Associations between digital maturity in health and primary health care performance, 109 countries

Objective: To investigate associations between digital maturity in health and primary health care performance globally. Methods: We conducted a search of publicly available data on digital maturity in health and primary health care performance for the 194 World Health Organization Member States. We identified 14 indicators of digital maturity in health, covering seven core subcomponents. A digital maturity in health index was derived from these indicators. Primary health care performance was assessed using the universal health coverage effective coverage index. Findings: Digital maturity in health data were missing for 85 of the 194 countries, with considerable variation across subcomponents. The remaining 109 countries were divided into four types by digital maturity in health index. We identified countries leading or lagging in digital maturity and highlighted the strongest and weakest subcomponents. Overall, there was a strong, nonlinear, positive correlation between digital maturity in health and primary health care performance (Spearman correlation: 0.85). However, there were notable exceptions, which indicates digital maturity can enhance primary health care but is not necessary for its improvement. The relationship between health-care expenditure and digital maturity in health and primary health care performance varied among countries with similar spending and digital maturity. Conclusion: Overall, primary health care performance was positively associated with digital maturity in health and health-care expenditure. However, some countries had a strong primary health care system despite low digital maturity, and some had high digital maturity but a weak primary health care system. The study's findings could help policy-makers prioritize investment in digital health.