Background

Digital health – defined broadly as the systematic application of information and communications technologies, computer science and data to support informed decision-making by individuals, the health workforce and health systems, to strengthen resilience to disease and improve health and wellness (1) – is increasingly being applied as an essential enabler of health-service delivery and accountability. Ministries of health have recognized the value of digital health as articulated within the World Health Assembly resolution (2) and the Global strategy on digital health (3). Likewise, donors have advocated for the rational use of digital tools as part of efforts to expand the coverage and quality of services and promote data use and monitoring efforts (4–6). Despite the investments into and abundance of digital systems, there is often limited transparency in the health data and logic contained in these digital tools, or the relationship with evidence-based clinical or public health recommendations, which not only undermines the credibility of such systems, but also impedes opportunities for interoperability and threatens the potential for continuity of care.

Evidence-based recommendations, such as those featured in World Health Organization (WHO) guidelines, establish standards of care and offer a reference point for informing the content of digital systems that countries adopt. However, guidelines are often only available in a narrative format that requires a resourceintensive process to be elaborated into the specifications needed for digital systems. This translation of guidelines for digital systems often results in subjective interpretation for implementers and software vendors, which can lead to inconsistencies or inability to verify the content within these systems, potentially leading to adverse health outcomes and other unintended effects. Where digital systems exist, the documentation of the underlying data and content may be unavailable or proprietary, requiring governments to start from scratch and expend additional resources each time they intend to deploy such a system. This lack of documentation of the health content can lead to dependence on one vendor and haphazard deployments that are unscalable or difficult to replicate across different settings.

WHO standards-based, machine-readable, adaptive, requirements-based and testable (SMART) guidelines provide essential ingredients to facilitate digital health transformation of health programmes in a way that is consistent with recommended clinical, public health and data practices and interoperability standards. As a type of SMART guideline, digital adaptation kits (DAKs) are designed to facilitate the accurate reflection of WHO’s clinical, public health and data use guidelines within the digital systems countries are adopting. DAKs are operational, software-neutral, standardized documentation that distils clinical, public health and data use guidance into a format that can be transparently incorporated into digital systems. Although digital implementations comprise multiple factors, including (1) health domain data and content, (2) digital intervention or functionality, and (3) digital application or communication channel for delivering the digital intervention, DAKs focus primarily on ensuring the validity of the health content (Fig. 1) (1, 7). Accordingly, DAKs provide the generic content requirements that should be housed within digital systems, independently of a specific software application and with the intention that countries can customize them to local needs.