Bridging the data-power paradox: a conceptual-empirical analysis of solar-powered digital health systems in low-resource settings.

Background: Digital health technologies are increasingly promoted as key enablers of health system strengthening in low-resource settings. However, their effectiveness is often constrained by inadequate infrastructure, particularly unreliable energy supply. This misalignment between digital innovation and infrastructural readiness can be conceptualized as the "Data-Power Paradox," whereby investments in digital health systems are undermined by unreliable electricity and connectivity. Objective: This study aims to examine the role of energy infrastructure as a foundational enabler of digital health systems and to develop a conceptual-empirical model for integrating solar-powered energy solutions into digital health architectures in low-resource settings. Methods: A conceptual-empirical approach was adopted, combining secondary analysis of data from the Bright Health feasibility study conducted in Kenya and Ethiopia with a targeted narrative review of the literature. Qualitative insights from healthcare facilities and stakeholders were analyzed thematically, while quantitative indicators related to infrastructure and system performance were interpreted descriptively. A systems-thinking framework was applied to examine the interdependencies between energy reliability, digital system functionality, and health service delivery. Results: Findings indicate that unreliable energy supply significantly disrupts digital health system performance, leading to system downtime, fragmented data, and reliance on manual processes. Facilities supported by more stable energy sources, particularly solar-powered systems, demonstrated improved system uptime, enhanced data continuity, and greater consistency in digital workflows. The analysis further shows that offline-first system design, when combined with hybrid connectivity and reliable energy infrastructure, can mitigate the effects of infrastructural constraints. These insights informed the development of a solar-powered digital health system architecture that integrates energy, connectivity, and data management components. Conclusions: Energy infrastructure is a critical determinant of the success of digital health systems in low-resource settings. Addressing the Data-Power Paradox requires integrated approaches that align digital health investments with reliable energy solutions. The proposed solar-powered digital health architecture provides a scalable and resilient model for improving healthcare delivery and advancing equitable access to digital health services.