Abstract
This study explores challenges and potential strategies related to sustaining digital health business models and markets in low-income and low-middle-income countries using a critical interpretive synthesis approach. We extracted 21 articles from a database search that yielded over 1300 hits and used insights from 7 expert reviewers with experience operating or funding digital health companies in low-middle -income countries. Findings reveal 4 key challenges: (1) internal challenges related to managing value creation for complex stakeholder networks and external challenges related to (2) infrastructure, (3) financing, and (4) regulation. Entrepreneurs must address these through iterative business strategies, but broader market-shaping interventions remain essential. Such interventions could include facilitating strategic partnerships, fit-for-purpose regulation, enhancing public procurement, and innovative financing instruments. Health systems can tailor interventions around their unique contexts by prioritizing technologies, recruiting local market participants, analyzing shared barriers in the business environment, focusing on feasible interventions, and iterating to sustain a competitive environment.