Digital health initiatives hold significant potential for transforming health care delivery in low- and middle-income countries (LMICs). Over the past two decades, the literature has documented how these initiatives can enhance health systems by improving early warning systems for disease outbreaks, strengthening emergency preparedness, and expanding access to essential health care services [1]. Moreover, digital solutions, ranging from basic SMS-based platforms to more advanced mobile health (mHealth) apps, have been used to address pressing health care challenges, particularly in remote and underserved communities [2].

A large and growing body of research highlights the potential of digital health interventions to address specific health challenges such as infectious disease surveillance, maternal and child health, and chronic disease management. In addition, digital health has played a key role during worldwide health crises such as the COVID-19 pandemic, where it has enabled virtual consultations and supported efforts to trace contacts and disseminate accurate health information. However, these achievements are often contextual, responding to isolated health problems, while the broader goal of universal health coverage (UHC) remains elusive in many LMICs [3].

Despite these advances, there remains a considerable gap in understanding how digital health initiatives specifically contribute to realizing UHC in LMICs. While numerous studies highlight the effectiveness of digital tools in specific interventions such as malaria treatment or chronic disease management, there is less clarity on how these technologies integrate into broader health systems to support UHC goals. In addition, disparities in digital literacy, infrastructure, and equitable access to technology continue to present significant challenges, further complicating the pathway toward achieving UHC.

This paper seeks to address this gap by examining the role of digital health initiatives in advancing UHC in LMICs. Through a review of key case studies and an analysis of the evolution of digital health interventions over the past two decades, this study will explore both the opportunities and challenges that arise with the implementation of these initiatives [4]. Special attention will be given to understanding how digital health can bridge gaps in health care delivery, particularly in marginalized and remote communities, and what strategies are required to ensure the long-term success and integration of these technologies into existing health systems.

By doing so, the aim is to contribute to the growing body of literature on the potential of digital health to transform health care systems and support UHC objectives in these contexts.

Digital health initiatives encompass a diverse array of technologies and strategies aimed at leveraging digital tools to enhance health and health care delivery, focusing on improving effectiveness, efficiency, accessibility, safety, and personalization [5]. At its core, digital health involves the integration of information and communication technologies into various health care domains, including diagnosis, treatment, monitoring, and management.

This concept is grounded in the belief that technological advancements, such as mobile devices, wearable sensors, artificial intelligence (AI), and data analytics [6], have the potential to transform traditional health care practices and systems [7]. These technologies, including electronic health records (EHRs), virtual visits, mHealth, wearable technology, digital therapeutics, AI, and machine learning, empower health care providers to streamline processes, increase efficiency, and deliver more personalized and effective care to patients [8]. Moreover, clinical decision support systems are integral to the modern digital health ecosystem. These systems offer tools that enhance clinical decision-making through evidence-based recommendations, predictive analytics, and real-time data integration. When integrated with interoperable health IT frameworks, clinical decision support systems can significantly improve patient outcomes by enabling seamless data exchange between different health care providers and systems. This interoperability ensures that vital information is easily accessible, thus improving care coordination and reducing the likelihood of error [9]. A pivotal component of digital health is the digitization of health records and information systems, exemplified by the widespread adoption of EHRs, facilitating quick and secure access to patient data, thereby improving care coordination and clinical decision-making [10]. The concept of “Loose Coupling” in EHR systems, as exemplified by the Ayushman Bharat Digital Mission approach in India, offers a flexible alternative to monolithic EHR implementations. This strategy enables the integration of diverse health IT systems without necessitating a single, centralized platform, thus allowing for scalable and adaptable health care solutions across varied health care settings [11]. Furthermore, digital health encompasses remote monitoring and telemedicine solutions [12], which are particularly valuable for reaching underserved populations and reducing barriers to care [13]. mHealth apps and devices play a significant role in empowering individuals to proactively manage their health, facilitating tracking of health metrics, adherence to treatment plans, and informed lifestyle decisions. These solutions are accessible and scalable, promoting behavior change, improving health outcomes, and reducing health care costs [14]. AI and machine learning are increasingly integrated into digital health solutions, enabling predictive analytics, disease detection, and personalized treatment recommendations [15]. These technologies can potentially revolutionize clinical decision support, drug discovery, and precision medicine approaches. In LMICs, community health workers are crucial in bridging the digital divide, particularly in remote and underserved areas. By using digital health tools, community health workers can provide essential health services, monitor patient progress, and facilitate communication between patients and formal health care providers, thereby enhancing health care delivery in these regions [16].

