegates named him president of the 1945 congress. Key participates included DuBois, Jomo Kenyatta, of Kenya, Kwame Nkrumah, of Ghana, Hastings Banda of Malawi, and Nnamdi Azikiwe of Nigeria.This led to the formation of the Pan African Federation. According to Dr. Monterio it inspired participants to become leaders in the anti-colonial movements in Africa.”
Dr. Monterio explained, at the 5th Pan-African Congress, “for the first time, a significant number of African freedom fighters and independence fighters (including Africans studying in England) were in attendance, which, in fact, was an indication that Pan Africanism was now the property of Africans, and that the African diaspora would become a movement of solidarity with the anti-colonial struggle and not the center of it.” African attendees of congresses, noted blackpast.org, subsequently led their countries to political independence. In May 1963, the influence of these men, including Dr. Nkrumah, helped galvanize the formation of the OAU, an association of independent African states and nationalist groups.
On May 30, 2025, Ghana’s Tertiary Education Commission (GTEC) issued what it termed a “final caution” against individuals, especially politicians, entrepreneurs, and other public figures whose vanity drives them to flaunt honorary doctorates and professorships as though these titles had been academically earned.
“The Commission will henceforth take legal action against individuals found flouting these directives, alongside publicly naming and shaming them,” GTEC said in a statement signed by Professor Augustine Ocloo, the Commission’s Acting Deputy Director-General.
Ghana’s commendable stance follows Malawi’s National Council for Higher Education, which, on March 27, 2025, categorically stated that honorary doctorates and professorships confer no entitlement to use the titles “Dr.” or “Prof.” in personal or professional contexts.
According to Malawi’s council, honorary degrees are ceremonial recognitions that are markedly distinct from academic qualifications, and recipients should refrain from using these titles as personal prefixes.
The concerns raised by Ghana and Malawi echo earlier decisions in Nigeria. At their 27th conference, held at Nasarawa State University, Keffi, in September 2012, the Association of Vice Chancellors of Nigerian Universities adopted the “Keffi Declaration,” which significantly tightened guidelines for honorary awards.
Central to this declaration was a prohibition on awarding honorary doctorates to serving elected or appointed government officials. They said such conferrals must recognize genuine contributions to scholarship and societal advancement rather than political influence or wealth.
The Keffi Declaration also placed stringent conditions on awarding honorary doctorates. Notably, institutions without established doctoral programs were barred from conferring honorary degrees, and even qualified institutions were restricted to awarding a maximum of three honorary doctorates annually.
Arguably, the declaration’s most contested provision, however, was its insistence that recipients of honorary degrees must not prefix their names with “Dr.” In a country with titular obsession like Nigeria, I knew that guideline would be observed in the breach because it has no force of authority.
But such collective measures represent significant progress toward remedying the degradation of academic culture across various African nations, where honorary degrees have increasingly become symbols of wealth and political clout rather than scholarly achievement.
It is widely recognized that honorary doctorates in many African contexts have frequently been dispensed indiscriminately, often in exchange for financial contributions or political favors rather than scholarly or societal merit.
Indeed with a few honorable exceptions, most of the people who receive honorary doctorates are the kinds of people Chinua Achebe, in his memoir There Was a Country, famously characterized as “politicians with plenty of money but very low IQs.”
His vivid characterization underscores the crux of the issue, which is the alarming and growing trend of conflating political power and financial prowess with academic excellence.
That higher education authorities in Ghana, Malawi, and Nigeria have taken deliberate steps to establish clear criteria and limitations for honorary awards is laudable. These guidelines directly confront practices where institutions with limited academic offerings, sometimes barely established, have historically granted honorary degrees without genuine justification.
Such indiscriminate practices have severely undermined the value and respect traditionally associated with doctoral titles.
Yet, while Africa’s rigorous approach to regulating honorary doctorates is justified by its unique cultural and political circumstances, it is useful to compare these developments with practices elsewhere.
In the United States, prestigious undergraduate-only institutions, such as Knox College in Illinois—known for conferring an honorary Doctor of Fine Arts to comedian Stephen Colbert—and Amherst College in Massachusetts, regularly grant honorary doctorates during their graduation ceremonies.
However, these institutions’ practices are typically symbolic gestures of recognition and respect, devoid of the vanity-driven excesses observed in many African contexts.
