Infrastructure Investment Research Articles

Analysis of Challenges and Opportunities for Improving the Health System in Afghanistan: Innovative Approaches and Sustainable Solutions

This research explores the challenges and opportunities for improving the health system in Afghanistan. The main objective is to identify the major issues within the healthcare system and propose sustainable solutions to enhance the quality of health services. Using a mixed-method approach (qualitative and quantitative), data were collected through semi-structured interviews with experts and a review of credible scientific sources. The findings indicate that a lack of healthcare infrastructure, a shortage of specialized human resources, and management issues are among the primary challenges facing Afghanistan's healthcare system. Additionally, opportunities such as international support and utilizing modern technologies in healthcare have been identified. The study concludes that investment in infrastructure, human resource training, and strengthening international collaborations are essential to improve the healthcare situation in Afghanistan. The study's recommendations emphasize the importance of investments in infrastructure, comprehensive training for health workers, and international partnerships to strengthen service delivery. This analysis provides practical insights for policymakers and international organizations, which could ultimately help build a more resilient health framework in Afghanistan.

Hydrogen Fuel Cells in Vehicles: Current Situation and Future Prospects

Hydrogen is emerging as a pivotal player in sustainable transportation, with hydrogen fuel cell electric vehicles (HFCEVs) gaining substantial traction. Despite the higher production costs compared to petroleum, hydrogen boasts a higher energy content by weight and produces zero toxic emissions. Advances in hydrogen storage, including cryogenic, pressurized tanks, and metal-organic frameworks, are overcoming density-related challenges. HFCEVs are making significant strides globally, particularly in South Korea, the United States, and China. By 2030, fuel cell prices are expected to be comparable with internal combustion engines due to advancements in technology. Enhanced control strategies, evolving safety measures, and supportive government policies are fostering the adoption of hydrogen as a viable clean power solution for future conveyance needs. Additionally, investments in infrastructure, such as hydrogen refueling stations, are expanding, further supporting the growth of HFCEVs. This paper explores the current advancements, challenges, and future outlook of hydrogen fuel cells in the automotive industry, highlighting their potential to revolutionize sustainable transport and contribute significantly to the reduction of greenhouse gas emissions.

Bridging The Infrastructure Gap: Assessing The Impact Of Critical Infrastructure Investments On Economic Growth In The United States And Emerging Markets

Infrastructure is an important driver in economic development, promoting trade, increasing access to basic services, and enabling productivity, however, the infrastructure gap that many nations are facing has become detrimental, threatening their long-term economic growth and competitiveness. While emerging markets contend with deficient infrastructure systems that impede industrialization and social development, industrialized economies such as the United States suffer from inefficiencies triggered by deteriorating infrastructure and periods of underinvestment. The purpose of this review is to assess the impact of critical infrastructure investments on economic growth in the United States and emerging markets. The study revealed that infrastructure investment significantly boosts economic development. Modernizing infrastructure in the United States enhances productivity and competitiveness globally, especially across sectors. Therefore, bridging the infrastructure gap is essential for promoting economic development and sustaining long-term growth.

Process evaluation of an urban piped water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo

