Abstract
Healthcare challenges in low and middle income countries (LMICs) have been the focus of many digital initiatives that have aimed to improve both access to healthcare and the quality of healthcare delivery. Moving beyond the initial phase of piloting and experimentation, these initiatives are now more clearly focused on the need for effective scaling and integration to provide sustainable benefit to healthcare systems.Based on real-life case studies of scaling digital health in LMICs, five key focus areas have been identified as being critical for success. Firstly, the intrinsic characteristics of the programme or initiative must offer tangible benefits to address an unmet need, with end-user input from the outset. Secondly, all stakeholders must be engaged, trained and motivated to implement a new initiative, and thirdly, the technical profile of the initiative should be driven by simplicity, interoperability and adaptability. The fourth focus area is the policy environment in which the digital healthcare initiative is intended to function, where alignment with broader healthcare policy is essential, as is sustainable funding that will support long-term growth, including private sector funding where appropriate. Finally, the extrinsic ecosystem should be considered, including the presence of the appropriate infrastructure to support the use of digital initiatives at scale.At the global level, collaborative efforts towards a less-siloed approach to scaling and integrating digital health may provide the necessary leadership to enable innovative solutions to reach healthcare workers and patients in LMICs. This review provides insights into best practice for scaling digital health initiatives in LMICs derived from practical experience in real-life case studies, discussing how these may influence the development and implementation of health programmes in the future.
Highlights
A wide range of digital health initiatives have been piloted in response to specific healthcare challenges in low and middle income countries (LMICs)
This review describes key considerations for scaling digital health solutions in LMICs, distilled from real-life case studies discussed at a Digital Health Dialogue held in Ghana
Offline capacity with the ability to store and delay the upload of data is an important feature of digital solutions in LMICs, as it allows users to enter data and make use of the system even when network connection is unreliable or not available. The recommendations in this manuscript have been collated based on case studies from programmes on the ground and from experts, who were willing to discuss the successes and failures of their work in digital health within LMICs
Summary
A wide range of digital health initiatives have been piloted in response to specific healthcare challenges in low and middle income countries (LMICs). To assess successful scaling of digital health initiatives, it is first necessary to define ‘scale’, considering the perspectives of end-users, patients, healthcare policy makers and investors, and the unmet needs within the relevant healthcare systems.
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