title: Digital technology for health sector governance in low and middle income countries: a scoping review.
abstract: BACKGROUND
  Poor governance impedes the provision of equitable and cost-effective health care in many low- and middle-income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, "good governance" interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care.
  
  
  METHODS
  Multi-stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized.
  
  
  RESULTS
  We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified little formal evaluative research.
  
  
  CONCLUSIONS
  Innovative digital approaches are increasingly being used to facilitate good governance in the health sectors of LMICs but evidence of their effectiveness is still limited. More empirical studies are needed to measure concrete impacts, document mechanisms of action, and elucidate the political and sociotechnical dynamics that make designing and implementing ICTs for good governance so complex. Many digital good governance interventions are driven by an assumption that transparency alone will effect change; however responsive feedback mechanisms are also likely to be necessary.
authors.affiliation: Cambridge Judge Business School, Cambridge, UK; Medic Mobile, San Francisco, CA, USA; Edinburgh Global Health Academy & Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Isaac
authors.initials: I
authors.lastname: Holeman
authors.affiliation: Department of Geography, University of Cambridge, Cambridge, UK.
authors.forename: Tara Patricia
authors.initials: TP
authors.lastname: Cookson
authors.affiliation: Edinburgh Global Health Academy & Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
mesh_terms: D040421:Cell Phone; D003142:Communication; D003146:Communications Media; D003657:Decision Making; D003695:Delivery of Health Care; D003906:Developing Countries; D005607:Fraud; D006076:Government; D006296:Health Services; D006801:Humans; D007182:Income; D007255:Information Services; D020407:Internet; D012941:Social Responsibility; D013672:Technology