Major investments in water supply infrastructure will be required to achieve Sustainable Development Goal (SDG) 6. Safely managed water services are also central to global cholera and diarrhoeal diseases prevention strategies. However, evidence remains scarce on how to efficiently improve piped water services in complex settings where infrastructure investments are most needed. We conducted a process evaluation of a large-scale water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo, in parallel to a pragmatic trial. Considering three evaluation domains–context, implementation, and population response–, we assessed the validity of the programme’s theory of change and underlying assumptions. Information sources included construction works documentation, operational and billing records from the water utility, and household surveys. The evaluation covers the period 2014–2021. Trial results are not within the scope of this manuscript. The programme did not achieve expected improvements in the water supply service during the evaluation period. Out of 16 assumptions underlying the theory of change, six remained valid, seven partially valid, and three turned out to be invalid. Contextual challenges included extreme flooding in 2020 and the Covid-19 pandemic, which disrupted construction works. Issues related to electricity supply and the rise of Lake Tanganyika emphasise the need for cross-sectoral approaches and consideration of climate change in the planning of water supply infrastructure. Implementation challenges underlined the importance of capacity strengthening alongside infrastructure improvements. Population response elements suggest that affordability and informal practices such as tap sharing should be taken into account. The programme was a good example of early engagement with researchers and provides unique insights into the implementation of large-scale infrastructure improvements in a complex, low-income setting. Pragmatic evaluation approaches should be adopted for the generation of scientific evidence from complex programmes in order to optimise future infrastructure investments contributing to progress towards SDG6.

SOCIO-ECONOMIC SUSTAINABILITY OF THE TOURISM SECTOR ENTERPRISES IN THE CONTEXT OF THE COVID-19 PANDEMIC: GLOBAL AND UKRAINIAN DIMENSIONS

In 2020, one of the main negative factors affecting the development of the tourism sector was the COVID-19 pandemic. Complicating the economic situation due to the coronavirus crisis for developing countries and local communities that are disproportionately dependent on tourism threatens the growth of poverty in these countries, not to mention the possibility of developing the tourism industry on a sustainable basis. The article examines the situation in the tourism industry of Ukraine, which has arisen as a result of the spread of the COVID-19 pandemic, and analyzes the possibilities of recovery and development of the tourism industry based on sustainable tourism. Based on the analysis of statistical data and the study of the level and trends in the development of the tourism business at the global and national levels, the authors proposed practical directions for the recovery of the tourism industry in the context of COVID-19, which will be beneficial not only for Ukraine but for developing countries as well. It is shown that the crisis in the tourism industry, which arose as a result of quarantine restrictions to reduce the spread of the pandemic, has complicated the process of implementing the Sustainable Tourism Concept for countries with low economic performance. It has been proven that the further development of tourism in developing countries based on cooperation and consistency of measures is needed to regulate travel at the bilateral, regional and international levels, to ensure safety for travellers and workers. Bringing together the government, the public, and the business community to work on a practical and implementable plan to revive the tourism sector. Increasing investment in technology, green infrastructure and jobs.

Enhancing policy on higher education accessibility in Myanmar: Sustainable impact of technology effectiveness, opportunities, and social development

This study explores the impact of technology effectiveness, social development, and opportunities on higher education accessibility in Myanmar, focusing on private higher education institutions. Utilizing a sample of 199 respondents, with an average age of X (SD = Y), the research employs standardized questionnaires and descriptive statistics, correlation analysis, and multiple regression analysis to examine the relationships between these variables. The findings indicate that technology effectiveness significantly enhances higher education accessibility, with strong positive correlations (r = 0.752, p < 0.001) and substantial impacts on educational outcomes (β = 0.334, p = 0.001). Social development also plays a crucial role, demonstrating that supportive social norms and community engagement significantly improve accessibility (β = 0.405, p < 0.001). Opportunities provided by technological advancements further contribute to enhanced accessibility (β = 0.356, p < 0.001), although socio-political and economic challenges pose significant barriers. The study highlights the interconnectedness of these factors and their collective influence on educational accessibility. Practical implications include the need for strategic investments in technological infrastructure, promotion of supportive social environments, and innovative solutions to leverage opportunities. Future research directions suggest longitudinal studies, broader demographic scopes, and in-depth analyses of specific technological and infrastructural challenges. By addressing these areas, stakeholders can develop effective strategies to improve higher education accessibility, ultimately contributing to the socio-economic development of Myanmar.