The crucial difference lies in how recipients use these honorary titles post-award. Internationally, accepted convention dictates that honorary titles be appended after the recipient’s name, using “h.c.” (honoris causa) to clearly distinguish honorary from earned academic credentials. For instance, one would write Muhammad Abdullah, LLD h.c., not “Dr. Muhammad Abdullah,” and certainly not “Dr. Muhammad Abdullah, LLD h.c.,” which I have seen a few times.
Yet, adherence to this convention varies considerably across cultures and individuals.
Even in the United States, exceptions to the convention exist. A notable example involved a community college president in California who insisted on being addressed as “Dr.” after being bestowed an honorary degree by an obscure institution.
His pretension triggered a humorous protest from his staff, who collectively adopted “Dr.” prefixes themselves, sarcastically citing equally obscure honors. Embarrassed, the president ultimately dropped his title.
Historical precedents further illustrate complexities surrounding honorary degrees and their usage. Benjamin Franklin, a foundational figure in American history whom many people outside America know through the 100-dollar bill, embraced the title “Dr.” purely on the strength of honorary degrees.
Similarly, Maya Angelou, the renowned African-American poet and activist who had no formal higher education qualifications, insisted on being addressed as “Dr. Angelou” based on the numerous honorary doctoral degrees that several institutions bestowed on her.
In Nigeria, iconic historical figures have also prominently used honorary doctoral titles as if they earned them. Nnamdi Azikiwe, Nigeria’s first ceremonial president, widely known as “Dr. Azikiwe,” held no earned doctorate. He started his PhD at Columbia University in New York but didn’t complete it.
Tai Solarin, a revered educational activist and social critic, similarly prefixed “Dr.” to his name based exclusively on honorary recognition. Unlike Azikiwe, he never even attempted earning a PhD.
These examples underscore the deep cultural and historical roots of the practice, which present significant challenges to the enforcement of new regulations. Indeed, the cultural acceptance of using honorary titles as legitimate prefixes is deeply entrenched, complicating efforts by African higher education regulators to enforce their prohibitions effectively.
Nevertheless, the new regulatory frameworks in Ghana, Malawi, and Nigeria represent critical efforts toward reestablishing the integrity and credibility of academic distinctions. The explicit threat of legal action by Ghana’s GTEC signals a strong commitment to combating egregious abuses of honorary titles, potentially serving as a deterrent against future misuse.
Whether these measures will succeed remains uncertain, especially given the cultural resistance to its reform and the fact that it’s an entrenched practice. However, the very act of publicly addressing and legislatively confronting these abuses represents significant progress. Such regulatory actions signal a praiseworthy commitment to restoring academic prestige and integrity within higher education institutions across the continent.
Ultimately, the effectiveness of these regulations will hinge not just on enforcement but also on widespread public education and the promotion of genuine academic achievements.
Universities must actively demonstrate the rigorous processes behind earned doctorates and highlight the scholarly dedication and intellectual rigor required. Only through a collective effort to valorize genuine academic accomplishments over superficial honors can the true prestige of doctoral titles be restored.
The Pan-African congresses Every year African countries commemorate Africa Day or Africa Freedom Day which is broadly in honour of the founding of the Organisation of African Unity (OAU) established on 25th May 1963 in the Ethiopian capital city Addis Ababa. In the year 2001, Zambia had the rare privilege to host the last OAU Summit held at Mulungushi International Conference Centre chaired by Second Republican President Frederick TJ Chiluba. It was also the last year of President Chiluba as head of state. His successor Levy Mwanswasa was to handover the instruments of chairmanship to South Africa’s Second Black President Thabo Mvuyelwa Mbeki. It was Mbeki, an intellectual urbane and strong proponent and advocate of Africa Renaissance who became the chairperson of the African Union (AU) which supplanted the aged OAU in 2002. The OAU founder leaders and their successors had done their very best to ensure that the last three countries to attain political freedom in Black Africa namely Zimbabwe (April 1980), Namibia (January 1990) and South Africa (May 1994) got their freedom under majority rule.
