Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review
6 affiliations
- 1School of Public Health, University of Ghana, Accra, Ghana
- 2The Medical Research Council Unit, The Gambia, at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- 3West African Centre for Cell Biology, University of Ghana, Accra, Ghana
- 4The Hague University of Applied Sciences, The Hague, The Netherlands
- 5Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- 6School of Nursing, Midwifery, Allied and Public Health, Canterbury Christ Church University, Canterbury, United Kingdom
Abstract
Digital point-of-care (POC) diagnostics, including connected and molecular platforms, have the potential to strengthen clinical decision-making and disease surveillance, particularly for febrile illness across African health systems. Yet context-relevant evidence on health system readiness and the institutional conditions shaping their integration and sustainability is limited. Following RAMESES standards, we conducted a realist review to examine how, why, and under what circumstances digital POC diagnostics for febrile illness are integrated into African health systems. We systematically searched PubMed and CINAHL (2005–2025) and supplemented these with purposive searches of the grey literature. Qualitative and mixed-methods studies addressing implementation, integration, or readiness were included. Data were synthesized using context–mechanism–outcome (CMO) configurations to develop and refine the program theory. Seventeen studies from multiple African countries were included. Readiness for integration was explained by five interacting system levers: (1) usability and workflow compatibility; (2) workforce competence, trust, and confidence; (3) reliable infrastructure and connectivity; (4) governance, policy alignment, and financing; and (5) data systems that generate actionable value. When these conditions aligned, mechanisms such as perceived usefulness, confidence, institutional legitimacy, and responsiveness were activated, leading to sustained use, improved diagnostic pathways, and enhanced surveillance. Conversely, weaknesses, particularly in infrastructure, procurement, or data-use capacity, triggered frustration, distrust, and discontinuation. The integration of digital POC diagnostics into African health systems depends more on the health system’s readiness to promote trust, continuity, and data-driven action than on the performance of the tests themselves. A realist, system-focused approach is required to enable context-specific implementation and prevent the reinforcement of pre-existing inequities in digital health adoption. Author summary: Limited access to reliable diagnostics remains a major challenge across many African health systems, where febrile illnesses are often treated based on symptoms instead of confirmed diagnoses. Digital point-of-care (POC) diagnostics—portable devices that quickly test patients and send results electronically—are becoming more popular as tools to improve clinical decision-making and disease monitoring. However, for these technologies to work effectively, healthcare facilities need to be ready to integrate them into routine care. In this study, we conducted a realist review of the literature to understand the methods, rationale, and conditions under which digital POC diagnostics are integrated into African health systems. Through the synthesis of evidence from 17 studies across multiple countries, we identified five key factors influencing readiness: device usability, workforce competence and reliability, infrastructure dependability, the effectiveness of governance and financing, and the capacity of data systems to provide relevant information. The findings suggest that digital diagnostics are most effective when health systems foster trust, continuity, and data-driven decision-making, offering practical guidance for policymakers and implementers of digital health technologies.
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BibTeX
@article{deleolowu2026health,
title = {{Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review}},
author = {Shola Molemodile Dele-Olowu and Mamadu Baldeh and Flavia Bawa and Leonard Baatiema and Frances Baaba da-Costa Vroom and Luc de Witte and Emilia Udofia and Alfred Edwin Yawson and Julie Balen and NIHR Global Health Research Group on Digital Diagnostics for African Health Systems},
journal = {PLOS Digital Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pdig.0001820},
url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001820},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review
AU - Shola Molemodile Dele-Olowu
AU - Mamadu Baldeh
AU - Flavia Bawa
AU - Leonard Baatiema
AU - Frances Baaba da-Costa Vroom
AU - Luc de Witte
AU - Emilia Udofia
AU - Alfred Edwin Yawson
AU - Julie Balen
AU - NIHR Global Health Research Group on Digital Diagnostics for African Health Systems
PY - 2026
DA - 2026/11/06
JO - PLOS Digital Health
DO - 10.1371/journal.pdig.0001820
UR - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001820
AB - Digital point-of-care (POC) diagnostics, including connected and molecular platforms, have the potential to strengthen clinical decision-making and disease surveillance, particularly for febrile illness across African health systems. Yet context-relevant evidence on health system readiness and the institutional conditions shaping their integration and sustainability is limited. Following RAMESES standards, we conducted a realist review to examine how, why, and under what circumstances digital POC diagnostics for febrile illness are integrated into African health systems. We systematically searched PubMed and CINAHL (2005–2025) and supplemented these with purposive searches of the grey literature. Qualitative and mixed-methods studies addressing implementation, integration, or readiness were included. Data were synthesized using context–mechanism–outcome (CMO) configurations to develop and refine the program theory. Seventeen studies from multiple African countries were included. Readiness for integration was explained by five interacting system levers: (1) usability and workflow compatibility; (2) workforce competence, trust, and confidence; (3) reliable infrastructure and connectivity; (4) governance, policy alignment, and financing; and (5) data systems that generate actionable value. When these conditions aligned, mechanisms such as perceived usefulness, confidence, institutional legitimacy, and responsiveness were activated, leading to sustained use, improved diagnostic pathways, and enhanced surveillance. Conversely, weaknesses, particularly in infrastructure, procurement, or data-use capacity, triggered frustration, distrust, and discontinuation. The integration of digital POC diagnostics into African health systems depends more on the health system’s readiness to promote trust, continuity, and data-driven action than on the performance of the tests themselves. A realist, system-focused approach is required to enable context-specific implementation and prevent the reinforcement of pre-existing inequities in digital health adoption. Author summary: Limited access to reliable diagnostics remains a major challenge across many African health systems, where febrile illnesses are often treated based on symptoms instead of confirmed diagnoses. Digital point-of-care (POC) diagnostics—portable devices that quickly test patients and send results electronically—are becoming more popular as tools to improve clinical decision-making and disease monitoring. However, for these technologies to work effectively, healthcare facilities need to be ready to integrate them into routine care. In this study, we conducted a realist review of the literature to understand the methods, rationale, and conditions under which digital POC diagnostics are integrated into African health systems. Through the synthesis of evidence from 17 studies across multiple countries, we identified five key factors influencing readiness: device usability, workforce competence and reliability, infrastructure dependability, the effectiveness of governance and financing, and the capacity of data systems to provide relevant information. The findings suggest that digital diagnostics are most effective when health systems foster trust, continuity, and data-driven decision-making, offering practical guidance for policymakers and implementers of digital health technologies.
SN - 2767-3170
ER -