Exploring the drivers of ecological footprint: Impacts of road transportation infrastructure, transport tax, and environment technologies

This study explores the dynamic effects of road transportation infrastructure, transport taxes, economic growth, trade openness, and environmental technologies on the ecological footprint using three quantile regression techniques: Simultaneous, Powell, and Method of Moments Quantile Regression (MMQR). These variables are selected for their significant influence on both economic outcomes and environmental sustainability, reflecting the interconnectedness of transportation systems, government policies, and technological advancements in shaping ecological impacts. Based on panel data from 19 European countries between 1995 and 2020, the results reveal that investments in road infrastructure and higher transport taxes contribute to reducing ecological footprint. At the middle and high quantiles, advancements in environment-related technologies further decrease the ecological footprint, whereas trade openness tends to worsen ecological quality. Importantly, the relationship between GDP and the ecological footprint follows an inverted U-shape, confirming the Environmental Kuznets Curve (EKC) hypothesis across all quantiles, which suggests that economic growth can support environmental sustainability in the long run. These findings are validated by robustness checks using fully modified ordinary least squares (FMOLS), dynamic ordinary least squares (DOLS), and canonical cointegration regression (CCR) models. Key policy implications include the need for targeted investments in road infrastructure and transport tax strategies, tailored to national contexts, along with technology-driven strategies to curb environmental degradation. Lastly, the panel causality test reveals unidirectional causality from economic growth, road transportation infrastructure, and environment-related technologies to ecological footprint, highlighting their significance as short-term contributors to environmental improvement.

The Role of Infrastructure Investment on Inclusive Growth and Human Development Index: Evidence from Emerging Economies

The paper examines the effect of infrastructure investment on the Human Development Index (HDI) score for five middle-income countries, namely Brazil, South Africa, Turkey, Mexico and Vietnam. The dynamic panel data model was used in the study. Data was sourced from the World Bank and the United Nations Development Programme focused on the prevalence and utilisation of five types of infrastructure in the countries mentioned above: electricity, water, sanitation, transport, telecommunications, and schools. The findings show that HDI is too narrow to be used as the main tool to measure human development and suggest that water and sanitation as well as the electrification of households were crucial infrastructures that had a positive impact on the HDI and be viewed as one type of infrastructure when researching the relationship between infrastructure investment and the HDI. The paper concluded and highlighted the need for infrastructure investors and policymakers to have a multi-dimensional approach to measuring the impact they would like to make. In this way, they would have more pronounced insights about which infrastructure they should invest in and how it will improve the wellbeing of society.

The role of telecommunications in enabling Internet of Things (IoT) connectivity and applications

This review paper explores the pivotal role of telecommunications in enabling Internet of Things (IoT) connectivity and applications, providing a comprehensive overview of the current landscape and future prospects. The primary objective is to synthesize existing research and industry insights to highlight how advancements in telecommunications infrastructure and technology have catalyzed the adoption and expansion of IoT. The review systematically examines the evolution of telecommunications technologies, including 4G, 5G, and emerging network protocols such as Narrowband IoT (NB-IoT) and Long-Term Evolution for Machines (LTE-M). It assesses how these technologies enhance IoT connectivity by providing the necessary bandwidth, low latency, and reliability for real-time data exchange and device interoperability. Key findings from the literature reveal that the deployment of 5G networks has been a game-changer for IoT, offering unprecedented speeds and connectivity capabilities that support a wide range of applications in smart cities, healthcare, agriculture, and industrial automation. Additionally, the paper discusses the role of telecommunications in addressing challenges related to security, scalability, and energy efficiency in IoT deployments. The review concludes that telecommunications are integral to the growth and sustainability of IoT ecosystems. As telecommunications technology continues to advance, its ability to support increasingly complex and ubiquitous IoT applications will drive innovation and enhance efficiency across various sectors. The paper emphasizes the necessity for ongoing investment in telecommunications infrastructure and research to fully exploit the transformative potential of IoT connectivity and applications.

