DHI features.

Low- middle-income countries, including Pakistan, are facing significant obstacles in their efforts to achieve the global targets for maternal, newborn, and child health (MNCH) defined by the Sustainable Development Goals. Barriers at the individual, health system, and contextual levels undermine healthcare access for pregnant women and children, disproportionately affecting those in low-resource settings. To address these challenges in the high-mortality, peri-urban areas of Karachi, VITAL Pakistan Trust and Aga Khan University launched a digital health intervention (DHI) to stimulate demand for health services and streamline care management for health workers at the primary care level. In this case study, we present a narrative review of the design, development, and deployment of the DHI, an Android-based application, in accordance with the Principles for Digital Development. We draw on the initial experience with implementation to reflect on how each of the nine Principles was considered during different phases of the project lifecycle, focusing on the lessons learned and challenges encountered during this process. By engaging with end-users and understanding the community, we were able to map existing relationships and workflows onto a digital platform to address major challenges hindering service delivery. Leveraging insights from field observations and user feedback, we collaborated with experts in healthcare and technology to develop the DHI, which has now scaled to 44 peri-urban settlements in Karachi. Our experience underscores the value of substantiated frameworks like the Principles. However, on-ground challenges reveal important caveats requiring further assessment. These include building community trust in new digital systems and ensuring the ethical use of health data, particularly in low digital and data literacy contexts. Based on this understanding, we share recommendations for conditions central to the effective integration and uptake of technology in healthcare, specifically within the context of digital health for MNCH.

包括巴基斯坦在内的中低收入国家，在落实可持续发展目标所设定的孕产妇、新生儿与儿童健康（MNCH）全球目标方面，正面临诸多严峻阻碍。个体层面、卫生系统层面与环境背景层面的各类障碍，削弱了孕产妇与儿童获取医疗服务的能力，对资源匮乏地区的人群造成了不成比例的负面影响。为解决卡拉奇高死亡率城郊地区的上述难题，巴基斯坦VITAL信托基金与阿迦汗大学联合推出了一项数字健康干预措施（Digital Health Intervention, DHI），旨在激发健康服务需求，并优化基层医疗工作者的护理管理流程。本案例研究依据《数字发展原则》（Principles for Digital Development），对这款基于安卓系统的DHI应用的设计、开发与部署过程进行了叙事性综述。本研究依托项目初期的实施经验，反思在项目生命周期的不同阶段如何落实九大数字发展原则，并重点梳理了该过程中汲取的经验教训与遭遇的各类挑战。通过与终端用户互动并深入了解社区需求，本团队得以将现有协作关系与工作流程整合至数字平台，以破解阻碍医疗服务供给的核心难题。借助实地观测与用户反馈所获得的洞察，本团队联合医疗与技术领域专家开发了这款DHI应用，目前该应用已在卡拉奇的44个城郊定居点推广落地。本团队的实践印证了《数字发展原则》这类经过验证的框架的价值，但实地执行过程中遇到的挑战也暴露出需进一步评估的重要注意事项。这些注意事项包括提升社区对新型数字系统的信任度，以及确保健康数据的伦理使用，尤其是在数字素养与数据素养水平较低的场景中。基于上述认知，本研究针对医疗领域技术的有效整合与推广所需的核心条件提出了建议，尤其聚焦于MNCH相关的数字健康场景。