Samenvatting

Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due,
in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan.

Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan,
as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these
projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and
external factors that can potentially facilitate or hinder the progress of digital health in Pakistan.

Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The
qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization’s
(WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy.

Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51)
used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for
app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics
(5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of
interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations’ inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects.