Avoiding the road to nowhere: Policy insights on scaling up and sustaining digital health

Abstract

The Principles for Digital Development, launched in 2017, outline 9 items to consider in designing digital health programs to mitigate predictable and preventable factors contributing to program failure (Principles for Digital Development 2020). These items include design with the user, understanding the existing ecosystem, scale design, building for sustainability, being data-driven, using open standards/data/source/ innovation, reuse, and improvement, addressing privacy and security, and being collaborative. This commentary has sought to be more specific than the broader principles and give a range of examples to provide a clearer path to action. As researchers and implementers, we draw on experiences of designing, implementing, and evaluating digital health solutions at a scale in several settings across Asia and Africa, while providing examples from India and South Africa to illustrate ten considerations to support the scale and sustainability of digital health solutions in LMICs. These can be categorized as (1) drivers of equity and unforeseen innovation; (2) foundations for a digital health ecosystem; and(3) elements for systems integration as detailed in Figure