Digital health has the immense potential to revolutionize health care by leveraging technology to improve access, efficiency, and quality of care. By embracing digital solutions, health care systems can address challenges and transition toward a patient-centered, data-driven, and sustainable health care delivery model.

Health care disparities in LMICs persist as a significant challenge, characterized by unequal access to medical services, limited infrastructure, and inadequate resources [17], [18]. These disparities exacerbate the already-existing health burdens, contributing to higher morbidity and mortality rates [19]. However, the advent of digital health technologies presents a promising solution to bridge these gaps and improve health care outcomes in LMICs.

The distribution of mobile phones and related technology is rapidly growing in LMICs. For example, India and sub-Saharan Africa will account for around half of new mobile subscribers globally over the 2022-2030 period [20], offering numerous opportunities for digital health to supply value to individuals and communities. However, despite these opportunities, digital health initiatives often fail to reach vulnerable populations due to structural, practical, commercial, and economic barriers [21].

Limited resources, infrastructure, information, and knowledge, as well as embedded structural complexities such as racism and power imbalances, contribute to inequitable access to digital health services. In addition, digital health applications may not be well suited to individuals with limited basic literacy skills such as reading and writing, further exacerbating disparities [22].

Despite their greater need for support, individuals in vulnerable situations often benefit less from digital health services. This exclusionary trend has become more apparent during the COVID-19 pandemic, widening the digital divide and exacerbating existing health care inequalities across continents, countries, and regions [23]. Recognizing the importance of reducing global health inequities, numerous global initiatives and national programs are committed to making digital health accessible to all citizens and communities. However, these initiatives often lack concrete examples of inclusive digital health projects on the ground and struggle to connect to create synergies.

To address these challenges, it is crucial to facilitate mutual knowledge exchange, both globally and locally, and to link initiatives to apply academic knowledge into practice. Collaboration between academia, the private sector, nongovernmental organizations, and citizens is essential to achieve the goal of “Digital Health for All” [24]. This collaboration should involve bundling knowledge from a wide range of disciplines, implementing this knowledge in concrete projects in collaboration with communities and health care providers, and using existing frameworks to ensure health equity.

Furthermore, to properly evaluate and facilitate the exchange of knowledge and its implementation, it is essential to develop a joint data infrastructure [24]. By combining data from various domains, such as health care, education, work, and income, it is possible to map out inequality and investigate how connecting data can promote well-being and structural change within vulnerable groups.

Digital health innovations have the potential to overcome geographical and practical barriers to health care, supporting UHC. However, to ensure accessibility and affordability of digital health for all, policy makers, health care professionals, and patients must collaborate, develop, implement, and share digital health initiatives that address the health needs of vulnerable populations [24]. Through inclusive approaches and concerted efforts, we can bridge health care disparities in LMICs and improve health outcomes for all citizens.

The rapid rise of digital health initiatives in LMICs over the last two and a half decades offers a great opportunity to improve access to health care and equity. Still, there is an urgent need for retrospective analysis to effectively shape future strategies. This study examines the evolution, impact, and prospects of digital health interventions in these regions, highlighting their role in promoting UHC. Despite their potential, challenges such as limited resources, infrastructure, and digital literacy hinder equal access to digital health services and exacerbate existing inequalities. In examining specific case studies and successes, this analysis aims to provide insights into the transformative power of digital health initiatives and address the barriers to their widespread adoption. In working together across stakeholders, including governments, health care providers, technology innovators, and communities, we can overcome these challenges and realize the full potential of digital health to improve health care and promote the well-being of vulnerable populations.

This study is a rapid systematic literature review on digital health interventions targeting UHC in LMICs [25]. We employed the PICO (Population, Intervention, Comparison, and Outcome) framework to structure our research question [26], focusing on digital health (Population), health interventions (Intervention), and impact on UHC (Outcome; Comparison is not applicable). Our research question addresses the impact of implementing digital health interventions on health system improvement in LMICs.

We used Research Rabbit, a citation-based literature mapping tool, to conduct the literature review [27]. Research Rabbit includes Semantic Scholar and PubMed, with over 200 million papers from various scientific fields [28]. For our search strategy, predefined keywords were used to identify relevant literature, including “digital health,” “health information systems,” “mobile health,” “universal health coverage,” “developing countries,” and “low- and middle-income countries.”

