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ICT for Health: Networks, standards and innovation

target audiences, sustainability potential and proliferation in workforce capacity and enriching academic programs to
certain sectors only. meet increasing demands for digital health expertise is
another area that requires investment and sustained
Much like the overall course of the health system evolution commitment by stakeholders. Engaging the private sector,
in Nepal [51], digital health solutions are frayed, issue and especially telecommunication companies, is an underutilized
organization-centric, and primarily driven by donor or non- strategy to address current barriers related to implementation,
governmental organizations. Most solutions have focused on technical, financial and sustainability challenges [12].
telemedicine to enhance gaps in healthcare access in rural Existing pioneers in this space (GoN and I/NGOs) must
areas with frontline workers heavily burdened with multiple engage in strategic planning on how to increase collaborative
e-health or m-health tools and solutions for different partnerships with the private sector or incentivize
programs or organizations. There are missed opportunities to independent commercial ventures [55].
increase service delivery beyond providing basic or
specialized healthcare in rural areas and addressing health 5. STRENGTHS AND LIMITATIONS
challenges related to maternal and child health or sexual and
reproductive health. The rise of non-communicable diseases, Our scoping study was successful in retrieving information
unplanned urbanization and demographic transition to a regarding 20 digital health solutions implemented via formal
higher number of elderly populations juxtaposed with a channels in Nepal to date. To the best of our knowledge, this
continuing flow of migrant youth working abroad warrant is the first paper to capture national level digital health efforts
the exploration of digital health solutions beyond its current implemented in Nepal and analyze the space utilizing two
limited scope and application [1,2,27,52,53,54]. Informal rigorous evidence-based frameworks [15,16]. Informal
consultations with key informants have shed light on the fact consultations with experts suggest the potential of additional
that digital health solutions are being implemented in Nepal digital health solutions implemented via both formal and
in these areas through informal channels on an as-needed informal channels that were not captured in our study since
basis and are yet to be documented or formalized due to they are not publicly accessible via the Internet or published
regulatory, financial/compensation or resource gaps. Our in academic journals. There is currently an effort on our part
team is currently analyzing findings of key informant to analyze findings from key informant interviews to bridge
interviews with stakeholders on the ground to share our this documentation gap. Evaluating the effectiveness of
review findings, attain insights regarding facilitators and identified solutions was not feasible with the limited
barriers, and explore the utilization and potential of digital resources available to achieve the scope of this study. This
health solutions in Nepal beyond what has been found line of investigation is a fruitful avenue for future studies to
through this review. explore and research.

From a leadership and governance perspective, progress has 6. CONCLUSION
been made to set the stage for digital health solutions to be
implemented in Nepal by establishing a few strategic Due to its current sociopolitical and ICT climate, Nepal is
frameworks and policies in place. However, integration and well-positioned to take a holistic multilevel systems
institutionalization of digital health solutions are still not at perspective accounting for the WHO building blocks in
the forefront of these policy agendas. While a national health charting the course of digital health solutions in Nepal. In
ID, data standardization, and interoperability frameworks are doing so, we echo the recommendation of Ahmed et al. [12]
critical key ingredients in this space [38], so too is gathering to adopt the guidelines and toolkits established by the
knowledge and evidence on the implementation and Rockefeller Foundation, WHO, and International
effectiveness of digital health solutions at a national level. It Telecommunication Union (ITU) in addition to conducting a
is also important to understand and tailor digital health national-level assessment exploring the application of digital
solutions and frameworks according to the needs of the target health solutions along with an evaluation of all solutions
audience so that the output is user-centric [6,59]. developed to date [12,56,57,58]. Additionally, we
Furthermore, there is a critical need to address technical, recommend the adoption of the Principles of Digital
cultural and knowledge barriers among stakeholders such as Development developed in consultation with multiple
lack of data and digital literacy, fear of technology, and a development and health organizations and foundations [59],
shared understanding of the definition and application of the recently released guidelines for digital interventions for
digital health solutions respectively among stakeholders, health systems strengthening by the World Health
decision-makers, and policy makers. Equally critical is the organization [60], while taking a whole-of-government
need for the GoN to mitigate the vast digital divide in Nepal investment approach [61].
[38]. A national-level monitoring and evaluation of
innovative digital health solutions is needed to identify cost- Taking a regional and global perspective on our findings,
effective solutions that can be scaled up and integrated to the China, India and Uganda serve as exemplary cases. With the
overall health system framework. Assuring sustainability of proliferation of the digital era, digital health interventions
effective solutions will require thought leadership, strategic have been prolific in middle and low-income countries.
oversight, resource allocation, transparency by the GoN, and However, they remain stuck in “pilotitis” without the ability
a baseline level of understanding of the potential of digital to scale [62]. Frustrated by this phenomenon, the
health solutions among stakeholders. Developing local government of Uganda issued a moratorium on digital health

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