@Article{info:doi/10.2196/58858,
author="Muliokela, Rosemary K
and Banda, Kuwani
and Hussen, Abdulaziz Mohammed
and Malumo, Sarai Bvulani
and Kashoka, Andrew
and Mwiche, Angel
and Chiboma, Innocent
and Barreix, Maria
and Nyirenda, Muyereka
and Sithole, Zvanaka
and Ratanaprayul, Natschja
and Endehabtu, Berhanu Fikadie
and Telake, Hanna Abayneh
and Weldeab, Adane
and Probert, William J M
and Tun{\c{c}}alp, Ӧzge
and Maya, Ernest
and Woldetsadik, Mulatu
and Tilahun, Binyam
and Guure, Chris
and Senya, Kafui
and Say, Lale
and Tamrat, Tigest",
title="Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned",
journal="JMIR Med Inform",
year="2025",
month="Feb",
day="7",
volume="13",
pages="e58858",
keywords="guidelines; reproductive health; maternal health; antenatal care; clinical decision support; clinical decision support systems; digital health; HIV/AIDS; family planning; electronic medical records; electronic health record; standards; interoperability; system uptake; digital health governance",
abstract="Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results): Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. ",
issn="2291-9694",
doi="10.2196/58858",
url="https://medinform.jmir.org/2025/1/e58858",
url="https://doi.org/10.2196/58858"
}