The Global Strategy on Digital Health 2020–2025 aims to use digital technologies as digital public goods to address health system challenges. Digital health technology and related products can help solve issues related to healthcare services provision and equal resource distribution. However, there is limited information on the best business models for local entrepreneurs in the digital health space.

A multi-site collective case study was conducted with private entrepreneurs in two African countries operating in digital health based on public global goods. Data was collected through semi-structured questionnaires and interviews to generate rich data, and framework analysis was used to guide themes using NVivo version 14.0 software.

The study identified four major themes: sustainable business models, value chains businesses participate in, enablers and obstacles to business sustainability.

The findings suggest that business-to-business, business-to-consumer, business-to-business-to-customer, and on-demand are sustainable business models.

Health Informatics in Africa is conducting studies to assess opportunities for Digital Health Entrepreneurs in the Digital health global goods ecosystem to better understand the market to inform on free and open source-based business models for digital health global goods companies in Africa.

Leveraging open-source technologies offers an enormous potential to rapidly scale - up technologies and speed up local adaptations of digital health solutions [1,2,3]. Remarkably, digital health solutions that are both digital public goods (DPGs) and global goods will have the highest impact for low and middle-income countries (LMICs) particularly in sub-Saharan Africa [4].Global goods are digital health tools that are adaptable to different countries and contexts to help address key health system challenges [5]. There are over 50 projects in Uganda that are registered on World Health Organization (WHO) Digital Health Atlas, that deal in digital health technologies [6].

Digital health technology and related products can help to solve the problems associated with providing healthcare services and equal distribution of resources [7, 8]. Various business models exist for local entrepreneurs in the digital health space [9], however, there is scanty information on what models have worked, what enablers and barriers are faced and which model is best to sustain. In order to run a digital health business, key components and critical factors need to be understood which can help to inform on free and open source-based business models.

There is an undersupply of public goods at the global level because countries have no incentive to produce them on their own accord without guarantees that other countries will also contribute their fair share [10, 11]. The possible shortage of global goods includes digital public goods (DPGs), COVID-19 presented an opportunity, where global public goods would have revolutionised the management of COVID-19 vaccines [12]. Private companies in digital public goods have undocumented challenges and opportunities, there is a need to document, explore and exploit the immense opportunities of the DPGs for the attainment of the sustainable development goals in Africa.

The Global Strategy on digital health 2020–2025 advises use of digital technologies as digital public goods, which are adaptable to different countries and contexts to help address key health system challenges [13]. Digital health technology and related products can help to solve the problems associated with providing healthcare services and equal distribution of resources [14].

There is a need to leverage on already existing open-source technologies to enable local adaptability of digital health solutions for the attainment of sustainable development goals (SDGs). This will help to inform policy and countries, of availability and ability of open source digital health tools to fulfil many of the technology needs of health systems faced in Africa for example human resource & staffing, tools for revenue cycle management and rescheduling and follow-up of patients.

Evidence points to the necessity to record, investigate, and take use of the DPGs’ enormous potential for achieving the SDGs in Africa, as well as the abundance of such products that are emerging on the continent. Therefore, in order to expand the digital health supply and value chains in Africa, researchers must objectively address the potential, problems, and necessary measures to enhance access to quality healthcare in Africa.

Research is required to better understand the African market for digital health global goods companies and to evaluate the opportunities found in the ecosystem for digital health entrepreneurs (start-ups, small and medium-sized enterprises, for-profit and non-profit organizations, and individual social entrepreneurs) by examining current solutions.

The sustainability of digital health business can be affected by various independent factors, and a rich understanding of these components and factors from the experts running, working with, and employed in these companies is paramount. The key components and critical factors for a sustainable digital health business may include but not limited to:

Various business models exist for local entrepreneurs in the digital health space [9], for example, a few business models on global goods include: Free Model- used by google, Facebook, Freemium Model-used by zoom, Open Source- used by RedHat, Redcap, Market place model- used by Amazon, Airbnb, On-demand model- used by Netflix.

