ArticleBMJ global health2021
A tale of 'politics and stars aligning': analysing the sustainability of scaled up digital tools for front-line health workers in India.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Adaptability, Scalability and Sustainability (ASaS) of complex health interventions: a systematic review of theories, models and frameworks.Implementation science : IS · 2024Pooled it
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- Strengthening digital competencies in India's health workforce: development and feasibility evaluation of a digital health competency framework for frontline healthcare workers in Uttar Pradesh.Oxford open digital health · 2026Article
- From intervention studies to national programs, what are the favoring and hindering factors? a scoping review.BMC public health · 2025Article
- From Peer Support to Program Supervision: Qualitative Insights on WhatsApp as Informal Digital Infrastructure for Community Health Workers and Public Health Officers in an Indian High-Priority Aspirational District.Healthcare (Basel, Switzerland) · 2025Article
- Reporting Digital Health Implementations Based on the iCHECK-DH Guidelines and Checklist: Development of an Interactive Toolkit.Journal of medical Internet research · 2025Article
- A non-specialist worker delivered digital assessment of cognitive development (DEEP) in young children: A longitudinal validation study in rural India.PLOS digital health · 2025Article
- Community health worker payment processes: a qualitative assessment of experiences in two Indian states.Health policy and planning · 2025Article
- Diabetes care for people experiencing homelessness in the UK: insights from a national survey of frontline professionals and the development of an integrated care model.Frontiers in public health · 2025Article
- Barriers and facilitators for the use of telehealth by healthcare providers in India-A systematic review.PLOS digital health · 2024Article
- Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India.SSM. Mental health · 2023Article
- Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review.International journal of environmental research and public health · 2023Article
- iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations.Journal of medical Internet research · 2023Article
- A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol.BMC pregnancy and childbirth · 2023Article
- Implementation of fixed-dose combination therapy for secondary prevention of atherosclerotic cardiovascular disease among Syrian refugees in Lebanon: a qualitative evaluation.BMC health services research · 2022Article
Corrections and comments
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Authors and funding
5 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIndia has become a lighthouse for large-scale digital innovation in the health sector, particularly for front-line health workers (FLHWs). However, among scaled digital health solutions, ensuring sustainability remains elusive. This study explores the factors underpinning scale-up of digital health solutions for FLHWs in India, and the potential implications of these factors for sustainability.
methodsWe assessed five FLHW digital tools scaled at the national and/or state level in India. We conducted in-depth interviews with implementers, technology and technical partners (n=11); senior government stakeholders (n=5); funders (n=1) and evaluators/academics (n=3). Emergent themes were grouped according to a broader framework that considered the (1) digital solution; (2) actors; (3) processes and (4) context.
resultsThe scale-up of digital solutions was facilitated by their perceived value, bounded adaptability, support from government champions, cultivation of networks, sustained leadership and formative research to support fit with the context and population. However, once scaled, embedding digital health solutions into the fabric of the health system was hampered by challenges related to transitioning management and ownership to government partners; overcoming government procurement hurdles; and establishing committed funding streams in government budgets. Strong data governance, continued engagement with FLHWs and building a robust evidence base, while identified in the literature as critical for sustainability, did not feature strongly among respondents. Sustainability may be less elusive once there is more consensus around the roles played between national and state government actors, implementing and technical partners and donors.
conclusionThe use of digital tools by FLHWs offers much promise for improving service delivery and health outcomes in India. However, the pathway to sustainability is bespoke to each programme and should be planned from the outset by investing in people, relationships and service delivery adjustments to navigate the challenges involved given the dynamic nature of digital tools in complex health systems.
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