{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:59:43Z","timestamp":1793213983527,"version":"4.5.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Digital health systems are increasingly recognised as critical components of health system strengthening in low- and middle-income countries (LMICs). However, their effectiveness is often constrained by unreliable energy infrastructure, weak governance, and fragmented implementation approaches. Solar-powered digital health systems offer a promising solution, but their scalability depends on integrated governance and sustainable implementation models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to develop a governance and implementation framework for scaling solar-powered digital health systems in LMICs, using empirical evidence from Kenya and Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods study was conducted across selected rural and peri-urban health facilities in Kenya and Ethiopia. Data sources included facility-level infrastructure assessments, key informant interviews with health system stakeholders, and a multi-sectoral validation workshop. Quantitative data were analysed descriptively, while qualitative data were analysed using thematic analysis to indicate governance, coordination, and implementation dimensions. Findings were synthesised into a policy-oriented framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study emerged from a hybrid governance model combining national-level policy oversight with decentralised implementation as critical for scalability. Cross-sector coordination, facilitated through a Joint Technical Steering Committee, emerged as essential for aligning health, energy, and information and communication technology (ICT) actors. A phased implementation pathway was developed, incorporating facility readiness assessment, system deployment, interoperability, and lifecycle-oriented maintenance supported by public\u2013private partnerships and blended financing mechanisms. The findings highlight the importance of integrating energy infrastructure into digital health governance to ensure system functionality and sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Solar-powered digital health systems can strengthen health service delivery in resource-constrained settings, but require coordinated governance, sustainable financing, and structured implementation strategies. The proposed framework advances an integrated energy\u2013digital health governance nexus, offering a practical and conceptual pathway for scaling resilient digital health infrastructure in LMICs. Policymakers should prioritise cross-sector collaboration and system-level integration to move beyond pilot-driven approaches and achieve sustainable impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2026.1860667","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:35:02Z","timestamp":1787895302000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Governance and implementation of solar-powered digital health systems in low- and middle-income countries: a mixed-methods study from Kenya and Ethiopia"],"prefix":"10.3389","volume":"8","author":[{"given":"Ronald Danny","family":"Nyatuka","sequence":"first","affiliation":[{"name":"School of Computing and Engineering Sciences (SCES), Strathmore University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Sakikhales","sequence":"additional","affiliation":[{"name":"School of Computing and Engineering, University of West London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pazion","family":"Cherinet","sequence":"additional","affiliation":[{"name":"Orbit Health","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Shafiqur Rahman","family":"Jabin","sequence":"additional","affiliation":[{"name":"Department of Medicine and Optometry, Linnaeus University","place":["Kalmar, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","volume-title":"Health at a Glance 2023: OECD Indicators","year":"2023"},{"key":"B2","volume-title":"Global Strategy on Digital Health 2020-2025","year":"2021"},{"key":"B3","doi-asserted-by":"publisher","first-page":"160","DOI":"10.9745\/GHSP-D-13-00031","article-title":"mHealth innovations as health system strengthening tools: 12 common applications and a visual framework","volume":"1","author":"Labrique","year":"2013","journal-title":"Glob Health Sci Pract"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2322","DOI":"10.59400\/jps2322","article-title":"Charting public health horizons: hybrid SMEs and the X. 0 wave theory in post-COVID governance","volume":"3","author":"Mattiello","year":"2025","journal-title":"J Policy Soc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3308","DOI":"10.18282\/pef.v12i1.3308","article-title":"Challenges of a sustainable energy and vehicle-related value chain for BEVs and FCEVs through the 5th wave theory","volume":"12","author":"Novak","year":"2023","journal-title":"Progress Energy Fuels (PEF) J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"20552076231203600","DOI":"10.1177\/20552076231203600","article-title":"Software-related challenges in Swedish healthcare through the lens of incident