Barriers to digital health implementation in low- and middle-income countries: a narrative review

Low- and middle-income countries [LMICs] face persistent challenges in scaling and sustaining digital health interventions. While technological innovations have advanced rapidly, organizational, ethical, and human-centric barriers often limit adoption, integration, and long-term impact. To synthesize evidence on non-technical barriers to digital health implementation in LMICs and identify strategies for sustainable, equitable, and context-appropriate deployment. This narrative review synthesizes peer-reviewed literature published between 2010 and 2025 on organizational, ethical, and human-centric factors influencing digital health adoption in LMICs. Key studies were identified through purposive searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, IEEE Xplore, and relevant gray literature, including World Health Organization reports. Evidence was analyzed thematically to identify recurring patterns, interdependencies, and systemic constraints. Organizational barriers include fragmented financing, donor dependency, limited interoperability, and insufficient institutional ownership. Ethical and governance challenges involve weak data protection, regulatory ambiguity, algorithmic bias, and inadequate accountability. Human-centric barriers encompass digital divides, cultural and linguistic misalignment, poor user experience, and workflow overload. These barriers interact dynamically, reinforcing fragmentation, inefficiency, and adoption failure. Interventions aligned with health system capacity, governance structures, and user realities demonstrated higher adoption, equity, and system-wide impact. Digital health implementation in LMICs is a socio-technical and political process rather than a purely technological endeavor. Integrated strategies addressing governance, workforce capacity, infrastructure, ethics, and human-centered design, combined with rigorous context-sensitive evaluation, are essential to translate digital innovations from isolated pilots into sustainable and equitable health system solutions.