Digital Health in Response to COVID-19 in Low- and Middle-income Countries: Opportunities and Challenges

Abstract COVID-19 has pulled back the curtain on health system fragility to expose persistent and deepening inequities worldwide The limited capacity of low- and lower-middle income countries (LMICs) to respond to the pandemic and its impact on the health of populations ? particularly the most vulnerable ? presents a marked challenge  In this context, countries face the enormous task of rethinking the way essential services will be delivered A critical and essential part of solving these challenges will be using information and communication technology and digital health to enhance direct communication with the public;scale proven and innovative service delivery models;and empower the frontlines However, if the deployment, adaptation, or expansion of these innovations are not user-centered for the most marginalized or do not learn from past lessons, it could be highly wasteful at best At worst, such shortcomings could exacerbate pre-existing weaknesses in the health care system such as exclusion of peripheral populations, disempowerment of health workers, and proliferation of unregulated private providers We provide recommendations of which innovations should be prioritized and implementation principles to address the current challenges while responding to the need to fundamentally change service delivery for accelerated impact