Subscription model- used by Spotify, however, there is scanty information on what models have worked locally, what enablers and barriers are faced within the business and which model is best to sustain [16, 17].

In order to run a digital health business, key components like value chain, sustainability and critical factors need to be understood which can help to inform on free and open source-based business models. Value chain refers to various processes and business activities involved in while performing a service. It has multiple stages e.g. sales, services, research and development [18]. Typical supply chain transactions and digital sales models include business to business, business to customer and business to business to customer. These models require proper planning to be successful [19].

Digital health applications in healthcare include telemedicine, electronic health records, health mobile apps as well as the application of artificial intelligence and machine learning algorithms [20].

In light of “digital health”, there are several web platforms and mobile health applications, from players who produce and offer services in non-linear and non-hierarchal ways [21]. Digital Innovation is a strong force of transformation in some industries, and it has just recently come to focus in the healthcare sector [22].

Digital health solutions that are both digital public goods (DPGs) and global goods will have the highest impact for low and middle-income countries (LMICs) particularly in sub-Saharan Africa [23]. The International Monetary Fund (IMF) states that Public goods are those that are available to all and that can be enjoyed over and over again by anyone without diminishing the benefits they deliver to others, can be local, national, or global. However, it goes on to show how COVID-19 exposed the need for public goods and lists challenges for undersupply which included a lack of incentives [24]. Global public goods are critical to addressing future pandemic preparedness, global health policy, health equity, and the unfolding climate crisis [25].

This was a mixed methods collective multisite case study design on two digital health entrepreneurship business companies in Uganda. In this study, the case was defined as a company that has been dealing in the digital health business for at least three years. The inclusion criteria were private entrepreneurs in the Uganda digital health space with business in digital public goods which included telehealth and or electronic medical records, supply chain systems, and patient scheduling. The exclusion criteria were private entrepreneurs using digital health not willing to participate in the case study, entrepreneurs in the market for less than three years, and entrepreneurs not registered on digital health atlas.

The study was site- based within Kampala central district, at Bukoto Clinic Master Office, and Lugogo By Pass-Rocket Health Offices. ClinicMaster International is a private business responsible for the Development and support of ClinicMaster, an integrated healthcare information management and medical billing software. It has been operational since 2013 and serves several healthcare facilities across five (05) African countries.

Rocket Health provides remote doctor consultations, pharmacy deliveries, and access to cashless healthcare services. It has been operational since 2018 in three [3] African Countries.

Cases included; private entrepreneurs in the Uganda digital health space, Companies with business in digital public goods which include telehealth and or electronic medical records, supply chain systems, and patient scheduling. Two cases were chosen, Clinic Master which deals in patient scheduling and billing; and Rocket Health which deals in telehealth. Key Informants were selected from the cases, and included the Head of business units, Head of software development, Head of Finance and Administration, Network engineer, Administration Manager, Quality Assurance & Compliance Manager, and Software Product Manager.

Between 13th Oct 2023 and 19th Oct 2023, we conducted semi-structured interviews (S1_Text) and interviewer-administered questionnaire (S2_Text) to explore barriers, enablers, business models, and value chain for the private businesses, and assessed areas for support from international organizations.

The data were collected through interviews to key informants and completion of an ethics-approved interviewer-administered questionnaire which was administered to lead key informants at the two business units. A total of eight interviews from key informants at the two sites were selected based at the case study sites.

The principal investigator is a post-graduate student with a medical background (ABN), a co-investigator (AKN) a software developer with information service, software, and technology(IS-IT) background, and a research assistant (JB) with a social sciences background and training in qualitative data collection conducted the interviews, the interviews were conducted in English. All the interviews were audio-recorded and transcribed by the research assistant, and checked for consistency and accuracy by the principal investigator.