The OAU was a product of the ideals of Pan-Africanism championed by great black enthusiastic political warriors such as Edward Wilmot Blyden a preacher and scholar of Liberia, Henry Sylvester Williams, Edward W. Burgardt Dubois, William Marcus Garvey and many others of African descent domiciled in the West Indies and the United States of America. Sylvester Williams, a lawyer and historian from Trinidad was the first person to use the term ‘Pan-Africanism and the first to organize and convene a Pan-African congress in 1900 in London. Dr Williams had extended invitations the men of African descent living in Europe to discuss the evils of white colonialism and white dominance over black peoples, racial prejudice, and the brutal treatment of black people in South Africa (Amate, 1986:34). The conference had to discuss the future of Africa and the international standing of the only three black states existing in the world at that time Haiti, Ethiopia and Liberia. Off the agenda was the pressing question of independence and Burgardt Dubois as a participant took an opportunity to introduce it into the key areas of the discussions and to persuade the congress to to call Britain, the largest colonial power and others with colonies across Africa and the Caribbean. Dubois emphasized on freedom and the right to govern for black people in the colonies of Africa and the West Indies with a deep sense of urgency.
Sylvester Williams died shortly after the first congress he had convened but the work he had pioneered did not go to the grave with him. Dubois took over from where his colleague had left and convened a series of five Pan-African congresses. He meritoriously carried the name ‘Father of Pan-Africanism. He was a practical and competent journalist who used the pen mightily to drive points home that Africa had come of age and needed no white government on the continent. He built up and administered a chain of newspapers which incessantly called for the granting of human rights to all black people treated like lifeless objects by inhuman extremist white people in the Americas, the West Indies and Africa.
Dubois organised congresses in the years 1919 (Paris); 1921 (London); 1923 (two sessions in succession in London and Lisbon); 1927 (New York); and the last one at the end of the Second World War in October 1945 which took place in Manchester, England. Dubois was 73 in 1945 and his vibrancy, radiancy and steam were on the verge of extinction. He remained a mobile spirit behind the influence, effectiveness and unwavering determination to arouse the consciousness of Black Africa to fight racism and colonial rule. The African-Americans and West Indian leaders who had convened the earlier congresses had fallen into the background as aged, ailing and physically weak champions and pacesetters of Pan-Africanism. Time was opportune to hand over the batons to a new breed of young Pan-Africanists. The Manchester Pan-African Congress had a new team of dynamic and strong young leaders such as Kwame Nkrumah from Ghana; Namdi Azikiwe, S.L. Akintola and Magnus Williams from Nigeria; Peter Abrahams from South Africa; Wallace Johnson from Sierra Leone; and Jomo Kenyatta (Johnston Kamau) from Kenya. Compared to the first batch of Pan-Africanists who had convened the first four congresses, the 1945 congress organisers were radical and militant in their pronouncements on how the pressing issues facing Africa were to be addressed and redressed (Amate, 1986:36). The Manchester Group resoundily declared that all the peoples of Africa and African descent everywhere should be emancipated forthwith from all diabolical and inhuman forms of inhibiting legislation and influences and be reunited with one another.
In Anglophone Africa emerged Pan-African leaders such as Abubakar Tafawa Balewa, Obafemi Awolowo and Benjamin Namdi Azikiwe of Nigeria; Kwame Nkrumah, Joseph Boakye Danquah and Kofi Busia of Ghana; Julius K. Nyerere of Tanganyika (now part of Tanzania with Zanzibar); Jaramogi Oginga Odinga, Thomas Joseph Mboya and Peter Mbiyu Koinange from Kenya; Apollo Milton Obote and Paulo Muwanga from Uganda; Joshua Nkomo, Robert Mugabe; Simon Mzenda, Josia Chinamano, Ndabaningi Sithole and Nathan Shamuyarira from Southern Rhodesia now Zimbabwe; Kenneth D. Kaunda, Harry M. Nkumbula, Simon M. Kapwepwe, Sikota Wina, Robinson Nabulyato, Munukayumbwa Sipalo, Nalumino Mundia and Hyden Dinguswayo Banda from Northern Rhodesia now Zambia; Kanyama Chiume, Orton Chirwa, Dunduza Chisiza, Henry Masauko Chipembere Chipembere and Yatuta Chisiza from Malawi; and Nelson Mandela, Oliver Tambo, Walter Sisulu, Govan Archibald Mbeki, Anthony Lembede, Robert Sobukwe, and Andrew Mlangeni from South Africa. Francophone Africa had more black leaders who pandered to the whims, caprices and manipulation of the French and Belgians. It had more of inveterate malleable opportunists and culturally colonised, aristocratic elite leaders such as Felix Houphuet-Boigny of Ivory Coast, Leopold Sedar Senghor (credited with the philosophy of negritude), Joseph Mobutu (who became a personality cult after the Belgians in collusion with him and Joseph Kasavubu brutally assassinated Patrice Lumumba who was a radical Pan-Africanist upon him being elected Prime Minister of Congo-Kinshasa) and Gnassimbe Eyadema who killed killed the radical Pan-Africanist Gilchrist Olympio in Togo. Benard Albert Bongo in Gabon who later discarded Christian names and named himself Omar Bongo after being converted to Islam was another great lackey of the French government in Paris in the late 1969s. So was his son-in-law Denis Sassou-Nguesso of Congo Brazzaville. The most radical Pan-Africanist in Francophone Africa with a fundamentalist disposition was Ahmed Sekou Tourre of Guinea in West Africa who refused to truckle to the dictates of the French when he told them: ” We prefer poverty in liberty to riches in slavery”. The French had succeeded in wooing a good number of presidents in Francophone Africa who became part of the French Community of nations but Sekou Tourre flatly and roundly rejected their overtures to submit his country to the enclave of puppet states of the French.
