Use of Technology to Support Health Care Providers Delivering Care in Low- and Lower-Middle-Income Countries: Systematic Umbrella Review.

BACKGROUND

Health care providers are at the forefront of the digital health transformation underway in low- and lower-middle-income countries (LLMICs). Digital health innovations (DHIs) promise more efficient and equitable health care delivery. However, their implementation often outpaces the generation of evidence supporting their effectiveness, resulting in fragmented projects that are poorly aligned with local system needs. Recognizing the diverse ways DHIs are used, the World Health Organization introduced a revised Classification of Digital Health Interventions in 2023 identifying 4 primary user groups, including health care providers.

OBJECTIVE

This study aims to synthesize the current evidence on the use and impact of DHIs by health care providers in LLMICs.

METHODS

We conducted an umbrella review of articles published between 2010 and 2024. Articles were sourced through PubMed, Embase, Scopus, and Web of Science. The search strategy combined keywords with Boolean operators. To be included, articles had to be original research published as systematic, thematic, or scoping reviews and had to use a systematic process for data identification and extraction. They needed to relate to a DHI implemented in at least 1 LLMIC and be available in English. World Bank country classifications were used to define LLMICs. Data extracted were deductively coded and thematically analyzed according to the 11 health system functions outlined in the 2023 World Health Organization classification of DHIs.

RESULTS

Overall, 88 reviews were included. Telemedicine was the most commonly studied DHI (60/88, 68%), with evidence suggesting that it has improved information sharing among providers (eg, hospitals and private providers) and enhanced delivery efficiency, particularly in limited-access settings. Outside of telemedicine, the evidence remains thin and uneven across other categories of DHIs. While DHIs appear to help providers interact more effectively with clients, systems, and one another, many interventions remain short lived, limited in scale, or contextually misaligned. The use of personal mobile devices by health care providers emerged as a common and practical platform for delivering DHIs, highlighting the potential for cost savings and rapid uptake. Persistent challenges such as insufficient infrastructure, high setup costs, and limited workforce capacity remain key barriers to sustainable scale-up.

CONCLUSIONS

Some evidence suggests DHIs are transforming health care delivery in LLMICs and contributing to broader health goals; however, robust and conclusive evidence on DHIs' impact on health outcomes, cost-effectiveness, and long-term sustainability is lacking. Caution is warranted when introducing DHIs that may not align with underlying system constraints. Policy makers and development partners are encouraged to support implementation research to build a more coherent global evidence base. DHIs should be seen not as a stand-alone solution but as a complementary tool to strengthen health systems.

TRIAL REGISTRATION

PROSPERO CRD42024586285; www.crd.york.ac.uk/PROSPERO/view/CRD42024586285.