Mobile health (mHealth) applications for community health workers in low- and middle-income countries: A scoping review.

Abstract

Mobile health (mHealth) applications are increasingly used to support community health workers (CHWs) in delivering primary care services in low- and middle-income countries (LMICs); however, evidence remains fragmented regarding how technical configuration intersects with the sociotechnical experience of the workforce. This scoping review aimed to characterize the technological and sociotechnical landscape of smartphone- and tablet-based mHealth applications used by CHWs in LMIC primary care settings. Following the PRISMA-ScR framework, systematic searches were conducted in PubMed, CINAHL, Cochrane, and Global Index Medicus to identify peer-reviewed and regionally diverse literature published between 2013 and 2025. Eligible studies reported on smartphone- or tablet-based applications designed to support CHWs working in LMIC primary care settings. Data were synthesized using a three-dimensional architecture framework (functions, connectivity, and interoperability) and thematic synthesis across five neutral sociotechnical domains: the Tool, Workflow, Worker, Client, and Health System. Thirty studies met the inclusion criteria. Evidence was geographically concentrated in Sub-Saharan Africa and South Asia, with notable gaps in upper-middle-income economies, including regions of Latin America and East Asia. While 25 of 30 applications utilized offline-first architecture, 29 lacked full interoperability with national health information systems. Thematic synthesis identified inherent tensions: while digital protocols (WHO function A3) enhanced clinical confidence and professional status, they simultaneously introduced dual-entry workload friction and managerial monitoring. Sustainability was consistently hindered by a digital island effect resulting from a lack of comprehensive back-end interoperability (functions D2, D6). The potential of mHealth applications for CHWs in LMICs is undermined by an architectural-systemic mismatch. Long-term success requires a shift from pilot-centric hardware deployment toward interoperability-first strategies that prioritize technical interoperability and clinical empowerment over top-down monitoring. Governments and partners should mandate architectural alignment with national health infrastructures to transition CHWs from isolated data-entry clerks to connected digital clinicians.