Background Health systems contribute to an important part of planetary boundaries overshoot, the effect of its rapid digitalization being however not well known. DYNAMIC is a Tanzanian digital health project, aimed at improving quality of care for sick children at primary care level through the provision of a tablet-based clinical decision support algorithm for clinicians. We evaluated the raw material resources and energy required by this intervention, as well as the environmental impacts, to inform strategies for improving its sustainability. Methods Additional resources, including IT equipment, diagnostics and medicines used by the health intervention compared to usual care, were quantified. A life cycle assessment was conducted to calculate greenhouse gas emissions, fossil energy and mineral resources use, and damages to ecosystems and human health. Findings GHG emissions of the intervention in 40 health facilities over one year, allowing to attend 90,992 children, were 20.6 tons of CO2-eq per year (PY). Medical supplies were the main source of emissions (13 tons), followed by digital supplies (5 tons), and logistics (2.6 tons). Fossil energy and mineral resources used were 380 GigaJoules and 77.9 kg deprived PY respectively. Damage on human health was 0.062 DALY, and on ecosystems 12,385 Potentially Disappeared Fraction of Species per m 2 of land PY. The two-third decrease in antibiotic prescription as a result of the DYNAMIC project could reduce 14.5 tons of CO2-eq emissions. Interpretation The digital component of the DYNAMIC health intervention increased its carbon footprint by a third, the main drivers remaining however the increase in medicines and medical devices use. Three quarters of the overall emissions could however be saved thanks to the antibiotic stewardship effect of the intervention. This shows that the rapid digitalization of health systems could accelerate their dependency on fossil fuels and other raw material. This negative effect on the environmental should be systematically evaluated to know if it is at least compensated by a benefit in terms of medical supplies savings. Promoting local, eco-friendly production of essential medical supplies and synergizing digital health interventions to use a shared IT infrastructure are also essential strategies for preserving resources and protecting the environment.
Karlen et al. (Thu,) studied this question.