Mapping inequities in digital health transformation within Ethiopia's primary health care system using PROGRESS-plus:...

Digital health technologies (DHTs) are recognized by the World Health Organization (WHO) as essential to achieving Universal Health Coverage, yet major equity gaps persist in low-resource settings such as Ethiopia. This scoping review applies the PROGRESS-Plus framework to examine how overlapping social identities (e.g., gender, residence, and income) shape inequities in access to, use of, and engagement with DHTs in Ethiopia's primary healthcare (PHC) system.

Following Arksey and O'Malley's framework enhanced by Levac et al. and reported using PRISMA-ScR 2020 guidelines. Searches were conducted in PubMed, Scopus, Web of Science, EMBASE, Google Scholar, and grey-literature sources for studies published between 2015 and 2025. Eligibility criteria were guided by the PCC framework, focusing on digital health interventions (DHIs) within Ethiopia's PHC system with explicit equity relevance. Data were extracted, charted, and synthesized using the PROGRESS-Plus framework, supported by thematic analysis, descriptive statistics, and integration with the WHO digital health intervention taxonomy and the NASSS implementation framework.

Twenty-one studies met inclusion criteria. Digital health inequities consistently clustered around residence, education, socioeconomic status, gender, occupation, and marginalized-group status. Structural barriers, poor connectivity, limited devices, and inadequate digital health skills, disproportionately affected rural and pastoralist communities. Advanced digital health tools (AI, telemedicine, EMRs) were largely restricted to urban and better-resourced settings. Engagement was shaped by cultural and linguistic relevance, trust, peer support, and institutional readiness.

Digital transformation in Ethiopia's PHC system remains constrained by intersecting social determinants. Applying PROGRESS-Plus demonstrates that technological expansion alone cannot ensure equitable uptake. Equity-centered digital strategies, emphasizing infrastructure, contextualized design, capacity building, and inclusive governance, are essential for meaningful and sustainable digital health transformation adoption across all populations.