The last two years of the pandemic may have fast-tracked the use of digital strategies to deliver healthcare. But there’s much ground still to be covered in middle and low income countries (LMIC), a recent study has found.

“Despite Covid-19 forcing the hand of digitally reticent governments and health organisations to update, upskill and adopt digital health tools, evidence of scaled up mobile phone health (mHealth) initiatives being accessible to the poorest and those most in need is so far thin on the ground,” according to an article in the Annual Review of Public Health, an independent non-profit publisher. The article examined peer-reviewed evidence on mHealth with a focus specifically on its application in low- and middle-income countries (LMICs).

Raising concerns on equity in digital healthcare, the review said, “Although mHealth in Higher Income Countries (HICs) is becoming increasingly mainstream, evidence of scaled-up, sustained initiatives in LMICs are not as well established.”

From the analyses till date, the note said, mHealth in LMICs has been focused largely on two areas: its use to support health workers in health service delivery and the use of mHealth to deliver health information directly to consumers and to support behaviour change in disease management interventions.

Pointing to the WHO Digital Health Strategy (2020–2025), the authors said several of its core principles are relevant to mHealth in LMICs, in particular, “the need for a sound regulatory framework for activities based on capacity building, equity, ethics, accountability, and governance.”

Three of the authors were involved with the University of Auckland, and one with Oxford University.

The review points out that possibly the greatest brake on the optimism surrounding mHealth was the issue of equity: who gains access and reaps the benefits. It suggests that groups with greater access to resources (technical as well as financial capital) are more likely to be early adopters of new technologies and cites the rollout of electric cars as a similar scenario.

The most obvious and well-described risks, the review suggests, was related to the safety and confidentiality of sharing data or personal health information via mobile devices, a note on the review said.

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In a seperate development, Annual Reviews said over the next 18 months they would make its entire portfolio of 51 academic journals available to everyone under a new model called Subscribe to Open. These journals are from across the sciences, including astronomy, environmental science, genomics, marine science, public health, and sociology.

In a pilot, the Annual Review had seen usage increase eight-fold in comparison to usage under toll access. In 2020, in response to the Covid-19 pandemic, Annual Reviews temporarily opened access to all its titles. Substantial increases in readership, typically more than four-fold, was seen across all journals.