Innovative healthcare solutions for resource-limited settings expanding pharmaceutical care to remote populations

Access to essential healthcare and pharmaceutical services remains a significant challenge in resource-limited settings. This paper explores innovative strategies for expanding pharmaceutical care to remote populations, focusing on the integration of mobile health technologies and community-based interventions. Mobile health (mHealth) technologies, including telemedicine and mobile pharmacies, offer a cost-effective means of delivering healthcare services, enhancing access, and improving real-time monitoring. Community-based interventions, such as the deployment of community health workers, health education campaigns, and peer support groups, play a critical role in addressing healthcare disparities and improving health literacy and medication adherence. The paper also discusses the integration of pharmaceutical care models, emphasizing the importance of collaboration among healthcare providers, pharmacists, and community health workers. Future directions highlight emerging innovations like AI and blockchain technology, while policy recommendations emphasize the need for investment in healthcare infrastructure, professional training, and regulatory support. By leveraging these strategies and innovations, healthcare outcomes and equity in resource-limited settings can significantly improve.

Online Instructional Supervision in an Advanced Higher Education

The continuity of learning in graduate and post-graduate education was ensured through online instructional supervision during the COVID-19 pandemic. This initiative aligns with the fourth Sustainable Development Goal (SDG 4), emphasizing the preservation of quality education amidst unprecedented challenges. The pandemic-induced shift to online learning environments underscored the critical need for robust supervisory practices that promote equitable and inclusive education for all students in the graduate studies. Employing a phenomenological approach, this study explored the experiences of 15 internal stakeholders involved in online instructional delivery at a state-funded university. The thematic analysis yielded five key insights: the lived experiences of internal stakeholders during the pandemic, transformative shifts in work and learning dynamics, perceptions of the internal stakeholders on online supervision, strategies for effective online supervision, and the opportunities and challenges inherent in this modality. Despite inherent limitations, online instructional supervision in advanced higher education during the pandemic proved to be both complex and transformative. The study recommends ongoing investment in human capital and technological infrastructure by educational institutions to secure sustainable educational outcomes for graduate and post-graduate students in the long term.

The non-linear relationship between ESG performance and bank stability in the digital era: new evidence from a regime-switching approach

This study analyzes the effect of environmental, social, and governance (ESG) performance on banking stability in the digital era for a selected group of European banking institutions. Unlike many research, this paper incorporates the digital environment in which the European banking system operates into its investigation to capture the relationship between ESG scores, digitization, and bank stability from 2005 to 2022. This study uses a regime-switching model to investigate the non-linear hypothesis of the relationship, an aspect that has received insufficient attention in previous research. The empirical results confirm the non-linearity between ESG performance and banking stability in the digital era, identifying three ESG performance regimes. Moreover, higher ESG scores are associated with a lower risk of bank failure, aligning with stakeholder theory. Finally, European banks with weak ESG scores fail to avoid the fragility caused by investments in technological infrastructure. Overall, our results suggest that critics and proponents of banks’ commitment to social responsibility are, to some extent, right. Indeed, low or moderate ESG performance (Regimes 1 and 2) aligns with the classical perspective, while high ESG engagement (Regime 3) is consistent with the stakeholder view. Consequently, European banks need to adopt a digital strategy based on improving sustainability to leverage the positive impact of digitization and ESG performance on bank stability. On the policymakers’ side, they need to strengthen the legal infrastructure to support digitization and engagement in social responsibility activities.

