JMIR Publications

ABSTRACT

Background:

The sustainability of digital health systems in low- and middle-income countries (LMICs) is frequently constrained by unreliable infrastructure and fragmented financing mechanisms. While solar-powered energy solutions offer a promising pathway to improve system reliability, there is limited evidence on how to sustainably finance such systems within resource-constrained health systems.

Objective:

This study aimed to examine sustainable financing models for solar-powered digital health systems in low-resource settings, focusing on cost structures, financing mechanisms, and economic implications.

Methods:

A cross-sectional mixed-methods study was conducted across selected health facilities and stakeholder environments in East Africa. Quantitative data were collected through facility-level assessments and cost evaluations, including capital and operational expenditures. Qualitative data were obtained through key informant interviews and document review. Descriptive statistical analysis was used to summarize quantitative findings, while thematic analysis was applied to qualitative data. Findings were integrated to generate system-level insights into financing feasibility and sustainability.

Results:

The findings indicate that solar-powered digital health systems are characterized by high upfront capital costs and moderate but recurring operational costs. Donor-funded models were the most commonly identified financing approach; however, they were associated with limited long-term sustainability. Blended financing and public–private partnership models demonstrated greater potential to align financial resources with lifecycle costs. Quantitative findings showed that a substantial proportion of facilities experienced unreliable electricity supply and high energy-related costs, while qualitative insights highlighted strong stakeholder support for solar-powered solutions, given their potential to reduce operational costs and improve system performance. Integrated analysis revealed a mismatch between existing short-term financing models and long-term infrastructure investment needs.

Conclusions:

Sustainable implementation of solar-powered digital health systems requires a shift toward integrated financing approaches that combine public, private, and donor resources. Addressing financing barriers alongside infrastructural challenges is essential to ensure scalability and long-term impact. Policymakers and stakeholders should prioritize blended financing mechanisms and strengthen governance frameworks to support sustainable health system transformation.