The interviews were recorded after seeking permission from the key informants. Audio files were transcribed, and scripts were imported into Nvivo software, which supported the data analysis.

We used a deductive and inductive thematic framework analysis approach using NVivo 14.0 to code interview scripts, and concurrent triangulation was done from the responses to questionnaires to validate and augment the interviews.

The process involved reading the transcripts several times, to further identify key themes and sub-themes to inform the development of a codebook. We identified quotations illustrative of the enablers and barriers to sustainability of digital health business of a codebook.

This study was approved by School of Medicine research ethics committee (Ref# Mak-SOMREC-2023-722) and regulatory approval got from Uganda National council of science and Technology (Ref# Ref: SS2051ES). We obtained written informed consent prior to data collection from all the participants.

Between 13th Oct 2023 and 19th Oct 2023, two cases were studied and a total of eight informants interviewed within the Kampala Metropolitan area. Two informants had concurrent interview and administration of a questionnaire. Majority of informants were male, see Table 1 below for a summary on participants.

Under this theme, there are four common and major models mentioned by the informants with one on-demand model and these included; business to business (B2B); business to business to customer (B2B2C), business to customers (B2C) and on demand business models.

The B2B, is a form of transaction between businesses e.g. delivering software to health facilities, B2B2C is where two companies provide complimentary services to reach the same customer e.g. provision of healthcare services to insured clients, B2C model is where products are sold directly to customers e.g. telehealth services and on demand business model, is where consumers are provided with services when they want them. e.g. provision of SMS services to clients for a given period.

The value chain framework includes four secondary activities: purchasing and procurement, human resource management (HRM), technology development, and business infrastructure, and five fundamental activities: inbound operations, operations, outward logistics, marketing and sales, and service. From product development to customer and patient services, the whole digital health value chain necessitates the smooth integration and interoperability of various health technologies. Significant value is created for patients and stakeholders through improved operational efficiency, cost reduction, and innovation stimulation brought about by effective value chain management [26].

Integrated healthcare information management and billing system, Telehealth/telemedicine a remote healthcare provision and consultancy, Mobile clinic via USSD code which offered laboratory, pharmacy and vaccinations services, and e-Shop with retail and wholesale pharmacy. The public global goods that the cases include: open source software, like; RapidPro - used to build interactive SMS systems, WordPress - used to build websites, Open MRS - an electronic medical record system used to support the delivery of healthcare and Linphone - a softphone that configures audio and video calls, they also mentioned use of open source databases like; PostgreSQL, MySQL which is a relational database management system and lastly the use of open source framework in particular Django, a python web framework for rapid development of applications. One of the cases hinted on attempting to boost productivity of the company through the adoption of digital technologies that leverage artificial intelligence and the Internet of Things (IoT), which has the potential to enhance supply chain connection.

Under the enablers of running a private digital business on global goods, six subthemes emerged, as discussed below, and Fig. 1 (after the quotes), shows the most common 500 words during the interviews.

Information technology and Information system infrastructure, under this sub theme various categories emerged that enabled entrepreneurs to run their businesses. These categories included: easy access to open source software and ability to develop new features on the system, comprehensive systems and back-up services.

“growth of technology, everyone is on phone these days, we know Uganda has an internet problem in fact to this day we could be the only large business without a mobile App because people first build the App then build the business around the App”(RH5).

The second subtheme enabling business, was, the ability to do in-house capacity building, where continuous training to upskill staff has led to handling of tech-related challenges.

“most of the systems we use are actually built and developed by a team in-house so for us as a company we don’t buy off the shelf like other companies where you go and get a system off the shelf and pay it, they invest more into the staff the technology department especially software developers to come up with systems that run the model of our business operations so for example the system that manages patient information and all that information that regards the patient was developed by our team here part of our software developers which is called the EMR system” (RH3).

