African digital health strategic plans analysis: key weaknesses in contextualization, intervention focus, and technological foresight

Digital health strategies are increasingly being adopted in Africa, but their consistency with best practice planning is poorly documented. 54 countries were screened; 48 had a plan in the Global Digital Health Monitor, and 11 recent plans met the inclusion criteria. Using the "Ready, Extract, Analyze, Distill" methodology and a customized grid merging the Walt-Gilson policy triangle with WHO/ITU standards, we compared four dimensions: context, content, priority actions, and emerging technologies. Only one strategy reported complete socio-economic and health data; more than half of the strategies did not provide the challenges facing health systems; and there were recurring gaps in the pillars relating to workforce, legal frameworks, financing, and interoperability. Most visions cited universal health coverage (8/11) and quality of care (7/11), but objectives followed three distinct approaches to achieving them. Of 148 planned digital health interventions, 45% target providers, and just 7% clients; linkages between interventions and stated health system challenges are often weak. None of the plans explicitly provides for the integration of emerging technologies or locally adapted innovations. These findings have highlighted weaknesses in contextualization, challenge-based planning, and innovation in strategies, set priorities for the next review of these plans, and aim to increase the expected outcome.