What Does It Take to Be an Effective National Steward of Digital Health Integration for Health Systems Strengthening in Low- and Middle-Income Countries?

Figures & Tables

TABLE 1.

Literature Search Strategy

Database Searched	Search Terms	Limits	Initial Search Results	Included in Review
Peer-Reviewed Literature
Scopus and Web of Science	Governance/stewardship/accountability PLUS Digital health/eHealth/electronic health/mHealth/mobile health	No articles before 1995 Medicine/health/nursing or social science/decision science or environment English or Spanish only	304 (Scopus) + 318 (Web of Science) = 404 deduplicated results	12¹⁶^–²⁷
Gray Literature
HingX.com and the GSMA, PEPFAR, Vodaphone Foundation, MAMA, mHealth Evidence and mHealth Knowledge by K4Health, Google, WHO, and others	Governance/stewardship PLUS eHealth/mHealth/digital health/mobile health/individual data/subject tracker/registry/register/registration tracker/patient tracking/individual data	English only		6¹¹^–¹³

Abbreviations: K4Health, Knowledge for Health project; MAMA, Mobile Alliance for Maternal Action; PEPFAR, U.S. President's Emergency Plan for AIDS Relief; WHO, World Health Organization.

TABLE 2.

Examples of Digital Health Institutions

Example	Institutional Features	Mandate and Focus Areas
Canada Health Infoway (founded 2000)¹⁶	Independent, not-for-profit organization governed by 14 deputy ministers of health representing provincial authorities	Establishing strategic direction for electronic health records in Canada in collaboration with local authorities. Areas of focus include interoperability; information systems for registries, drugs, and labs; and innovation/adoption.
MedCom (established in 1994)¹⁶	Danish coordinating agency for health care IT. Danish central government contributes to health care IT through its National Board of Health.	Establishes standards for electronic data exchange.
eHealth Governance Initiative (established formally in 2011)¹⁷^,¹⁸	Created with agreement of member states, and reports to high-level councils of the European Union	Created to promote eHealth services, establish strategies around eHealth, and help foster cooperation at the political, strategic, and operational levels. Four key areas of focus are identification and authentication of eHealth users, trust and acceptance of eHealth systems, legal issues (such as differing security and privacy requirements), and technical challenges.