“we also have an e-shop which a system where you can go to an online sales platform where you go and buy items for example medical items etc. it was also built by a team in here and what makes it so competitive to stand out is the team understood the problem that needs to be solved and was able to sit down and develop a system that was able to understand the problem they were trying to solve “(RH3).

Policies and regulations also came out during the interviews, some government policies favoured digital health business. Some informants had this to say:

“government has made a very deliberate effort to support innovations in technology and this has helped people embrace this”(RH2).

“we have regulations currently which have enabled the public gain a lot of trust especially when it comes to confidentiality and privacy of information and data so when you tell an insurer that am licensed by NITA (National Information Technology Authority), by the data protection and privacy authority they actually get to trust your system and entrust you with clients”(RH2).

Having skilled human resource, especially in-house developers, and tech savvy generation has made the businesses survive with more innovative ideas.

“the gen-z these guys are always up to the next thing so they are very energetic, they are very smart, very hardworking though difficult to work with but they are very smart and very innovative and sometimes the ideas no longer come from the co-founders they come from the people working these processes”(RH2).

Partnership and collaboration with financial organizations and insurance companies. Business can only survive where there is good collaboration with partners.

“provide a case for insurers as a telemedicine provider as part of a service provider that their beneficiaries could utilize and that’s how we got into a more predictable cash flow when we on boarded insurance companies”(RH1).

“we partnered with another financial institution called Pezesha where we offer financial credit to clinics, drug shops etc that purchase from us wholesale so all you have to do is to buy from RH twice, get into the RH profile then depending on the volume of purchase that you do you can qualify for a particular credit limit so RH gives you the medicine and then you sort it out with the financial company”(RH3).

COVID-19 pandemic - The lockdown and restrictions promoted use of telehealth and use of the USSD code to order from the pharmacy.

“Covid-19 presented us with one of the biggest opportunities we have ever seen; we did not know that we could stretch that much during Covid-19 because it got us to a point where we had to train every single person to be able to at least pick the calls because the calls were just coming in”(RH2).

“Covid-19 came in when the pharmacy was still small so it had to be expanded because of the products that we had to bring in but also the resources now we had to hire so many other people because it was either a PCR test and a lab sample or covidex and saraya (alcohol-based hand sanitizer) those were the main things”(RH2).

Under this theme, there were five subthemes that emerged which included:

“you will have a few features of modules working the way you want them to work but you find that perhaps whoever was developing stopped somewhere and left things hanging somewhere so you have a feature what is available but let’s say delivers 80% of what exactly you would want to be the end goal”(RH4).

“technology is running so fast I think every other day there is a new product being released and we can’t stay on the same page of having the same things year in year out we find ourselves also we have to move so fast so that we can be able to have our products with the new technologies in the market so it’s also a challenge finding things changing day in day out”(R2).

“ability to have robust software that is agile meaning that for example pre-covid you are serving 20 clients in a month so your software infrastructure, human resource is put to serving 2 clients; covid-19 comes and you go to 100 clients in a day so from 20 clients a month to 100 clients a day that means our USSD code crashed because it was not built to handle that much”(RH1).

Disease outbreaks and pandemics for example COVID-19 heavily disrupted ways of living, the businesses too were disrupted and up to today, they have not recovered as some customers are still in debts.

“most of those were paid as arrears we still actually suffering from that up to today people are still struggling to pay for the support of 2020”(R1).

“it was an obstacle I think to a bigger extent maybe hospitals benefited but most of them were closed and it was an obstacle because I remember most of our clients didn’t even pay support so it was an obstacle in the sense that they had less patients because of lockdown “(R3).

Lack of skilled human resource for example, lack of all-round trained developers (knowing only the front end of the frameworks, data bases and software) on the market makes it hard to innovate around the softwares.

“you find that you have to do both front end and back end at the same time so most of the young techs we meet you find they are front end developers and then they don’t have any passion for the back end so it’s a challenge we have also fund that we lose out on very good people but they might not meet the need that we might have at that very moment so that is the challenge we have with the young developers”(R2).

