Challenges and Opportunities for Data Sharing Related to Artificial Intelligence Tools in Health Care in Low- and Middle-Income Countries: Systematic Review and Case Study From Thailand
Authors: Kaushik Aprajita , Barcellona Capucine , Mandyam Nikita Kanumoory , Tan Si Ying , Tromp Jasper 
Published: November 2024

Background
Health care systems in low- and middle-income countries (LMICs) can greatly benefit from artificial intelligence (AI) interventions in various use cases such as diagnostics, treatment, and public health monitoring but face significant challenges in sharing data for developing and deploying AI in health care.

Objective
This study aimed to identify barriers and enablers to data sharing for AI in health care in LMICs and to test the relevance of these in a local context.

Methods
First, we conducted a systematic literature search using PubMed, SCOPUS, Embase, Web of Science, and ACM using controlled vocabulary. Primary research studies, perspectives, policy landscape analyses, and commentaries performed in or involving an LMIC context were included. Studies that lacked a clear connection to health information exchange systems or were not reported in English were excluded from the review. Two reviewers independently screened titles and abstracts of the included articles and critically appraised each study. All identified barriers and enablers were classified according to 7 categories as per the predefined framework—technical, motivational, economic, political, legal and policy, ethical, social, organisational, and managerial. Second, we tested the local relevance of barriers and enablers in Thailand through stakeholder interviews with 15 academic experts, technology developers, regulators, policy makers, and health care providers. The interviewers took notes and analyzed data using framework analysis. Coding procedures were standardized to enhance the reliability of our approach. Coded data were reverified and themes were readjusted where necessary to avoid researcher bias.

Results
We identified 22 studies, the majority of which were conducted across Africa (n=12, 55%) and Asia (n=6, 27%). The most important data-sharing challenges were unreliable internet connectivity, lack of equipment, poor staff and management motivation, uneven resource distribution, and ethical concerns. Possible solutions included improving IT infrastructure, enhancing funding, introducing user-friendly software, and incentivizing health care organizations and personnel to share data for AI-related tools. In Thailand, inconsistent data systems, limited staff time, low health data literacy, complex and unclear policies, and cybersecurity issues were important data-sharing challenges. Key solutions included building a conducive digital ecosystem—having shared data input platforms for health facilities to ensure data uniformity and to develop easy-to-understand consent forms, having standardized guidelines for data sharing, and having compensation policies for data breach victims.

Conclusions
Although AI in LMICs has the potential to overcome health inequalities, these countries face technical, political, legal, policy, and organizational barriers to sharing data, which impede effective AI development and deployment. When tested in a local context, most of these barriers were relevant. Although our findings might not be generalizable to other contexts, this study can be used by LMICs as a framework to identify barriers and strengths within their health care systems and devise localized solutions for enhanced data sharing.

Trial Registration
PROSPERO CRD42022360644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=360644