Co-creation as a knowledge mobilization process in digital health regulation in East Africa: The making of the...

Regulating digital health in low- and middle-income countries requires policy-makers to organize and use multiple forms of knowledge, including academic research, technical expertise and experiential insights, to make tough decisions under conditions of existential uncertainty. We examine co-creation as a mode of knowledge mobilization in digital health regulation in Kenya, Rwanda and Uganda. Using content analysis and a multi-country stakeholder workshop, we trace how regulators, clinicians, technologists and civil society actors collectively interpreted comparative evidence on existing frameworks and used it to negotiate trade-offs in the institutional design of digital health regulatory frameworks. Through this process, participants co-produced the DigiReg Compass, a tiered heuristic that structures options for legal form, administrative arrangements, expertise, financing, participation and political sponsorship. We show, first, how co-creation can extend regulatory capacity by organizing distributed expertise into a usable evidence base; second, how social learning in such settings reshapes actors' understandings of regulatory problems and solutions; and third, how tools such as the DigiReg Compass can function as knowledge translation mechanisms that link health systems research to regulatory practice. These findings contribute to debates on the organization and use of health research in health systems by illustrating how, in resource-constrained contexts, participatory processes can transform fragmented knowledge into shared guidance for regulatory decision-making.