“there are healthcare providers with no IT background and an IT person with no healthcare background but work together to develop systems or infrastructure so there is that challenge of each one of you having to teach each other and be on the same page”(RH1).

Inability to customize and brand open source applications, this has tended to be time consuming and in leads to delays in product research and development.

“challenges I have faced in my position mostly is dealing with a product that is medical because it’s a medical field if I can call it that so you find most of the things you do not understand them and you have to reach out to a medical personnel of which these people are very busy people who will have to sit down with you and explain everything in detail for you to be able to come up with a comprehensive product”(R2).

“research taking so much time and then you find this somehow delays the delivery a bit but for you to have everything comprehensively done you have to prolong this research and be able to capture everything so that is a major challenge”(R2).

“another challenge would be the tech we use the fact that we cannot scale out so quickly and yet if we scaled out so quickly we would have the best devices, we would have the best technology to actually give to the customer that also takes from us perhaps the clientele that we would have had for example if a field agent came to your place and their machine crushed in front of you and they can’t bill you, they can’t do anything you get, there are those frustrating problems you have 30 minutes spent and you are at a customer’s place fidgeting with your laptop, it’s a fake laptop or its not up to the standards” (RH4).

Policies and regulations: Some policies and regulations have not been favorable to the digital health businesses, for example, because they are in health, they have to subscribe and pay licenses to various bodies under medical, pharmacy, and information technology. On top of that there are no clear policies on digital health businesses.

“also, data privacy from the customer’s perspective because its electronic data there is always concern from both the end user and bodies that oversee like NITA-U they are always knocking on our doors and making sure that we meet that standards and have in place processes or systems or checkpoints that help us ensure data privacy” (RH1).

“regulatory bodies not being updated or tuned to the pace of innovation because now you ask yourself who regulates you is it the UMDPC (Uganda Medical and Dental practitioners’ Council), is it Allied health, is it MoH (Ministry of Health) so you just say okay am a health company that uses IT so a health company you have to subscribe to MoH, UMDPC, Allied health sciences then PSoUg (Pharmacy Society of Uganda), so you have to get licences. Then IT you have to make sure that NITA you pay annual fees and meet regulatory requirements”(RH1).

“our short codes we have to renew our licences with UCC every year and its very expensive because one we chose not to use those middlemen who banks use and everybody uses because you cannot run a whole business on a short code because not everybody has the ten million to get their own dedicated short code from UCC and for us we have two dedicated short codes one for SMS and one for USSD so that’s a cost, licence, then the software”(RH5).

This last theme, there were four (04) subthemes, where support was needed support, these included; capacity building, information technology and information systems infrastructure, partnership and collaboration and aid in set-up costs.

Under capacity building, the companies felt they needed soft skills training on adoption and use of global goods. Various global public goods are available, but the entrepreneurs need training to enable them build innovations.

“IT software people who know global goods as in people in grants and projects these are people who know how to use them, to customize them and then when you come to the private sector these guys will only know proprietary tools you tell them okay how do you open ODK how do you use it the guy will not know but they will tell them there is this software that you can use in processing cash flow and he will get it its like there is that niching or super specialization with these guys so how can the developmental partners interest private sector players and motivate software engineers”(RH1).

“because they are freely available but then retooling is the challenge, providing opportunities of short training is key”(RH1).

“experts to come and train us I know they usually invest in soft skills so the capacity building, they will not give you money”(R1).

Information technology and Information system infrastructure was another area for support, especially; storage space and computing power, internet costs and backup power.

“the funder can choose to present themselves as a support funder in that way they could have a package for you say you need an ARP tool or say you need another server that is robust that can do clustering it can connect to an external network let’s say storage system that you have, one that is compatible but guess what the cost of it is about USD 80000 that the company is not willing to spend on so the funder could also come in for that in that direction of things”(RH4).

