Synthesis of Findings

Based on research we have conducted on digital health technologies in lower- and middle-income countries, we identified the following set of lessons learned from the implementation of tools that were either developed for or adapted to the context of the COVID-19 pandemic.

Introduction

This cross-case synthesis presents high-level lessons and challenges from our research on the implementation of digital tools in various countries, which can be explored further in detailed case studies. These findings are relevant for policy makers, funders, and nongovernmental leaders seeking to understand how implementers and governments have introduced, adapted, and scaled digital tools, especially in the context of COVID-19.

In this synthesis we highlight the most critical strengths and challenges from the implementation case studies. The hyperlinks on this page take the reader to the corresponding background and illustrative examples that support our findings within each case study.

Summary of Strengths and Challenges

Using the mHealth Assessment and Planning for Scale Toolkit, we assessed the performance of implementations of digital tools across six domains: groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Three core lessons emerged from our findings:

• User-centered design is key to the widespread adoption of digital tools. Each development and implementation team identified an ongoing practical problem and established a clear, user-friendly solution—whether those users were health workers or members of the public. To ensure continued ease of use,  prioritizes offline functionality and access to multimedia resources for users with low connectivity and digital literacy. The project also includes a robust troubleshooting hierarchy and an iterative approach; users feel connected to the process when they see that their feedback has been incorporated into newer versions of the app. CommCare’s modular “no code” platform has enabled the MOH and Terre des hommes to independently maintain and modify the scope of the app to address emerging health priorities. In Uttar Pradesh, India, the  was designed to be an end-to-end surveillance platform that meets the needs of users across the continuum of care. The platform’s modular design is able to accommodate different use cases and stakeholders from tracking teams to testing laboratories to patients accessing test results or quarantining at home.
• Strong, country-led partnerships are essential for scaling up digital tools successfully. The solutions that scaled up most successfully during the COVID-19 pandemic benefited from close, long-established partnerships with the government to establish and promote the tools.  was initially co-developed by the Nigeria Centre for Disease Control and the Helmholtz Center for Infection Research in 2014, and the use of District Health Information Software 2  reflects a partnership of more than a decade between the Ministry of Health and the Health Information Systems Programme. The tools we assessed in  were catalyzed by demand from the highest levels of government. In India, Prime Minister Narendra Modi launched the , an end-to-end solution that captures each step of the vaccination process from appointment scheduling to certification. India’s COVID-19 vaccination program was coordinated by several government ministries and private partners who were committed to scaling CoWIN which helped administer 1 billion doses within a span of nine months. 
• Using adaptable digital tools enables implementers to focus on the content rather than the technology. Within the global digital health community, there has been a push toward the use and development of , or digital health tools that are adaptable and designed to be used in many contexts. This adaptability enables implementers to focus on user-centered design and scale. Each of the digital tools we assessed built on existing tools already in use, in-country or elsewhere—with the exception of tools assessed in India and Vietnam. For example,  partnered with Medic in part due to its experience in over ten other countries. In the context of crisis response, the adaptability of the tools to quickly aid in response has been especially critical.  to deploy a COVID-19 helpline in March 2020, and the same technology was adapted for other specific use cases, like higher education, within weeks.

Common challenges in implementation of the digital tools also emerged. Few of the tools in our assessment have established sustainable financing, business models or methods to regularly and rigorously evaluate their impact. Monitoring and evaluation are not typically prioritized during health emergencies, but the long-term sustainability of these tools remains at risk when funding is not guaranteed and when evidence of improved health outcomes is limited.

Overview of Implementations Profiled

In our assessment, we examined the implementation of digital tools with the goal of identifying common success factors for digital health programs that have achieved scale in-country. The following case studies provide a set of examples across diverse geographies, use cases, and technologies.

Though the COVID-19 pandemic has been a catalytic opportunity for digital health, scaling and sustaining digital innovations remains a challenge. This cross-case synthesis builds on  and presents lessons from our research on the implementation of digital tools that were developed for or adapted to the context of the COVID-19 pandemic. These findings are relevant for policy makers, funders, and nongovernmental leaders seeking to understand best practices for the implementation of digital tools. Measuring the impact of programs has been particularly challenging throughout the pandemic, but it is clear that digital health can increase access to health care, increase the quality of care delivered, diminish costs of providing care, and empower patients to manage their own health.

The hyperlinks on this page take the reader to the corresponding background and illustrative examples that support our findings within each case study.