We conducted a rapid systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to determine the inclusion and exclusion of papers. Using the PRISMA framework, we meticulously screened abstracts and titles of papers based on specific criteria outlined in Textbox 1. The review process was conducted by two independent researchers at each stage, ensuring the robustness and reliability of the findings.

Inclusion criteria were defined as papers published in either English or French, focusing on digital-based health solutions contributing to UHC, and implemented in LMICs (excluding China and India) according to the World Bank classification. China and India were excluded from this study due to their unique and advanced digital health ecosystems, which significantly differ from those in other LMICs. Both countries have implemented large-scale national programs, such as China’s national health information system and India’s Ayushman Bharat Digital Mission, which feature comprehensive EHR systems and integrated telemedicine platforms. These initiatives, supported by substantial government investment and robust digital infrastructure, place China and India in a distinct category of digital health readiness. Including them in the analysis could skew the comparative results, as their challenges and outcomes in digital health are not directly comparable to those in other LMICs. We considered papers published between 1999 and 2024, aligning with PRISMA’s emphasis on comprehensive search strategies and transparent reporting practices.

Data extraction was performed based on predefined variables, including author and publication year, country or region of implementation, technology characteristics, sector of intervention, and the paper’s contributions to UHC. The study aligns with the World Health Organization’s definition of UHC, which includes ensuring that everyone receives essential health services without experiencing financial hardship. This entails investing in health service delivery systems, the health workforce, facilities, communication networks, health technologies, information systems, quality assurance mechanisms, and governance and legislation [29].

Quantitative analysis of extracted data was conducted using SPSS 28 (IBM Corporation) software. Absolute and relative frequencies were computed to analyze the data quantitatively, providing insights into the prevalence and distribution of various factors related to digital health interventions and their impact on UHC. The results, including quantitative summaries, are presented through tables and figures. These analyses contribute to a comprehensive understanding of the effectiveness and implications of digital health interventions in promoting UHC in LMICs.

Using Research Rabbit, a citation-based literature mapping tool, we conducted an extensive search. As illustrated in Figure 1, during the identification phase, databases and tools, including the Research Rabbit tool, were used to map documents. A total of 50 records via PubMed and 48 records via Semantic Scholar were identified. After removing duplicates, there were 98 unique records. In the screening phase, the titles and abstracts of the 98 records were screened. Of these, 38 were excluded because they had not been published in English or French between 1999 and 2024. In the eligibility phase, the full-text articles (60 in total) were checked for suitability. Of these, 22 were excluded because they did not focus on digital health in LMICs. This left 38 studies to be included in the wider project. In addition, 4 studies were excluded because they did not focus on improving UHC, leaving 34 studies (Table 1) to be included in this review.

During the early years of digital health initiatives in LMICs, efforts were primarily focused on establishing sustainable health information systems [30,31]. Organizations such as the Health Information Systems Program (HISP) played a significant role in driving these initiatives, aiming to design and support the implementation of robust health information systems in low- and middle-income countries [32,34]. The HISP, initiated by the Department of Informatics at the University of Oslo in the mid-1990s, focused on improving data collection, management, and communication between health care institutions [35].

The integration of fundamental digital health technologies marked a significant advancement in health care accessibility, especially in remote regions with limited traditional services. For instance, initiatives like text message–based platforms for health education in rural areas exemplify this transformative trend [44]. These platforms use the widespread availability of mobile phones to disseminate crucial health information, effectively bridging the gap in health care access and empowering individuals with knowledge for improved health outcomes.

In a qualitative study investigating the feasibility of implementing a mobile text message reminder system for child vaccination in northwest Ethiopia, challenges such as limited mobile phone ownership, access to networks, electricity, and illiteracy among the target population were identified [40]. However, stakeholder collaboration, user orientation or training, and the client’s willingness to pay were recognized as potential facilitators [40]. This research underscores the importance of considering these factors when introducing mHealth interventions in resource-limited settings.

A targeted approach to addressing specific health challenges emerged in the rollout of SMS-based platforms for malaria diagnosis and treatment in sub-Saharan Africa [45]. This focused strategy harnesses mobile technology to enable prompt detection and intervention, significantly contributing to malaria control efforts [45]. Such initiatives highlight the potential of digital solutions to address pressing health issues and enhance health care delivery in underserved communities.

