Equity Effects of Digital Primary Care Interventions in Low- and Middle-Income Countries: A Systematic Review Using the PROGRESS-Plus Framework
DOI:
https://doi.org/10.59890/ijgsr.v4i10.8Keywords:
Digital Primary Care, Mhealth, PROGRESS-Plus, Primary Healthcare, Low- and Middle-Income CountriesAbstract
Purpose: Digital primary care is increasingly promoted as a strategy to overcome barriers in low- and middle-income countries (LMICs). However, whether these interventions reduce health inequities remains uncertain. This systematic review examined equity effects across disadvantaged populations using PROGRESS-Plus. Methods: Following PRISMA 2020, peer-reviewed primary empirical studies published between January 2020 and September 2026 were identified through bibliographic databases and citation searching. Twenty-six studies evaluating digital primary care interventions in LMICs were included in a structured narrative synthesis. Equity evidence was mapped across PROGRESS-Plus dimensions. Main Findings: Digital primary care generally improved healthcare access, continuity, referral completion, service utilization, and selected clinical outcomes among rural, remote, low-resource, maternal, refugee, and underserved populations. However, equity gains depended on education, digital and health literacy, socioeconomic resources, connectivity, device access, gender, autonomy, and health-system readiness. Human-supported models involving community health workers and frontline providers appeared more equity-sensitive than technology-only approaches. Most studies demonstrated improved access among disadvantaged populations rather than directly measuring reductions in inequalities between advantaged and disadvantaged groups
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