Partnerships and collaboration: There is a need for private partnerships to scale up business to other regions and this will motivate the software engineers.

“public-private partnership, but in this case IT infrastructure, it has been mainly talked about in health service delivery when you come to healthcare they know how to subsidize costs and donors come in to subsidize costs especially around family planning commodities and the like, but how can that be mirrored in software and tech”(RH1).

“the public sector is adopting global goods because of developmental partners because they offset trainings, even support you in servers hosting internet, as a private sector, I may need some cushioning how do you expand that if you interest me and say a private sector player that uses Open MRS will have the following benefits so you will motivate me and I will develop my EMR using global goods”(RH1).

Setup costs, is another area for support, especially for the initial steps with the customers, provide the appropriate infrastructure during initial setup of the software, and this in turn will lead to offsetting costs to the customer.

“actually, support us so that we also reduce on some of these costs, we can change the technology on which we are running so that instead of asking for a core i5 which costs 3 million we ask for an arm processor which is an IOT (internet of things)”(R1).

“the cost of obtaining software, right now we have a burden of buying an SQL server; the environment that runs the database, most of our clients once you tell them to buy SQL they will not be able to catch up to that cost; there are those who can but most of them cannot”(R3).

Word cloud output from NVivo software summarizing 500 most common words

Full size image

Six major themes were deduced from the guide; (1) business models, (2) enablers for running a private digital business, (3) barriers or obstacles on running a private digital health business,4) value chains and 5) areas for support. Several subthemes emerged and Table 2 below, shows the main subthemes.

We found that the sustainable business models were mainly four, which were B2B, B2C, B2B2C and the On-demand business model. Elsewhere in the telemedicine field, a systematic review of seven companies also identified three business models in their research i.e. B2B, B2C and on-demand models which were sustainable [27].

The enablers in this study included government policies & regulations, there is deliberate effort to support innovations in technology thus favouring growth of digital health. Schlieter, et al., 2022, in their workshop in Valletta, Malta highlighted regulatory issues as enablers, citing that guidelines and rules make market entry easy for digital health businesses [28].

However, some cases reported regulatory fees and policies which are a barrier to the digital health transformation, this has been documented, where, regulations about digital health are sometimes disjointed in underdeveloped countries, with several entities exercising authority without clearly defined roles. The efficient application of digital health technologies may be hampered by fragmented laws, which could result in market inefficiencies and possible health hazards. Regulatory authorities are frequently unable to keep up with technological advancements, capped by shortage of technical expertise among regulatory staff, this results in out-of-date norms and legal ambiguities that make regulation procedures even more difficult [29].

In the same study at Malta, collaborations and partnership was also enabler as found in this study, which involves cocreation of interdisciplinary teams and dialoguing with different experts in medical, computer sciences and business fields. Elsewhere, COVID-19 pandemic enabled the utilization of digital health technologies as was the case in our study, and the digital health technologies and business became accentuated as an alternative solution for increasing access to medical services [30].

Another enabler of digital health business was the information technology & information systems (IT& IS) infrastructure this was also pointed out in systematic review done in 2023 on barriers and facilitators to using digital interventions in health care [31] and adoption of different waves of IT&IS has helped integrate different parts of core processes within individual organizations in Uganda, the USA and UK [32].

Regarding barriers to digital health business, IT&IS infrastructure was highlighted, due to the evolving and advancing technology where the developers fail to keep abreast, the unreliable, costly internet and software packages and low understanding of technology especially by the customers. Similar findings were mentioned in an article “Value Architectures for Digital Business: Beyond the Business Model” [33]. Depending on the nation, the type of technological tool, and the healthcare environment, different technical problems face the integration and operation of digital health in developing countries, these tech problems are; the infrastructure limitations like internet and stable electricity, data security, interoperability, health information management, and the ability and training of the healthcare staff [29].