To remove barriers to the uptake of digital health care, targeted health care policies that reflect sociocultural norms and practices need to be implemented. Measures such as affordable internet access, infrastructure development, and digital literacy programs are essential to facilitate access to digital health tools, especially for economically disadvantaged populations [74]. Investment in human resource development, capacity building, and better remuneration of health workers is critical to improving access to health care in Africa. Monitoring and evaluation systems must be prioritized to address implementation challenges and improve health care delivery [78]. In addition, technology companies and development organizations should invest in the research and development of assistive technologies to bridge the digital divide and ensure equitable access to health care.

In terms of future directions and opportunities for digital health in LMICs, emerging technologies such as AI are very promising. For example, the integration of AI algorithms for early detection of noncommunicable diseases in Southeast Asia could significantly improve proactive interventions, thereby improving health outcomes and reducing health care costs. International collaborations and partnerships play a critical role in leveraging expertise and resources to address health care challenges. Joint initiatives between governments and technology companies to develop scalable digital health solutions in Africa can improve access to and quality of health care and align with the goals of UHC.

Engaging and empowering the community is critical to the successful implementation of digital health. By empowering local health workers to train communities in the use of digital health tools for disease prevention in the Caribbean, ownership, trust, and sustainability can be fostered, leading to greater uptake and effectiveness. Strategies that ensure equitable access and inclusion of the population are of paramount importance. Implementing subsidized smartphone distribution programs in South America can reduce barriers to technology use in low-income populations, narrow the digital divide, and promote health equity. Capitalizing on these future directions and opportunities can pave the way for transformative advances in health care delivery and outcomes in LMICs.

This study reviews digital health interventions targeting UHC in LMICs, identifying 30 studies from 1999 to 2024 using the Research Rabbit AI Mapping Tool for papers and following PRISMA guidelines. These studies highlight the contributions of digital health interventions to UHC, emphasizing improvements in health data management, access to health care, and system sustainability across diverse geographical regions and technological domains.

However, the study is subject to certain limitations. While comprehensive, the scope may have inadvertently excluded relevant studies due to search strategies and indexing limitations. For instance, relatively few papers were identified from curated JMIR Publications sections, such as “mHealth in the Developing World and LMICs, Underserved Communities, and for Global Health” (JMIR mHealth and uHealth); “Clinical Informatics in Low-Resource Settings and the Developing World” (JMIR Medical Informatics); and “Health Services in Resource-Poor Settings and LMICs” (JMIR Public Health and Surveillance). This gap may be attributed to indexing challenges or the specificity of search terms. In addition, the study is susceptible to language, potential publication, and time biases, as only studies published in English and within specific timeframes were included.

Despite these limitations, the study provides valuable insights into the evolving landscape of digital health interventions in LMICs and their potential to advance UHC goals. Addressing these gaps in future research could enhance the comprehensiveness and impact of studies in this critical field, contributing to more equitable and effective health strategies globally.

To conclude, digital health initiatives in LMICs have spanned decades of innovation, adaptation, and perseverance. From early developments in establishing sustainable health information systems to recent advances in the use of cutting-edge technologies, this reflects a collective commitment to improving accessibility, equity, and health outcomes.

The development of digital health interventions underscores their transformative potential in bridging long-standing gaps in health care delivery. Initiatives such as SMS-based health education platforms, remote patient monitoring, and digital contact tracing apps have shown tangible benefits in improving health awareness, disease management, and controlling disease outbreaks. These achievements have not only enhanced individual health outcomes but have also contributed to broader public health goals, including the realization of UHC.

Amid the progress, however, are daunting challenges requiring concerted action and innovative solutions. Inadequate infrastructure, scarce resources, governance issues, and inequitable access to health care remain barriers to equitable health systems in LMICs. The rapid adoption of digital health technologies faces hurdles such as unequal access to technology, privacy concerns, and regulatory complexity that require targeted action and policy frameworks to address effectively.

To overcome these challenges and realize the full potential of digital health, a multifaceted approach is essential. This includes prioritizing investment in infrastructure development, digital literacy programs, and human capacity building. It also includes fostering collaboration between governments, technology companies, health care providers, and local communities to ensure inclusive and sustainable solutions. In addition, proactive measures on privacy, security, and ethical considerations are essential to build trust in digital health interventions. The future of digital health in LMICs is bright. Emerging technologies such as AI, telemedicine, and big data analytics offer unprecedented opportunities to revolutionize health care, disease prevention, and health promotion. By harnessing these innovations responsibly and equitably, it is possible to accelerate progress towards universal health care and improve health outcomes for all.

The evolution of digital health in LMICs is a testament to human ingenuity, resilience, and collective determination to overcome challenges and create a healthier and more equitable world.