SUMMARY
There is evidence that several eHealth pilot projects in developing countries could not progress to full-scale implementation — sometimes referred to as the ‘pilotitis’ of the eHealth system. The sustainable eHealth implementation frameworks reported in the literature are linearly modelled, and fail to reflect the nonlinear and dynamic complexity of eHealth systems implementation. This study proposes a sustainable eHealth implementation framework to support the long-term sustainability of eHealth systems in developing countries. The framework addresses the nonlinear and dynamic relationships among elements of the ecosystem in the implementation of eHealth through feedback systems by following a system dynamics method. A literature review and systems approach is used to understand the interactions between the elements of a sustainable eHealth system. System dynamics modelling is applied to develop a nonlinear and dynamic model of sustainable eHealth implementation. The study indicates that the long-term sustainability of eHealth depends not only on technological factors, but also on economic, social, and organisational factors. Moreover, the causal loop diagram highlights the dynamic interplay between the factors of a sustainable eHealth system through feedback loops.