Abstract
A growing body of evidence shows the use of digital technologies in health—referred to as eHealth, mHealth or ‘digital health’—is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind.
Highlights
The spread and uptake of digital health in low- and middle-income countries (LMICs) presents promising opportunities to extend coverage of, and access to, life-saving health services, customize health information for marginalized and vulnerable groups and improve upward and downward accountability of the health system.[1,2,3,4] These opportunities directly contribute to achieving the Sustainable Development Goals (SDGs) and the commitment to ‘leaving no one behind’
There continues to be a dearth of studies that focus on health equity and gender as critical axes for analysis and action.[11,12]
Gender analysis was identified as a shared area of interest among the research teams and one that could benefit from additional targeted capacity strengthening efforts
Summary
The spread and uptake of digital health (including eHealth and mHealth) in low- and middle-income countries (LMICs) presents promising opportunities to extend coverage of, and access to, life-saving health services, customize health information for marginalized and vulnerable groups and improve upward and downward accountability of the health system.[1,2,3,4] These opportunities directly contribute to achieving the Sustainable Development Goals (SDGs) and the commitment to ‘leaving no one behind’. There is a growing body of evidence on the use of digital health in LMICs, including systematic reviews on mHealth,[5] and on maternal, newborn and child health.[6,7,8] The literature has an increasing number of contributions on suitable digital health frameworks,[9] and guidelines on how to report evidence.[10] Questions of adoption, uptake, efficacy and changes in outcomes have been answered to varying extents.[3] Yet, there continues to be a dearth of studies that focus on health equity and gender as critical axes for analysis and action.[11,12] This collection of seven original papers and two commentaries seeks to contribute to filling this gap in knowledge by presenting practical lessons and findings from a cohort of seven implementation research projects. Its dual focus on accountability of HEWs to the community, as well as strengthening bidirectional accountability between HEWs and their supervisors, provides much-needed findings that link improvements in health outcomes with how health workers are incentivized and supported
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