Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E5543, Baltimore, MD, 21205, USA.
Novartis Foundation, Basel, Switzerland.
Global Health. 2018 Nov 3;14(1):103. doi: 10.1186/s12992-018-0424-z.
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.
中低收入国家（LMICs）的医疗保健挑战一直是许多数字计划的重点，这些计划旨在改善医疗保健的可及性和提供医疗保健的质量。这些计划已经超越了试点和试验的初始阶段，现在更加明确地关注有效扩展和整合的需求，以给医疗保健系统提供可持续的效益。基于在 LMICs 中扩展数字健康的实际案例研究，确定了五个关键重点领域，这些领域对于成功至关重要。首先，计划或倡议的内在特征必须提供切实可行的好处，以满足未满足的需求，并从一开始就获得最终用户的投入。其次，所有利益相关者都必须参与、接受培训并积极实施新计划，第三，倡议的技术特征应该由简单性、互操作性和适应性驱动。第四个重点领域是数字医疗保健计划预期运作的政策环境，与更广泛的医疗保健政策保持一致至关重要，可持续的资金支持也是必要的，包括适当的私营部门资金。最后，应考虑外在生态系统，包括支持大规模使用数字计划的适当基础设施的存在。在全球层面上，朝着减少数字健康扩展和整合孤立方法的协作努力可能为创新解决方案提供必要的领导力，使创新解决方案能够惠及 LMICs 的医疗保健工作者和患者。本综述提供了从中低收入国家实际案例研究中的实践经验中得出的扩展数字健康计划的最佳实践的见解，讨论了这些实践如何影响未来卫生方案的制定和实施。
