Each country is different, but have policy goals in common: to achieve Universal Health Coverage (UHC) and other Sustainable Development Goals (SDG). Learning from progress and problems that peers experience is valuable. But so too is learning from others who may be more advanced. There are several ways of assessing health systems’ readiness and digital health maturity <LINK>, and how they respond to the challenges of their projected burdens of ill-health and the changes in the sizes and distributions of populations. income and wealth.

1: Low income; large population

In these most challenging of countries, much depends on the dynamics of urbanisation. Where a large low-income population is concentrated in urban areas then there may well be many public health issues; but at least it is likely that a large proportion of the population will have access to mobile phones and reasonable connectivity. For countries where there is a large, and perhaps scattered, low income rural population, public funding of basic communications infrastructure may well be needed. Aligning health strategies with others that support community development can release synergies and savings.

2: High and middle income; large population

Where there are large populations, there are often areas of deprivation, even though average incomes may be high or in a central range. Monitoring service provision to ensure universal coverage can involve considerable investment in health management information systems, and also in having sufficient health workers who are digitally savvy. If these investments are made, and do enable better informed decisions to be made, and services become responsive to changing needs, then there is the prospect in these countries of having a large and healthy population that can be productive and support further economic development.

3: Low income; small population

In these countries many of the key challenges are to do with the high cost per capita of any investment. The economies of scale are difficult to realise. Whilst low-cost solutions may be at a premium, there are often hidden costs and, once revealed, there is limited scope to deal with them. It is particularly important to develop strategies and investment plans that recognise these challenges and mitigate the risks – there is much less room for error.

4: High and middle income; small population

These countries should be leading the way in digital health. However, their challenges will be changing. High levels of non-communicable disease and obesity are changing the patterns of services required. With an ICT infrastructure that could be available to everyone, these countries may well find that their citizens are increasingly engaged in the use of their own mobile technologies. Strategies that focus on encouraging the “engaged patient” may show how digital health can transform the way health can be delivered. The major new challenges may focus on how the private sector, which is becoming increasingly engaged in digital health, can both play its part and be appropriately regulated.