Data analytics as a driver of digital transformation in financial institutions

Data analytics plays a pivotal role in driving digital transformation within financial institutions, enabling organizations to leverage insights from vast amounts of data to enhance decision-making and optimize operational performance. This paper explores the multifaceted impact of data analytics on the financial services sector, highlighting how it can improve customer experience, streamline processes, and foster innovation. By implementing advanced analytics techniques, financial institutions can better understand customer behaviour, identify market trends, and personalize services to meet evolving customer needs. The study discusses effective strategies for integrating data analytics into decision-making processes and operational workflows, emphasizing the importance of creating a data-driven culture that encourages collaboration across departments. Case studies of leading financial institutions that have successfully integrated data analytics into their operations illustrate the transformative outcomes, including improved customer satisfaction and increased revenue growth. Additionally, the paper addresses challenges such as data silos, regulatory compliance, and the need for skilled personnel to analyse and interpret data effectively. To overcome these hurdles, best practices are outlined, including investment in robust data infrastructure, fostering cross-functional teams, and ensuring continuous training for employees. The findings indicate that a strategic approach to data analytics not only enhances performance but also positions financial institutions to adapt to rapidly changing market conditions. Ultimately, this paper underscores the critical role of data analytics in shaping the future of financial services and achieving sustainable growth in an increasingly competitive landscape.

The Adoption and Usage of ICT in Teaching and Learning in Tanzanian Secondary Schools: A Systematic Review

This systematic review aims to enhance understanding of the level and factors affecting the adoption and use of ICT in teaching and learning in Tanzanian secondary schools over a 10-year period from 2015 to 2024. The review involved a comprehensive literature search across various online research databases and institutional library sources for studies published within this timeframe. Extracted data included year of publication, level of ICT adoption and use, geographical scope, factors influencing adoption and use, target population, and type of school ownership. A total of 544 records were identified from different databases and repositories, with 266 screened, 48 full-text articles assessed for eligibility, and 17 articles ultimately meeting the inclusion criteria for analysis. The qualitative analysis of these studies revealed that, overall, the adoption and use of ICT in Tanzanian secondary schools remained low. Key factors affecting effective integration of ICT included insufficient ICT infrastructure (94.1%), limited ICT skills and knowledge among teachers (47.1%), inadequate teacher training (29.4%), teacher attitudes, perceptions, and experience (23.5%), and a lack of technical support (23.5%). The review concludes that ICT adoption and usage in Tanzanian secondary schools is at a low level. It is recommended for an increased investment in ICT infrastructure to ensure that public secondary schools, in particular, have access to the necessary technological resources for teaching and learning.

A Novel Neuro-Probabilistic Framework for Energy Demand Forecasting in Electric Vehicle Integration

This paper presents a novel grid-to-vehicle modeling framework that leverages probabilistic methods and neural networks to accurately forecast electric vehicle (EV) charging demand and overall energy consumption. The proposed methodology, tailored to the specific context of Medellin, Colombia, provides valuable insights for optimizing charging infrastructure and grid operations. Based on collected local data, mathematical models are developed and coded to accurately reflect the characteristics of EV charging. Through a rigorous analysis of criteria, indices, and mathematical relationships, the most suitable model for the city is selected. By combining probabilistic modeling with neural networks, this study offers a comprehensive approach to predicting future energy demand as EV penetration increases. The EV charging model effectively captures the charging behavior of various EV types, while the neural network accurately forecasts energy demand. The findings can inform decision-making regarding charging infrastructure planning, investment strategies, and policy development to support the sustainable integration of electric vehicles into the power grid.

From Pandemic to Heatwave: Digital Strategies for Health Resilience

Abstract Heatwaves threaten public health in the EU, as evidenced by the high heat-related mortality in the summer of 2022. Despite their frequency, European heat-health action plans (HHAPs) largely exclude digital solutions. The COVID-19 pandemic shifted perceptions and use of digital health tools, demonstrating their effectiveness in responding to health crises and providing insights for heatwave management. This work explores the potential of further including digital health interventions into European HHAPs. The objective is to identify adaptable digital strategies to mitigate heatwave health impacts. We started by analyzing WHO’s guidance on the creation of HHAPs, as well as the European Observatory on Health Systems and Policies’ assessment of the four main areas supported by digital health tools during the pandemic. Later, we proposed four main areas where digital health solutions could be efficiently integrated. Each area underwent a rapid literature review to identify digital solutions used during COVID-19, followed by a critical analysis for applicability in heat-health action planning. We identified four areas where the implementation of digital tools should be explored: Communication and Information Dissemination (focusing on raising awareness among vulnerable groups, caregivers, and organizations); Modeling and Forecasting (developing precise forecasts for proactive planning); Health services coordination (among services delivering immediate care during heatwaves); Monitoring and Population Surveillance (implementing strategies to identify and mitigate heat-related risks e.g. among vulnerable populations). Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events. The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats. Key messages • Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events. • The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats.

