Strengthening Digital Competencies in India’s Health Workforce: Development and Feasibility Evaluation of a Digital Health Competency Framework for Frontline Healthcare Workers in Uttar Pradesh

Introduction The rapid growth of digital health initiatives has heightened dependence on frontline health workers (FLHWs) to deliver, document, and manage services via digital tools, especially in low- and middle-income countries. In India, widespread adoption of platforms under the Ayushman Bharat Digital Mission (ABDM) lacks a standardized digital health competency framework for FLHWs, hindering systematic skill development, assessment, and integration. This study designed, developed, and evaluated a theory-driven, evidence-based, scalable Digital Health Competency Framework (DHCF) for India’s health workforce, framed as a feasibility and proof-of-concept study, piloted among FLHWs in Uttar Pradesh. Methods We used a three-stage approach: design, implementation, and evaluation. Development drew from a systematic literature review and the Government of India’s Framework for Roles, Activities, and Competencies (FRAC). A cadre-agnostic competency dictionary was created, covering functional, behavioral, domain-specific, and intervention-specific skills at graded proficiency levels. Competencies were mapped to FLHW roles, with aligned training materials and assessments developed. The framework was piloted via in-person, instructor-led sessions for Auxiliary Nurse Midwives (ANMs) in two districts (n=70), plus baseline evaluations for Accredited Social Health Activists (ASHAs; n=32). Results The DHCF comprises a three-component package: (i) a cadre-agnostic competency dictionary with progressive proficiency levels, (ii) systematic role-to-competency mapping via the FRAC methodology, and (iii) integrated training content and assessment scaffolding designed for institutional embedding. The DHCF defined ten core competencies, enabling role-specific mapping across cadres. Feasibility testing showed significant gains in ANMs’ knowledge and digital skills (Wilcoxon signed-rank test showed significant gains in two of four competency levels (C1L1 and C2L1, both p<0.001), with the largest effect in data collection basics (r=0.84)); ASHA baselines exposed major foundational literacy gaps (mean total score 11.97/30, 39.9%; data collection competency weakest at 32.5%, with no ASHA scoring above 60% on C2L1). Stakeholders affirmed the framework’s relevance, feasibility, and adaptability, but noted needs for hybrid training and better institutional embedding. Conclusion The DHCF offers a structured, scalable method to standardize digital health training for FLHWs, enhancing workforce preparedness in resource-limited settings during India’s digital health evolution. This feasibility study demonstrates the framework’s relevance and applicability, with future work needed to assess effectiveness at scale, long-term competency retention, and linkage to service delivery outcomes. Parallel attention to digital tool design and usability is essential to complement competency-building efforts.