Scoping review on the enabling environments to support the digital health solutions in Bangladesh, India, Indonesia, Malaysia and Pakistan

Clinical Research Results Abstract Aim: Management of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is challenging. Digital health solutions can overcome the problems of distance, poor infrastructure, limited medical provision in rural areas and the need to provide community practitioners with specialist support. Colleagues from RESPIRE global unit identified the digital health solutions valuable in their local setting, worked together iteratively to review published literature and online open sources to answer the questions: What digital health policy, IT and electricity infrastructures are available to support digital health? What socio-cultural factors influence access to the infrastructure, and users’ ability to adopt and utilise digital health? Methods: We adopted the Implementation and Operation of Mobile Health projects framework and The Extended Technology Acceptance Model of Mobile Telephony in rural India to categorise the results. We used open sources statistics (e.g. National/WHO/International Telecommunication Union(ITU)/Groupe Spécial Mobile (GSMA)) and local news /articles/government statistics recommended by local colleagues to scope the current status. We systematically searched six databases for information about infrastructure and the digital technologies valued by local clinicians. Results: We identified 118 studies (2015-2021) and 114 supplementary online news articles and national statistics. Digital health policy was available in all countries, but limited skilled labour, lack of legislation, interoperability support, and interrupted electricity and internet services remain challenging. Older patients, women and those living in rural areas were least likely to have access to necessary IT infrastructure. Renewable energy has potential in enabling digital healthcare. Low usage mobile data and voice service packages are relatively affordable options for mHealth in the five countries.Conclusion: Digital health technology can support healthcare in LMIC communities, but projects need to consider the available infrastructure (especially in rural areas), adopt low cost options and address the age/gender disparities. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest Conflict of interest: N/AFunding: This project is funded by NIHR Global Health Research Centres: Research and Institutional Capacity Strengthening In NCDs (NIHR203250) and the Scottish Funding Council, The University of Edinburgh and GCRF Partnership Fund (PF_48). References and Clinical Trial Registry Information [1]Monsur Habib, Parisa Khandakr, Chowdhury Zabir Hossain Tanim (Bangladesh); Rutuja Patil, Ashish Satav, Shweta Panwar, Jitendra Shah (India); Mulya Nurmansyah, Fedri Ruluwedrata Rinawan (Indonesia); Adina Abdullah, Toh Teck Hock, Hani Salim (Malaysia); Zakiuddin Ahmed, Hana Mahmood, Aimal Rextin (Pakistan); Dominique Balharry, Hilary Pinnock (UK)