What was the common vision of the Pan-Africanists?
Pan-Africanists from the outset envisioned a united Africa hermetically sealed with people of African descent in the United States, the Caribbean and other parts of the world. They advocated a discovery for recovery of African black pride, sense of humanity and economic liberation from Western manipulation which bound millions of black people to both physical and mental servitude. The patriarchs of Pan-Africanism wanted an economically, politically, socially and ideologically free Africa with total dependence on its own resources and not perpetually bound to the Portuguese, British, French, Belgians, Germany, Spanish or Italian colonialists. A united Africa was their battle cry. Rodney (1988:135) asserts that in the centuries before colonial rule, Europe had augmented its economic capacity in leaps and bounds while Africa was almost static. The Europeans had displaced and dispossessed Africa of her human resources and the slave labour dislocated from Africa and shipped in chains to America and the Caribbeans provided hard labour services to the slave owners and the European governments which paid them absolutely nothing. Economies in Europe and Americas prospered and the continent stagnated and fell below zero in the long run. The advent of both slave traders and colonial masters afterwards brutally decimated the peasantry and exploited the black people individually sold as slaves and forcefully taken to Europe. The great social evils perpetuated and perpetrated by the Europeans in collusion left so many vestiges of dehumanization, suppression, exploitation and oppression. The evils are still scars on the beautiful face of Africa which will always remind us of the unpardonable acts of slavery and colonial rule. The divide and rule machinations employed by the colonialists made Africa suffer brands of colonial rule as the continent bled to near extinction with hundreds of people barbarically killed for claiming their right to self-rule under a government of the majorities who were black people. The Conference of Berlin convene by Chancellor Otto Von Bismarck of Germany was a gathering of greedy European colonial powers desperate for turning Africa into a poor continent void of all minerals, timber, and intellectual prowess. The Conference decide which thief among the countries gathered should steal which part of Africa without permission from the indigenous owners of the land. The duality of implacable poles which pitied the colonised and the coloniser later influenced the genesis of a new force of radical Africans on the continent and in the diaspora. The colonialists were never ready to give up the countries they stole and the black people with the arousal of political and social consciousness through the vision of Pan-Africanists who emerged in the late 19th century. The visionary Pan-Africanists began an unstoppable revolt against colonial rule which started with the non-violence approach mistaken for weakness by the colonial powers. Round table discussions for political freedom worked in some African countries which were very poor. The mineral-rich as well as the oil-rich countries such as the Congo-Kinshasa, Zambia, Zimbabwe, Angola, Nigeria, Ghana and many others experienced violence with alarming proportions and in the ultimate the colonialists had to vacate the continent against their will or wish. Victory was on the side of Pan-Africanists and puppets of the whites had to grind their teeth in stunning embarrassment as the forces of oppression always have a divinely-set expiry date.
Are ideals of the Pan-Africanists being honoured on Africa Day?