The COVID-19 pandemic lockdown and restrictions, whereas boosted the businesses operating in telemedicine, those that dealt in integrated healthcare information management and billing system found it an obstacle, to the extent that the clinics utilising this system had low turn-up for physical patient-facing services. The COVID-19 pandemic did not affect all the entrepreneurs in digital health but most of the service providers who were patient facing, in fact, there was an increase in teleconsultations which boosted some digital health companies dealing with mHealth and e-health as majority were involved in surveillance [34, 35].

Availability of skilled human resource was an enabler whereas lack of it was an obstacle to the business. The companies made sure there is in-house capacity building with continuous training to upskill the staff. It was mentioned that often times, there is lack of all-round trained developers and thus unable to customise the open source applications to suit the business’ needs. These skills are the competencies with which entrepreneurs create, extend, and modify the way they do business, and they may be classified into managerial human capital, or general conceptual and social skills, industry-specific skills, and firm-specific skills [36]. To strengthen digital health innovations, there is need to have modest infrastructure and human resource capacity [37].

There were many areas where the businesses needed support from International Development Organisations (IDO), these areas were in capacity building which included training of developers to become full stack software developers, and this would help them build on the free and open source software to fit their needs. They mentioned the soft skills training and mentorship will benefit them more than getting funds from the IDO.

Another area for support was partnership and collaboration, Partnerships are essential for every digital health company’s success. By collaborating with other firms, you not only gain access to complementary resources, but you also increase your chances of gaining contributions and partner possibilities from other countries who may be interested in supporting your business model [38].

Promoting healthy lifestyles and well-being for all people, everywhere, and at all ages is the goal of the Global Strategy on Digital Health. National or regional digital health efforts must be directed by a strong strategy that combines organizational, financial, human, and technological resources in order to realize their full potential.

This study calls out to national governments and international health partners to support digital health entrepreneurs to unlock their potential of digital health to scale up access to health care services by putting up friendly policy frameworks on regulations and making sure the infrastructure like electricity and internet are widely available and stable to create an enabling environment.

Improved access to healthcare services and strong inequalities in health can be bridged by digital health entrepreneurs which will contribute to SDG-3 to promote well-being and healthy lives for everyone, regardless of age. Digital health policies should help catalyze improved access to health care in developing countries.

Governments can more effectively create specialized answers to significant and pressing problems by utilizing open-source technologies. In order for governments to maximize digital ecosystems and hasten the attainment of the UN Sustainable Development Goals, significant adjustments must be made.

To the entrepreneurs in health care, this study shares the sustainable and scalable business models based on global goods that inform practice and improve livelihoods, leveraging digital public infrastructure (DPI) through the implementation of digital public goods (DPGs) can yield vital interventions for development and emergencies.

AE:

Adverse events

DH:

Digital Health

DPG:

Digital Public Goods

GG:

Global Goods

GPG:

Global Public Goods

HELINA:

Health Informatics in Africa

IDI:

Infectious Diseases Institute

IRB:

Institutional Review Board

LMIC:

Low & Middle-Income Countries

SDG:

Sustainable Development Goals

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ABN received the grant, contributed to study conception and design, data collection, analysis and of results, and manuscript write-up.JB contributed to review of the study design, data collection and analysis, and manuscript reviewJLSN contributed to the study concept and study design, manuscript reviewANK, MN contributed to the review of the study concept, data collection, analysis, and manuscript reviewFM, MB contributed to the study conception and manuscript reviewRPR contributed to study conception, manuscript review, and supervision of the study conduct. All authors agreed to the final version of the manuscript.

Correspondence to Agnes Bwanika Naggirinya.

This study was approved by school of medicine research ethics committee (Ref# Mak-SOMREC-2023-722) and regulatory approval got from Uganda National council of science and Technology (Ref# Ref: SS2051ES). We obtained written informed consent prior to data collection from all the participants.

All participants give consent to publish and written informed consent for study participation.

The authors declare no competing interests.

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