TY  - JOUR
AU  - Muliokela, Rosemary K
AU  - Banda, Kuwani
AU  - Hussen, Abdulaziz Mohammed
AU  - Malumo, Sarai Bvulani
AU  - Kashoka, Andrew
AU  - Mwiche, Angel
AU  - Chiboma, Innocent
AU  - Barreix, Maria
AU  - Nyirenda, Muyereka
AU  - Sithole, Zvanaka
AU  - Ratanaprayul, Natschja
AU  - Endehabtu, Berhanu Fikadie
AU  - Telake, Hanna Abayneh
AU  - Weldeab, Adane
AU  - Probert, William J M
AU  - Tunçalp, Ӧzge
AU  - Maya, Ernest
AU  - Woldetsadik, Mulatu
AU  - Tilahun, Binyam
AU  - Guure, Chris
AU  - Senya, Kafui
AU  - Say, Lale
AU  - Tamrat, Tigest
PY  - 2025
DA  - 2025/2/7
TI  - Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned
JO  - JMIR Med Inform
SP  - e58858
VL  - 13
KW  - guidelines
KW  - reproductive health
KW  - maternal health
KW  - antenatal care
KW  - clinical decision support
KW  - clinical decision support systems
KW  - digital health
KW  - HIV/AIDS
KW  - family planning
KW  - electronic medical records
KW  - electronic health record
KW  - standards
KW  - interoperability
KW  - system uptake
KW  - digital health governance
AB  - 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. 
SN  - 2291-9694
UR  - https://medinform.jmir.org/2025/1/e58858
UR  - https://doi.org/10.2196/58858
DO  - 10.2196/58858
ID  - info:doi/10.2196/58858
ER  -