reports: a desktop study","volume":"9","author":"Jabin","year":"2023","journal-title":"Digit Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"14604582221105440","DOI":"10.1177\/14604582221105440","article-title":"Characterizing healthcare incidents in Sweden related to health information technology affecting care management of multiple patients","volume":"28","author":"Jabin","year":"2022","journal-title":"Health Inform J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1260521","DOI":"10.3389\/fdgth.2024.1260521","article-title":"Characterizing patient details-related challenges from health information technology-related incident reports from Swedish healthcare","volume":"6","author":"Jabin","year":"2024","journal-title":"Front Digit Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"249","DOI":"10.9745\/GHSP-D-13-00037","article-title":"Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability","volume":"1","author":"Adair-Rohani","year":"2013","journal-title":"Glob Health Sci Pract"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e50375","DOI":"10.2196\/50375","article-title":"Maturity assessment of district health information system version 2 implementation in Ethiopia: current status and improvement pathways","volume":"12","author":"Yilma","year":"2024","journal-title":"JMIR Med Inform"},{"key":"B11","doi-asserted-by":"publisher","first-page":"381","DOI":"10.2307\/25148796","article-title":"Developing health information systems in developing countries: the flexible standards strategy","volume":"31","author":"Braa","year":"2007","journal-title":"MIS Q"},{"key":"B12","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.9745\/GHSP-D-18-00342","article-title":"Digital health and health systems of the future","volume":"6","author":"Labrique","year":"2018","journal-title":"Glob Health Sci Pract"},{"key":"B13","volume-title":"Delivering Quality Health Services: A Global Imperative for Universal Health Coverage","year":"2019"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e92560","DOI":"10.2196\/92560","article-title":"Health information technology\u2013related loss of central surveillance data in a heart intensive care unit: multi-framework case report","volume":"13","author":"Jabin","year":"2026","journal-title":"JMIR Hum Factors"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1785141","DOI":"10.3389\/fdgth.2026.1785141","article-title":"Why health information technology safety problems remain invisible","volume":"8","author":"Jabin","year":"2026","journal-title":"Front Digit Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1785086","DOI":"10.3389\/fdgth.2026.1785086","article-title":"Why digital health fails silently: a sociotechnical theory of health information technology\u2013related risk","volume":"8","author":"Jabin","year":"2026","journal-title":"Front Digit Health"},{"key":"B17","year":"2023"},{"key":"B18","volume-title":"Digital Progress and Trends Report 2025: Strengthening AI Foundations","year":"2025"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3493","DOI":"10.1111\/jgs.18020","article-title":"A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic","volume":"70","author":"Powell","year":"2022","journal-title":"J Am Geriatr Soc"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1786358","DOI":"10.3389\/fdgth.2026.1786358","article-title":"A qualitative, multi-framework methodology for analysing health information technology\u2013related patient safety incidents","volume":"8","author":"Jabin","year":"2026","journal-title":"Front Digit Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1848840","DOI":"10.3389\/fdgth.2026.1848840","article-title":"Bridging the data\u2013power paradox: a conceptual\u2013empirical analysis of solar-powered digital health systems in low-resource settings","volume":"8","author":"Jabin","year":"2026","journal-title":"Front Digit Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1848844","DOI":"10.3389\/fdgth.2026.1848844","article-title":"Assessing the feasibility of solar-powered digital health infrastructure in rural and peri-urban Kenya: a mixed-methods study","volume":"8","author":"Jabin","year":"2026","journal-title":"Front Digit Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e24","DOI":"10.1016\/j.ijmedinf.2008.06.014","article-title":"Usability testing of mobile ICT for clinical settings: methodological and practical challenges","volume":"79","author":"Svanaes","year":"2010","journal-title":"Int J Med Inf"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e0186744","DOI":"10.1371\/journal.pone.0186744","article-title":"Human-centred design in global health: a scoping review of applications and contexts","volume":"12","author":"Bazzano","year":"2017","journal-title":"PLoS One"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e18198","DOI":"10.2196\/18198","article-title":"Conceptualizing usability for the eHealth context: content analysis of usability problems of eHealth applications","volume":"5","author":"Broekhuis","year":"2021","journal-title":"JMIR Form Res"},{"key":"B26","volume-title":"Mixed Methods Research","author":"Creswell","year":"2007"},{"key":"B27","volume-title":"Research