Integrating telemedicine in European healthcare settings: Key enablers for healthcare professionals

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action (JA), we aimed to understand the facilitating factors for the use of telemedicine services in healthcare organisations (HCOs) involved in cancer care, such as comprehensive cancer centres and hospitals. eCAN JA runs pilot studies in 18 HCOs across 10 EU Member States (MS) to test the integration of telemedicine into the daily practice of healthcare professionals. Methods Based on a literature review, we identified 26 facilitators to implement telemedicine services at the organisational level; these were integrated to an online survey and sent to healthcare professionals working in cancer care. Next, they were invited to a foresight workshop to complement the quantitative survey data with qualitative insights. Results 24 healthcare professionals across 12 EU MS, predominantly from the pilot sites of the eCAN JA, responded to the survey. They advocate for trainings on telemedicine, emphasising the importance of user-friendly and interoperable platforms, alongside sufficient technological support, time, and financial resources to effectively implement telemedicine in HCOs. Trial periods for both healthcare professionals and patients should offer first-hand experience, while harmonising telemedicine protocols ensure consistency. In addition, promoting digital literacy among physicians and providing IT education from an early age could facilitate adoption. These strategies, coupled with awareness campaigns and infrastructure investments in HCOs, can pave the way for telemedicine adoption. Conclusions Based on the quantitative and qualitative outcomes, it can be concluded that policies should establish telemedicine training for healthcare professionals, support interoperability and user-friendliness of these services in HCOs. They should also address hospital workload challenges, create harmonised protocols, provide incentives, and invest in digital infrastructure in HCOs for telemedicine adoption. Key messages • Telemedicine implementation in HCOs requires equipping healthcare professionals with the necessary skills, ensuring system compatibility, and addressing resource constraints in HCOs for success. • Financial and infrastructural support to HCOs is crucial for the seamless integration of telemedicine services into the daily workflows of healthcare professionals, enhancing health service delivery.

Navigating the challenges of public transport and urban mobility in Thohoyandou, South Africa

Background: Transport systems are an essential feature of functional urban settlements. Yet, almost all of South Africa’s secondary cities and small towns lack a true public transportation system. Because of this, quasi-public, privately operated mini-bus taxis are the main form of transport for most urban residents. Thohoyandou, Limpopo, a town of over 70 000 people, is a typical South African town in this regard.Objectives: The purpose of this research was to understand passenger experiences of mini-bus taxis in Thohoyandou, Limpopo province, South Africa.Method: This study used semi-structured interviews to explore the mobility challenges faced by the residents of Thohoyandou.Results: This study revealed several negative aspects impacting passenger experiences. Passengers consistently reported concerns regarding driver’s behaviour that compromised safety and security. This included overloading of vehicles and disregard for traffic regulations. Passengers also highlighted the challenges posed by poor transport infrastructure and a lack of reliable service. Collectively, these factors contribute to limited mobility options, increased transportation costs and a reduced quality of life. Furthermore, the shortcomings of mini-bus taxi services disproportionately affect people with disability, who already face significant societal barriers, further marginalising them within the transportation system.Conclusion: The government should increase investment in transport infrastructure, the enforcement of traffic laws and better driver training. However, a strong government combined with much political will is required if passengers and safety are to be the main priorities of the mini-bus taxi industry.Contribution: This study highlights challenges faced by public transport users in Thohoyandou, where mini-bus taxis serve as the main mode of transport. The challenges experienced by transport users not only reduce their mobility but also contribute to marginalisation of vulnerable groups, especially people with disability.

