# Digitalized human resources for health information systems in low- and middle-income countries: a scoping review

## TL;DR

This paper reviews digital health systems in low- and middle-income countries, highlighting implementation stages, challenges, and policy impacts.

## Contribution

A novel stratified analysis framework for facilitators and barriers in digital health systems in LMICs is proposed.

## Key findings

- Digital HRH systems in LMICs face significant governance and interoperability challenges.
- Political commitment and leadership are key to successful policy outcomes.
- HRH registry is the most common functional component, while migration tracking is rare.

## Abstract

Tracking country-wide human resources for health (HRH) information is a milestone in the global strategy for HRH 2030, and digitalized HRH information systems have been recommended by the World Health Organization. However, the implementation status differs among countries, and most systematic reviews on this topic have been conducted in high-income countries. This scoping review aimed to identify (1) stages of implementation, (2) functional components, (3) facilitators and barriers, and (4) policy impacts or outcomes of digitalized HRH information systems in low- and middle-income countries (LMICs).

The methodological framework of the Johanna Briggs Institute was used in this scoping review. English articles in two databases (PubMed and Web of Science) with publication dates ranging from inception to August 2023 were gathered, followed by a gray literature search and a reference search. Two author pairs independently performed the study selection. Data were extracted, analyzed, and presented in tabular form alongside a narrative summary.

Forty studies and gray literature from 26 LMICs in Asia and Africa were included in the scoping review. Thirty-three studies and gray literature covered different stages of digitalized HRH information systems’ implementation, including development, pilot, rollout, and maintenance. The HRH registry was the most common, whereas finances and migration were the least common functional components. Thirty-two studies and gray literature reported barriers and facilitators, stratified into four factors and stages. Many barriers were identified in organizational and environmental factors, especially in governance. Interoperability among multiple HRH information systems within a country is the key facilitator, where development partners play a critical role. Sixteen studies and gray literature from nine countries reported positive policy impacts/outcomes. Political commitment, strong national and subnational leadership, and coordination mechanisms among national stakeholders and development partners were key to gaining policy impact.

Barriers and facilitators were common across the studies, and governance factors were particularly crucial at all stages of digitalization. Our stratified methodology for analyzing facilitators and barriers can serve as an analytical framework for evaluating HRH information systems in any country. Data on the private sector and migration could be further strengthened as system components.

The online version contains supplementary material available at 10.1186/s12960-025-01043-x.