Health Digitalization in Community-Led Programs: A Scoping Review of Successes, Challenges, and Systemic Impacts (2020–2025)

Abstract

Introduction: Community Health Workers (CHWs) are increasingly being equipped with digital tools to address healthcare shortages in low- and middle-income countries (LMICs). While these technologies aim to improve service delivery, their impact on the CHW’s professional role and the systemic barriers to their sustainability are not fully understood.

Objectives: This scoping review aims to characterize the integration of digital health tools within community-led programs in LMICs, specifically analysing the emergence of ‘technological task-shifting’ in CHWs roles. Furthermore, it seeks to identify the systemic barriers, specifically data and energy poverty that act as critical determinants of implementation success and long-term program sustainability.

Methods: A systematic search was conducted in PubMed and Scopus, supplemented by manual snowballing of reference lists. Following the PRISMA-ScR guidelines, 167 records were identified (132 via databases; 35 via manual search). Sources were screened against pre-defined inclusion criteria. A total of 118 records were excluded due to automated filters (n = 62), irrelevant population/setting (n = 36), or lack of focus on digital frictions (n = 20), resulting in 49 included sources

Results: Reviewing 49 studies revealed that digitalization has successfully expanded the clinical capacity of CHWs, improving diagnostic accuracy and real-time data surveillance. This ‘technological task-shifting’ has empowered CHWs to provide complex screenings in remote areas. However, these successes are often undermined by systemic barriers, specifically ‘Data Poverty’ (self-funded internet) and ‘Energy Poverty’ (lack of charging infrastructure), which act as primary barriers to sustainability. Furthermore, the transition frequently introduces an administrative ‘dual burden’ that complicates daily workflows.

Conclusions: Digital health has successfully transformed CHW reach; however, long-term success requires shifting from technology-centric to worker-centric policies. To sustain these gains, health systems must address the hidden costs of data and energy access to ensure digital tools empower rather than burden the frontline workforce.