Design: Qualitative, Quantitative and Mixed Methods Approaches","author":"Creswell","year":"2014"},{"key":"B28","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"26152","DOI":"10.3402\/qhw.v9.26152","article-title":"What can \u201cthematic analysis\u201d offer health and wellbeing researchers?","volume":"9","author":"Braun","year":"2014","journal-title":"Int J Qual Stud Health Well-being"},{"key":"B30","author":"Reader","year":"2012"},{"key":"B31","volume-title":"Health Policy and Systems Research: A Methodology Reader","author":"Gilson","year":"2012"},{"key":"B32","year":"2019"},{"key":"B33","year":"2020"},{"key":"B34","doi-asserted-by":"publisher","first-page":"249","DOI":"10.9745\/GHSP-D-13-00037","article-title":"Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability","volume":"1","author":"Adair-Rohani","year":"2013","journal-title":"Glob Health Sci Pract"},{"key":"B35","volume-title":"Energizing Health: Accelerating Electricity Access In Health-Care Facilities: Executive Summary","year":"2023"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e626","DOI":"10.1016\/S2214-109X(25)00537-6","article-title":"Reliable electricity to advance quality health care in low-resource settings","volume":"14","author":"Vinci","year":"2026","journal-title":"Lancet Glob Health"},{"key":"B37","doi-asserted-by":"publisher","first-page":"iv1","DOI":"10.1093\/heapol\/czs084","article-title":"Systems thinking for strengthening health systems in LMICs: need for a paradigm shift","volume":"27","author":"Adam","year":"2012","journal-title":"Health Policy Plan"},{"key":"B38","volume-title":"Systems Thinking for Health Systems Strengthening","author":"De Savigny","year":"2009"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e78950","DOI":"10.2196\/78950","article-title":"Contextual barriers to health information systems optimization in underserved communities in Kenya: qualitative study informed by frugal innovation and information and communication technologies for development","volume":"10","author":"Nyatuka","year":"2026","journal-title":"JMIR Form Res"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e81996","DOI":"10.2196\/81996","article-title":"Kenyan Neonatal mortality risk predictor: protocol for a user-centered design evaluation","volume":"15","author":"Nyatuka","year":"2026","journal-title":"JMIR Res Protoc"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1126\/science.1258926","article-title":"Prioritizing integrated mHealth strategies for universal health coverage","volume":"345","author":"Mehl","year":"2014","journal-title":"Science"},{"key":"B42","volume-title":"A Framework for Cloud-Based Patient-Centred Health and Wellbeing Services in Kenya","author":"Nyatuka","year":"2021"},{"key":"B43","first-page":"153","author":"Nyatuka","year":"2019"},{"key":"B44","doi-asserted-by":"publisher","first-page":"62","DOI":"10.4018\/IJISMD.20210701.oa1","article-title":"Service design as a catalyst for patient-centered eHealth innovation: an architectural design framework for cloud-based maternal health information service in underserved setting","volume":"12","author":"Nyatuka","year":"2021","journal-title":"Int J Inf Syst Modeling Des"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e1001382","DOI":"10.1371\/journal.pmed.1001382","article-title":"Scaling up mHealth: where is the evidence?","volume":"10","author":"Tomlinson","year":"2013","journal-title":"PLoS Med"},{"key":"B46","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.2196\/jmir.2130","article-title":"Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review","volume":"15","author":"K\u00e4llander","year":"2013","journal-title":"J Med Internet Res"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2026.1883524","article-title":"Governance pathways for scaling neonatal risk stratification tools in LMIC health systems: a multi-site qualitative study in Kenya","volume":"8","author":"Nyatuka","year":"2026","journal-title":"Front Digit Health"},{"key":"B48","first-page":"140001","article-title":"Frugal embedded service design framework for low-cost digital health innovations in LMICs: case of maternal and child health promotion in Kenya","author":"Nyatuka","year":"2026"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e12164","DOI":"10.1002\/isd2.12164","article-title":"Design considerations for patient-centered eHealth interventions in an underserved context: a case of health and wellbeing services within Nairobi's Informal settlements in Kenya","volume":"88","author":"Nyatuka","year":"2022","journal-title":"Electron J Inf Syst Dev Countries"},{"key":"B50","doi-asserted-by":"publisher","first-page":"e70052","DOI":"10.1002\/isd2.70052","article-title":"A framework for people-centred digital health and social protection information systems for maternal and child health in underserved Kenya","volume":"92","author":"Nyatuka","year":"2026","journal-title":"Electron J Inf Syst Dev Countries"},{"key":"B51","doi-asserted-by":"publisher","first-page":"e1001081","DOI":"10.1371\/journal.pmed.1001081","article-title":"Building the field of health policy and systems research: an agenda for