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Sustainable by Design: Digital Health Business Models for Equitable Global Health Impact in Low-Income and Low-Middle-Income Countries

Open access
Irihamye, Elvin, Hadad, Justin, Ali, Natasha, Holthof, Bruno, Wafula, Francis, Paton, Chris, English, Mike, Nagraj, Shobhana·2025·Mayo Clinic Proceedings: Digital Health
DOI 10.1016/j.mcpdig.2025.100261PMC PMC12547002
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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.

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  • This is likely relevant to other low-and middle-income country health-AI teams whose funding fit depends on geography, entity type, partner relationships, and diseasespecific evidence.

    “This is likely relevant to other low-and middle-income country health-AI teams whose funding fit depends on geography, entity type, partner relationships, and diseasespecific evidence [1,5].”

    From A Workflow for Grant Discovery and Proposal Development Using Large Language Models: Development and Formative Evaluation (2026) · cites this paper as [5]

    The Results section (External Market-Shaping Interventions; page unavailable) discusses funding constraints for LMIC digital-health companies, strategic partnerships, and financing tied to clinical or operational performance metrics. It does not establish that a health-AI team’s funding fit depends on geography, entity type, or disease-specific evidence. The citing authors’ suggestion that these issues may be relevant to other teams is their own inference. (LLM, conf=0.83)

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  • Digital health sustainability literature emphasizes financing barriers, fragmented markets, and the need for strategic partnerships.

    “Digital health sustainability literature emphasizes financing barriers, fragmented markets, and the need for strategic partnerships [1,5,20,21].”

    From A Workflow for Grant Discovery and Proposal Development Using Large Language Models: Development and Formative Evaluation (2026) · cites this paper as [5]

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Research works printed but not linked: 4

  1. [19]Albert J. van der Auwermeulen T. Why classic Business Modelling doesn’t work for complex business domains—a new Business Modelling approach for Digital Health ISPIM Innovation Symposium. The International Society for Professional Innovation Management (ISPIM) 2017 1 18
  2. [24]Mueller C. mHealth business model framework for the maternal and baby segment: a design science research approach 32nd Bled eConference Humanizing Technology for a Sustainable Society, BLED 2019—Conference Proceedings 2020 1055 1063
  3. [26]Sprenger M. Mettler T. On the utility of e-health business model design patterns Proceedings of the Twenty-Fourth European Conference on Information Systems 2016 ECIS
  4. [30]Osterwalder A. The business model ontology—a proposition in a design science approach. University of Lausanne https://www.researchgate.net/publication/33681401_The_Business_Model_Ontology_-_A_Proposition_in_a_Design_Science_Approach

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Authors
Irihamye, E., Hadad, J., Ali, N., Holthof, B., Wafula, F., Paton, C., English, M., & Nagraj, S.
Affiliations
  • University of Oxford (GB)
  • Strathmore University (KE)
  • University of Auckland (NZ)
  • Kenya Medical Research Institute (KE)
  • University of Cambridge (GB)
Corresponding author
Irihamye, Elvin
ORCID
Venue
Mayo Clinic Proceedings: Digital Health
Publisher
Elsevier BV
Published
2025-12
Volume
3
Issue
4
Pages
100261
ISSN
2949-7612 (ISSN-L)
DOI
10.1016/j.mcpdig.2025.100261
PMC
PMC12547002
OpenAlex
W4414039420
Cited by
8
References
28
Citations by year
2026: 7 · 2025: 1
FWCI
4.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Mayo Clinic Proceedings Digital Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Wellcome Trust (227396/Z/23/Z)
Topics
  • Social Sciences › Business, Management and Accounting › Business and International Management › Innovation and Socioeconomic Development
  • Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
  • Social Sciences › Business, Management and Accounting › Strategy and Management › Business Strategies and Innovation
Keywords
corporate sustainability, low-income countries, low-middle income countries, global health equity, stakeholder networks, digital health infrastructure, health care financing, health regulation, strategic partnership, public procurement, innovative financing, health system adaptation

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