Effectiveness of Digital Health Interventions on Healthcare Access and Outcomes in Low- and Middle-Income Countries: A Systematic Review

Abstract

Background: Digital health interventions (DHIs) are increasingly used to improve access to care and health outcomes in low- and middle-income countries (LMICs), but evidence remains dispersed across technologies, health conditions, and implementation contexts. Objective: To synthesize evidence on the effectiveness of DHIs for healthcare access, clinical outcomes, quality of care, cost-effectiveness, and implementation in LMICs.

Methods: A PRISMA-informed systematic review was conducted. PubMed, SciSpace, Google Scholar, and specialized deep-search platforms were searched for studies published from January 2016 to March 2026. Eligible records included randomized trials, cluster randomized trials, quasi-experimental studies, and systematic reviews/meta-analyses evaluating telemedicine, mHealth, SMS/text messaging, electronic health records, clinical decision support, remote monitoring, wearables, or artificial intelligence tools in LMICs. Data were extracted on study design, setting, intervention type, population, outcomes, implementation factors, and economic evidence.

Results: Searches identified 1,080 records; 262 unique records were screened, 70 full texts were assessed, and 30 studies were included in the synthesis. The evidence base comprised randomized trials (n=15), cluster randomized trials (n=8), systematic reviews/meta-analyses (n=5), and quasi-experimental studies (n=2). DHIs improved maternal and child health service utilization, including antenatal care, skilled birth attendance, institutional delivery, and postnatal care. mHealth interventions increased antenatal care attendance (OR=1.81, 95% CI 1.49-2.19) and postnatal care utilization (OR=2.54, 95% CI 2.15-2.99). Digital mental health interventions reduced symptoms of common mental disorders (g=-0.89, 95% CI -1.26 to -0.52), while telemedicine and decision-support tools showed benefits for diabetes, hypertension, provider performance, and care quality. Economic evidence was limited but favourable, including one social return on investment ratio of 13:1. Protocol-only sources were interpreted cautiously and did not contribute effect estimates where outcome data were unavailable.

Conclusion: DHIs can strengthen access, outcomes, and quality of care in LMICs, but effectiveness depends on infrastructure, digital literacy, training, interoperability, sustainable financing, and equity-oriented implementation within routine health systems.