Background

Despite increasing investments in digital health, many countries continue to face challenges related to fragmentation, interoperability, governance, sustainable financing, and equitable access to digital health systems. To better understand how countries can successfully leverage digital technologies to strengthen primary health care (PHC), the Digital Health Exemplars (DHE) project was implemented under the Exemplars in Global Health initiative through a collaboration between the Johns Hopkins Center for Global Digital Health Innovation, the Center for Digital Health and Implementation Science (CDHI) at the University of Gondar, and other global partners.

The Digital Health Exemplars (DHE) study, examined how five exemplar countries; Rwanda, Ghana, India, Brazil, and Finland have leveraged digital health technologies to improve health service delivery and strengthen PHC systems.

Representing different stages of digital health maturity, these countries provided valuable insights into the pathways, enablers, and outcomes of digital transformation and enable meaningful cross-country learning.

Approach

Retrospective Country Case Studies: Documented the evolution of digital health systems, key success factors, and implementation milestones through document reviews, and stakeholder workshops.
Identifying Enablers and Pathways to Scale: Conducted key informant interviews and examined 2-3 major digital health interventions in each country to identify factors that influence the adoption, scale-up, and sustainability of digital health interventions, including key drivers, barriers, and successful strategies.
Assessing the Impact of Digital Health Interventions: Existing quantitative data sources were analyzed for the contribution of selected digital health interventions to improvements in health service coverage, access, quality, efficiency, and understanding the broader effects of digital transformation on PHC systems.

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Key Findings

How can countries gain value from digital health?

Digital health interventions delivered most value when anchored to a clearly articulated health need — "intervention-context fit"
Efficiency gains in administrative tasks were the most consistent measurable benefit, freeing staff for clinical work
Rwanda: E-Tracker and Kwivuza produced an 82% reduction in admin hours and a 78% cut in annual facility operating costs
Time savings do not automatically become cost savings — this depended on which cadres benefited

Recommendation: Align digital interventions to specific problems in the health system.

How to build strong enabling ecosystems?

Sustainable scale requires system readiness — moving fast risks digitizing broken processes
Common sequencing: foundational readiness → scaled systems → integrated and sustained
AI requires the same foundations, with added emphasis on data governance and infrastructure
Ghana GhiLMIS: 140% better timely order-supply; 70% faster stock order delivery

Recommendation: Invest in staged improvements across infrastructure, governance, workforce and financing.

How to move from siloed solutions to full digitization?

End-to-end digitization offers long-term value but requires substantial readiness and investment
Four stages: foundational data blocks → national aggregation → cross-level expansion → direct patient access
Finland MyKanta: €554M invested (2005–2024); 100% of facilities covered; direct patient access to health data
India ABDM: combined incentives and regulations, with a sandbox for private sector testing and innovation

Recommendation: Establish a long-term vision for full digitization balanced with a readiness-based approach.

Influencing Decisions at Global and National Level

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Digital Health Exemplars (DHE)

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