Developing an Evidence Guide to Strengthen Public Investment Decisions for Digital Health Technologies in Low- and Middle-Income Countries
สิ้นสุด : 30 พฤศจิกายน 2570
Developing an Evidence Guide to Strengthen Public Investment Decisions for Digital Health Technologies in Low- and Middle-Income Countries
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Digital health technologies (e.g., wearables, electronic health records, and artificial intelligence tools) are increasingly recognized for their potential to enhance care quality, efficiency, and reach of healthcare services while potentially reducing costs [1]. Landscape reviews have shown increasing investments by governments and other stakeholders in developing digital health technologies. However, there remains a need to assess the value of these rapidly evolving technologies, taking into account that different evidence is needed for different categories of digital health technologies and at different stages of technology maturity, and the need to strike a balance between innovation, affordability, and long-term sustainability [2].
Policymakers often struggle to address these questions using current methods and priority-setting processes, given the unique characteristics of digital health technologies. Evidence is frequently incomplete [3], only applicable to specific settings, highly heterogeneous, or quickly outdated, making it difficult to determine the value of the technology. For low- and middle-income countries (LMIC), these challenges are more prominent, given the limitations in data systems and governance, interoperability within fragile digital ecosystems, and additional barriers such as geographical challenges, cultural acceptability, workforce readiness, regulatory gaps, and limited research, financial, and implementation capacities further complicate the landscape [4-6].
Value frameworks provide a structured, transparent approach to guide evidence production [7,8]. Although some value frameworks to assess digital health technologies exist [9-12], they tend to be country-specific, intended for use in some high-income countries, and few are fully operationalized. Moreover, limited consensus on digital health technology classification further complicates the operationalization. For example, the National Institute for Health and Care Excellence (NICE) evidence standard framework for digital health technologies developed a classification system based on risk level and intended use, and outlines the evidence requirements for each category [12], whereas the World Health Organization (WHO) classification is based on how these technologies address individual and health system needs and advance health goals [13]. Therefore, there is an opportunity to address the gap in operationalizing frameworks in practice, and further assessment is needed to understand applicability to LMIC settings.
Demand for practical, context-appropriate frameworks, along with operationalization guidance (i.e. what evidence is required to demonstrate each value domain for which type of technology), has grown among LMIC policymakers. Thailand’s ongoing development of guidance for evaluating digital health technologies, intended for inclusion in its national health technology assessment guidelines, illustrates the demand to adapt, refine, and operationalize existing frameworks to better align with LMIC contexts.
We propose an evidence guide, comprised of an adapted or newly developed value framework and a newly developed implementation guide, to operationalize the value framework domains. This evidence guide will help to assess the value of digital health technologies for public investment, highlighting elements of evidence that may differ from traditional approaches in health technology assessment (HTA) or used in other settings (for example, high-income countries).
The value framework will identify which types of evidence are most helpful at different stages of the digital health product lifecycle. The implementation guide will then set out the principles for producing the evidence, considering different options that may be possible in limited-resource contexts. The evidence guide will be designed for policymakers and researchers, providing a structured, adaptable, and practical resource that offers a menu of evidence and evaluation options suited to different levels of data maturity, resource capacity, and investment goals. It is that in subsequent phases of the project, which are beyond the scope of this proposal, case studies in selected LMICs will evaluate the real-world applicability of the evidence guide and refine the guide based on learnings.
This work will contribute to the broader regional and global health agenda by supporting the ASEAN recommendations on Transforming the Digital Health Landscape [14], WHO Global Strategy on Digital Health and advancing Sustainable Development Goal 3.8 on Universal Health Coverage through equitable and efficient technology adoption.
References
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- Health Intervention and Technology Assessment Foundation. Navigating the landscape of Digital Health. Accessed 27 Nov 2026: https://www.hitap.net/en/research-detail/?research_id=167&research_title=Navigating+the+landscape+of+Digital+Health.
- WHO guideline: recommendations on digital interventions for health system strengthening. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
- Nemzoff C, Ruiz F, Chalkidou K, et al. Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries. BMJ Global Health https://doi.org/10.1136/bmjgh-2020-004549
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