Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned
Abstract BackgroundThe adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-reada...
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JMIR Publications
2025-02-01
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| Series: | JMIR Medical Informatics |
| Online Access: | https://medinform.jmir.org/2025/1/e58858 |
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| author | Rosemary K Muliokela Kuwani Banda Abdulaziz Mohammed Hussen Sarai Bvulani Malumo Andrew Kashoka Angel Mwiche Innocent Chiboma Maria Barreix Muyereka Nyirenda Zvanaka Sithole Natschja Ratanaprayul Berhanu Fikadie Endehabtu Hanna Abayneh Telake Adane Weldeab William J M Probert Ӧzge Tunçalp Ernest Maya Mulatu Woldetsadik Binyam Tilahun Chris Guure Kafui Senya Lale Say Tigest Tamrat |
| author_facet | Rosemary K Muliokela Kuwani Banda Abdulaziz Mohammed Hussen Sarai Bvulani Malumo Andrew Kashoka Angel Mwiche Innocent Chiboma Maria Barreix Muyereka Nyirenda Zvanaka Sithole Natschja Ratanaprayul Berhanu Fikadie Endehabtu Hanna Abayneh Telake Adane Weldeab William J M Probert Ӧzge Tunçalp Ernest Maya Mulatu Woldetsadik Binyam Tilahun Chris Guure Kafui Senya Lale Say Tigest Tamrat |
| author_sort | Rosemary K Muliokela |
| collection | DOAJ |
| description |
Abstract
BackgroundThe adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts.
ObjectiveThis paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs.
MethodsA DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings.
Implementation (Results)Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health.
ConclusionsCountry experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. |
| format | Article |
| id | doaj-art-79d91259d75f4ca4808bb3bb288acef8 |
| institution | OA Journals |
| issn | 2291-9694 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | JMIR Publications |
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| series | JMIR Medical Informatics |
| spelling | doaj-art-79d91259d75f4ca4808bb3bb288acef82025-08-20T02:13:03ZengJMIR PublicationsJMIR Medical Informatics2291-96942025-02-0113e58858e5885810.2196/58858Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons LearnedRosemary K Muliokelahttp://orcid.org/0000-0003-0614-3646Kuwani Bandahttp://orcid.org/0009-0000-1429-2444Abdulaziz Mohammed Hussenhttp://orcid.org/0000-0003-1609-8498Sarai Bvulani Malumohttp://orcid.org/0000-0001-5212-9963Andrew Kashokahttp://orcid.org/0000-0003-4581-7842Angel Mwichehttp://orcid.org/0000-0001-6155-3491Innocent Chibomahttp://orcid.org/0009-0000-5776-6443Maria Barreixhttp://orcid.org/0000-0003-3613-9672Muyereka Nyirendahttp://orcid.org/0000-0003-2922-0173Zvanaka Sitholehttp://orcid.org/0000-0002-0972-326XNatschja Ratanaprayulhttp://orcid.org/0000-0003-0085-2900Berhanu Fikadie Endehabtuhttp://orcid.org/0000-0001-7117-6407Hanna Abayneh Telakehttp://orcid.org/0009-0001-0623-8808Adane Weldeabhttp://orcid.org/0000-0003-0321-8542William J M Proberthttp://orcid.org/0000-0002-3437-759XӦzge Tunçalphttp://orcid.org/0000-0002-5370-682XErnest Mayahttp://orcid.org/0000-0001-6050-6837Mulatu Woldetsadikhttp://orcid.org/0000-0003-1223-9003Binyam Tilahunhttp://orcid.org/0000-0002-1813-167XChris Guurehttp://orcid.org/0000-0001-6768-8215Kafui Senyahttp://orcid.org/0000-0001-9168-2542Lale Sayhttp://orcid.org/0000-0002-1377-1328Tigest Tamrathttp://orcid.org/0000-0001-8579-5698 Abstract BackgroundThe adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. ObjectiveThis paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. MethodsA DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results)Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. ConclusionsCountry experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact.https://medinform.jmir.org/2025/1/e58858 |
| spellingShingle | Rosemary K Muliokela Kuwani Banda Abdulaziz Mohammed Hussen Sarai Bvulani Malumo Andrew Kashoka Angel Mwiche Innocent Chiboma Maria Barreix Muyereka Nyirenda Zvanaka Sithole Natschja Ratanaprayul Berhanu Fikadie Endehabtu Hanna Abayneh Telake Adane Weldeab William J M Probert Ӧzge Tunçalp Ernest Maya Mulatu Woldetsadik Binyam Tilahun Chris Guure Kafui Senya Lale Say Tigest Tamrat Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned JMIR Medical Informatics |
| title | Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned |
| title_full | Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned |
| title_fullStr | Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned |
| title_full_unstemmed | Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned |
| title_short | Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned |
| title_sort | implementation of who smart guidelines digital adaptation kits in pathfinder countries in africa processes and early lessons learned |
| url | https://medinform.jmir.org/2025/1/e58858 |
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