Digital health solutions offer tremendous potential to enhance the reach and quality of health services and population-level outcomes in low- and middle-income countries (LMICs). While the number of programs reaching scale increases yearly, the long-term sustainability for most remains uncertain. In this article, as researchers and implementors, we draw on experiences of designing, implementing and evaluating digital health solutions at scale in Africa and Asia, and provide examples from India and South Africa to illustrate ten considerations to support scale and sustainability of digital health solutions in LMICs. Given the investments being made in digital health solutions and the urgent concurrent needs to strengthen health systems to ensure their responsiveness to marginalized populations in LMICs, we cannot afford to go down roads that ‘lead to nowhere’. These ten considerations focus on drivers of equity and innovation, the foundations for a digital health ecosystem, and the elements for systems integration. We urge technology enthusiasts to consider these issues before and during the roll-out of large-scale digital health initiatives to navigate the complexities of achieving scale and enabling sustainability.

中文翻译：

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避免无路可走：关于扩大和维持数字健康的政策见解

数字健康解决方案提供了巨大的潜力，可以提高低收入和中等收入国家 (LMIC) 的卫生服务和人口水平结果的覆盖面和质量。虽然达到规模的项目数量逐年增加，但大多数项目的长期可持续性仍不确定。在本文中，作为研究人员和实施者，我们借鉴了非洲和亚洲大规模设计、实施和评估数字健康解决方案的经验，并提供了来自印度和南非的示例，以说明支持数字健康解决方案规模化和可持续性的十个考虑因素在中低收入国家。鉴于对数字卫生解决方案的投资以及加强卫生系统以确保其对中低收入国家边缘化人群做出反应的迫切需求，我们不能走“无处可去”的道路。这十个考虑重点关注公平和创新的驱动因素、数字健康生态系统的基础以及系统集成的要素。我们敦促技术爱好者在大规模数字健康计划推出之前和期间考虑这些问题，以应对实现规模和实现可持续性的复杂性。