Sustainability in the Next Generation Hospital. Needs and Requirements collection from healthcare infrastructures supply chain stakeholders with One Health approach

Abstract Technological, demographic, epidemiological, environmental and social changes require investment in new sustainable hospital infrastructure; there is a lack of guidelines and interaction between Stakeholders. In February 2022, the Joint Research Platform Healthcare Infrastructures (JRP HI) was established consisting of Hospital Strategic Directions and Industrial Partners in Italy. Starting from the WHO Techincal Brief “Hospitals of the Future”, a national survey was carried out via web-survey and semi-structured interviews with a sample of 30 stakeholders to collect the main drivers and constraints for innovation and the framework from a One Health perspective and in terms of sustainability. The main needs to be addressed through the guidelines refer to digitalization (27%), flexibility (32%), environmental sustainability (36%) and economic sustainability (27%) as well as flow management (18%) and hospital infection (14%). The participants consider SDG-3 ‘Good Health and Wellbeing’ to be the most relevant for development activities. Hospital managers prioritize SDG-8 ‘Decent Work and Economic Growth’ (23%); vice-versa the industrial partners suggest SDG-11 ‘Sustainable Cities and Communities’ and SDG- 13 ‘Climate Actions’ (32%) as topics to be addressed. Furthermore, 57% of the respondents state that they lack adequate training, budget or leadership to apply innovative strategies in the day-to-day management of the healthcare organization. The survey highlighted a lack of initiatives, budget, and standardization for enhancing environmental sustainability in healthcare infrastructures. The sustainability of building systems depends on factors such as energy consumption, alternative energy sources, thermal comfort, water usage, waste management, ventilation, lighting efficiency, air quality, and construction materials. Ensuring the adoption of monitoring systems and harmonized standards of performance measurement is crucial for increasing the environmental sustainability.

How advanced is your digital public health system? A qualitative analysis of suitable indicators

Abstract Background Revealing the full potential of digital public health (DiPH) systems necessitates a wide-ranging tool to assess their maturity. Essential domains that need to be considered include the literacy and interest in DiPH tool application by society and the workforce and the legal and ICT maturity of DiPH systems. No review has investigated indicators on these national DiPH system maturity (DiPHSM) domains yet. Our narrative review and qualitative analysis aimed to map the landscape of indicators related to DiPHSM measurement and rank them based on their importance for such assessments. Methods As original indicators were not published in scientific databases but as grey literature, we used DuckDuckGo to apply a pre-defined search strategy for 11 countries from all continents classified as having reached level 4 of 5 in the Global Digital Health Monitor. Of the 1484 identified references, 137 were included which named 15806 indicators. Consensus on importance was defined as at least 3 or 4 authors rating an indicator as important. Results We recognized 180 indicators on different constructs with importance for DiPHSM analysis, including the availability and use of Smartphones, computers, the Internet or the DiPH intervention, the existence of skilled workforce, infrastructure (investment), and interoperability between interventions, the secondary use of health data, a DiPH strategy and controlling agency, or the application of big data and artificial intelligence for health data collection, analysis, and sharing. Conclusions Our study holds the potential to develop more comprehensive tools for DiPHSM assessments. Further examination is required to analyze the suitability and applicability of all identified indicators for diverse healthcare settings. By working towards a uniform evaluation of DiPHSM, we foster informed decision-making among healthcare planners and practitioners, improve resource distribution, and continue to drive innovation in healthcare delivery. Key messages • Maturity assessment tools need to consider the complexity of DiPH systems. Thereby, DiPH system evaluations need to be accompanied by analyses of the legal, ICT, and literacy perspective maturities. • New methods are needed to systematically assess and use multidisciplinary grey literature for research.