Susan S. Francis
1 
, Vijay Kumar Chattu
2,3,4* 1 Center for Evidence-based Research, Global Health Research and Innovations Canada Inc. (GHRIC), Toronto, ON, Canada
2 United Nations University Institute on Comparative Regional Integration Studies (UNU-CRIS), Potterierei 72, 8000 Bruges, Belgium
3 School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
4 Central Research Facility (CRF), Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y Patil Vidyapeeth, Pune- 411018, India
Abstract
Universal Health Coverage (UHC) is one of the core objectives of global health and development programs worldwide, but progress remains uneven and fragile, particularly in low- and middle-income countries (LMICs). This perspective paper examines the role of digital health innovations (DHIs) in improving UHC and argues that their impact is shaped by the quality of governance under which they are designed and implemented. DHIs have increasingly been promoted as mechanisms to improve access, efficiency, transparency, and continuity of care. Yet across several LMICs, DHIs are often implemented in a fragmented manner, limiting their contribution to equitable, sustainable progress toward UHC. The paper highlights how governance attributes such as accountability, transparency, responsiveness, and ethical oversight influence digital health outcomes. It also discusses how smart health governance, characterized by simple, moral, accountable, responsive, and transparent institutional arrangements, is essential to align digital health investments with national health priorities and equity objectives. The paper argues that integrating digital health innovation with governance reform is critical for strengthening health system performance and achieving sustainable progress toward UHC for all.