Assessing the Current State of Digitalisation at the Edward Francis Small Teaching Hospital (EFSTH), The Gambia

The digital transformation of healthcare systems presents significant opportunities for improving efficiency, accuracy, and patient outcomes in low-resource settings like The Gambia. This study assessed the current state of digitalisation at Edward Francis Small Teaching Hospital, to identify gaps, barriers and opportunities for sustainable digital health integration. Using a survey method to enrol all heads of departments in a qualitative descriptive cross-sectional study, a structured interview schedule was used to capture their perspectives on digital infrastructure, workforce readiness, and policy challenges. Purposive sampling was used to select participants from key decision-makers across clinical and administrative units. Data were analysed using content, thematic analysis and direct quotations made by the respondents. The results indicated that EFSTH operates primarily at the Initial/Ad Hoc stage of digital maturity, with fragmented systems and limited standardisation. Key barriers include unreliable electricity, inadequate internet connectivity, low digital literacy among staff, and resistance to change. Despite these challenges, opportunities exist for phased digital integration, particularly in high-impact areas like electronic health records (EHRs). The study highlighted the important role of leadership engagement, targeted training, and context-appropriate solutions in driving sustainable transformation.