Strengthening data-driven primary health care delivery in Rajasthan, India.

Digital health information systems have the potential to improve data-driven decision-making and strengthen primary health care delivery in low- and middle-income countries (LMICs). This study examines Rajasthan's public health information systems with an aim to describe data processes and identify key barriers and opportunities for improvement. Using a qualitative approach, we conducted in-depth interviews with 39 stakeholders, including frontline health workers and state health officials. Our findings highlight inefficiencies in parallel paper and digital reporting systems, leading to high health worker burden, redundant data entry, delays in patient care, and poor data accountability. While digital platforms have improved data accessibility and care coordination, challenges such as poor design, interoperability, IT infrastructure limitations, and gaps in digital literacy remain. Lessons from successful digital health implementations in other LMICs suggest that integrated, human-centered, and interoperable systems are critical for sustainable digital transformation. We propose a "5I Framework" for policymakers to streamline Rajasthan's digital health ecosystem: (i) Integrated platforms, (ii) Implementable systems co-designed with health workers, (iii) Ink-free transitions away from paper-based systems, (iv) Insights from geospatial and real-time data, and (v) Incentives aligned with workforce needs. Strengthening Rajasthan's digital health systems through these strategies can enhance service delivery, improve public health outcomes, and serve as a model for other LMICs.