action","volume":"8","author":"Bennett","year":"2011","journal-title":"PLoS Med"},{"key":"B52","doi-asserted-by":"publisher","first-page":"205520762210751","DOI":"10.1177\/20552076221075194","article-title":"Digital health testbeds in Sweden: an exploratory study","volume":"8","author":"Jabin","year":"2022","journal-title":"Digit Health"},{"key":"B53","doi-asserted-by":"publisher","first-page":"20552076231174307","DOI":"10.1177\/20552076231174307","article-title":"Assessing the healthcare quality issues for digital incident reporting in Sweden: incident reports analysis","volume":"9","author":"Jabin","year":"2023","journal-title":"Digit Health"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1371761","DOI":"10.3389\/fdgth.2024.1371761","article-title":"A case report of system configuration issue in medical imaging due to system upgrade- changes in hardware and software","volume":"6","author":"Jabin","year":"2024","journal-title":"Front Digit Health"},{"key":"B55","year":"2023"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e008822","DOI":"10.1136\/bmjopen-2015-008822","article-title":"Including health in systems responsible for urban planning': a realist policy analysis research programme","volume":"5","author":"Harris","year":"2015","journal-title":"BMJ Open"},{"key":"B57","doi-asserted-by":"publisher","first-page":"205520762211311","DOI":"10.1177\/20552076221131139","article-title":"Issues with the Swedish e-prescribing system\u2014an analysis of health information technology-related incident reports using an existing classification system","volume":"8","author":"Jabin","year":"2022","journal-title":"Digit Health"},{"key":"B58","doi-asserted-by":"publisher","first-page":"14604582241270742","DOI":"10.1177\/14604582241270742","article-title":"A review of incidents related to health information technology in Swedish healthcare to characterise system issues as a basis for improvement in clinical practice","volume":"30","author":"Pan","year":"2024","journal-title":"Health Informatics J"},{"key":"B59","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s12992-019-0513-7","article-title":"Financing intersectoral action for health: a systematic review of co-financing models","volume":"15","author":"McGuire","year":"2019","journal-title":"Global Health"},{"key":"B60","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1186\/s12913-020-05435-8","article-title":"Insights for the future of health system partnerships in low- and middle-income countries: a systematic literature review","volume":"20","author":"Fanelli","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1367431","DOI":"10.3389\/fdgth.2024.1367431","article-title":"Operational disruption in healthcare associated with software functionality issue due to software security patching: a case report","volume":"6","author":"Jabin","year":"2024","journal-title":"Front Digit Health"},{"key":"B62","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1136\/bmj.f6753","article-title":"Republished research: implementation research: what it is and how to do it","volume":"48","author":"Peters","year":"2014","journal-title":"Br J Sports Med"},{"key":"B63","doi-asserted-by":"publisher","first-page":"381","DOI":"10.2307\/25148796","article-title":"Developing health information systems in developing countries: the flexible standards Strategy1","volume":"31","author":"Braa","year":"2007","journal-title":"Manag Inf Syst Q"},{"key":"B64","doi-asserted-by":"publisher","first-page":"e39698","DOI":"10.2196\/39698","article-title":"Technical, ethical, legal, and societal challenges with digital twin systems for the management of chronic diseases in children and young people","volume":"24","author":"Drummond","year":"2022","journal-title":"J Med Internet Res"},{"key":"B65","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond","year":"2015"},{"key":"B66","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/1478-4505-12-19","article-title":"People-centred science: strengthening the practice of health policy and systems research","volume":"12","author":"Sheikh","year":"2014","journal-title":"Health Res Policy Syst"},{"key":"B67","doi-asserted-by":"publisher","first-page":"e367","DOI":"10.2196\/jmir.8775","article-title":"Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies","volume":"19","author":"Greenhalgh","year":"2017","journal-title":"J Med Internet Res"},{"key":"B68","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"B69","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3233\/SHTI250742","article-title":"A conceptual framework for a successful adoption of digital health systems in developing countries","volume":"328","author":"Nakkas","year":"2025","journal-title":"Stud Health Technol Inform"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1860667\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:35:06Z","timestamp":1787895306000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1860667\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":69,"alternative-id":["10.3389\/fdgth.2026.1860667"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2026.1860667","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1860667"}}