From 25th May 1963 Africa as a continent has been celebrating its Freedom Day with fanfare highly beautified by defence and security brass bands belting out freedom songs in instrumental lyrics to the temporary amusement and amazement of the people at various stadia and presidential palaces and state houses. The excitement is just ceremonial and for just some hours as political speeches are given in some countries and in countries like Zambia, some citizens and special guests from other countries are honoured for their distinguished services to their country or to Africa. This for over 63 years has been the case and it now looks like a very casual and cheap way of honouring our brave fallen heroes who strove sacrificially for the decolonisation of Africa and total ownership of the wealth of the continent by Africans themselves. Economic freedom which the forefathers and foremothers yearned for is still a pipedream after over a hundred years since Sylvester Williams convened the first Pan African Congress in London in 1900. The West still runs our economies and it is shameful that even the drugs Africans are supposed to manufacture themselves in their sovereign states are donated by the West and the advent of the neophyte extreme white president Donald J. Trump has seen African leaders subjected to agonizing embarrassment even where the art of diplomacy is supposed to be employed, Trump and his lackeys have used vulgarity and uncouth language to depreciate the dignity of the black African personality to the level of wild beasts or brainless apes. The scandals exposed by a foreign donor at the Ministry of Health is just unacceptable and agonizing as a crude embarrassment. We should not shield criminal cartels in any ministry but to be exposed by a benevolent cooperating partner in such a callous manner is disgusting and widely exasperating. Why should we condone such heights of high profile thefts in such key ministries like Health? Are there intensive and extensive audits of drugs supplied to the Ministry of Health? The buck stops at all of us! Pan Africanism must exhort us to be responsible and accountable in the way we discharge our duties and responsibilities. It must speak transparent honesty and integrity as bywords for all the occupants of state offices who must be there to serve the people of Africa and not to steal what belongs to them.
The African Union leaders seem not to be doing much to honour the vision of its founding fathers of its forerunner, the OAU. The unification of Africa into a great continental power to make every African proud and free is still a far-fetched dream darkened by the cloud of greed and treachery perpetrated by ourselves. We always give leverage to Western investors to take control of our economies and pay lip service to promotion of local investments into mining which has been monopolized by Transnational Corporations backed by the World Bank and the International Monetary Fund (IMF). We have had great African geniuses running international institutions such as Dr Ngozi Okonjo-Iwela, former managing director of the IMF and currently managing director of the World Trade Organization from Nigeria, Obiageli ‘Oby’ Ezekwesili former vice president of the World Bank – Africa Region who also stood as presidential candidate in the 2019 elections of Nigeria an outspoken, blunt-speaking advocate of women’s rights, Nkosana-Dlamimi Zuma former African Union Commissioner and first woman to lead the African Union Secretariat, Chief Emeka Anyouku former Secretary -General of the Commonwealth Group of Nations from Nigeria, Salim Ahmed Salim former Organisation of African Unity (OAU) from Tanzania, late Koffi Attah Annan first black African Secretary -General of the United Nations from Ghana and many more personages who have done wonders for the continent in the continental and regional organisations but our continent still wallows in the muddy waters of underdevelopment with millions barely able to make ends meet as poverty is generating rapidly and rubbing off the little gains nations-states recorded in respect with gross domestic product (GDP) though some countries like Rwanda, Burkina Faso, Uganda and Mauritius seem to be doing very well and shining economically akin to the attainment of Singapore which many countries are looking up to.
The tragedy of Africa is that, unlike the commitment of the founding fathers and pioneers of African unity like Kwame Nkrumah, Abubakar Tafawa Balewa Julius Nyerere, Sekou Tourre, Leopold Sedar Senghor, Gilchrist Olympio, Kenneth Kaunda and Milton Obote among few others, the new breed of political party leaders is more of greed and admiration of long-stay in power to amass personal wealth and enrich their children, leaving a trail of grinding poverty in their paths beyond the solution of their successors. Corruption is more, less a formal and normal practice in government circles. They are devoid of good morals and are overshadowed by the egocentric ambition to rule their nations for life and suppress leaders of the opposition with brazen impunity. Misery is what they deliver to their citizens and forcibly turn themselves into personality cults which swallow the pride of political parties. Their names and political parties they lead become synonymous.
Time has come for the African government leaders to rise to the occasion and honour the ideals of the Pan-Africanists of yesteryear and emulate their great works and principles. The nation-states must enact laws which should ban from participating in national elections for life corrupt leaders found guilty by the courts.
Young Zambians in schools must be enlightened on the importance of Africa Freedom Day and what the founding fathers of the OAU had envisioned about a poverty-free Africa with learned people to protect the continent on the pride of Africa as our Motherland fashioned with and blessed by God’s mighty Hands and emphasise the importance of unity which goes counter to ethnic hostility which has left many African nations scarred beyond recognition. The problems besetting Africa are as wide as the whole world but with a great sense of fortitude, resilience and maximum commitment anchored on deep sense of patriotism and continental unity Africa will awaken into a giant it is supposed to be, like a shining city built on a great hill emitting beacons of hope to all people in squalor, poverty, hunger and ill-health.