Holistically assessing digital public health systems: The Digital Public Health Maturity Index

BACKGROUND: In their toolkit on national eHealth strategies, the WHO lists core areas for a holistic approach to digital public health (DiPH) systems: governance, investment, services, infrastructure, interoperability, workforce, legislation, policy, and compliance. However, addressing all of them is challenging, time-consuming, and expensive. Therefore, countries must first assess their DiPH system's maturity to identify gaps or improvement areas and prioritise investments. This ensures that policies align with the system's current state and guide future policy and regulation development. Assessing the system also has international advantages, as global benchmarking and policy learning are possible when multiple countries use the same tool for evaluating their DiPH system's maturity. However, until now, no index asses DiPH systems as comprehensively as the WHO proposes. This is where our research seeks to support public health policymakers by proposing the Digital Public Health Maturity Index (DiPHMI) to holistically assess the maturity of national DiPH systems following the WHO toolkit. METHODS: We developed the DiPHMI through systematic literature research on the characteristics and requirements of DiPH interventions. Indicators were collected through a Delphi process and compared with validated indicators by the EU, the World Bank, and the ITU. RESULTS: Our composite index consists of four main topics: 1. The required ICT infrastructure 2. The legal framework and political support 3. The attitudes of the population and public health workforce toward DiPH 4. The level of national DiPH intervention rollout Each area includes thematic subgroups to measure various aspects of national maturity. It will allow experts and policymakers to systematically assess their DiPH system's strengths, weaknesses, and opportunities. CONCLUSIONS: We are confident that using the DiPHMI to evaluate and compare European countries will enable the continent to move forward in unprecedented ways. KEY MESSAGES: • The digitalisation of national health systems increases their complexity and needs to be evaluated accordingly. One can only identify its potential and barriers by applying a holistic approach. • The DiPHMI is currently the only tool that follows the holistic approach suggested by the WHO: Supporting ICT infrastructure and legislative, tool-application level, and social interest in tool use.