Localizing WHO SMART Guidelines-Digital Adaptation Kits (DAKs) for Country Impact: Implementation insights from Cameroon, Ethiopia, Ghana and Zambia

Abstract Global investments in digital health are accelerating progress toward universal health coverage, yet low- and middle-income countries face persistent challenges: fragmented data and limited interoperability inhibit systematic transformation. The World Health Organisation’s SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) Guidelines and Digital Adaptation Kits (DAKs) offer a standardized, evidence-based framework that enables countries to localize digital content and reinforce the uptake of standards at the point of care. Lessons from early adopters, including Cameroon, Ethiopia, Ghana, and Zambia, demonstrate that structured DAK localization strengthens alignment with national digital strategies and the potential to harmonise information systems. Effective adoption is driven by early user engagement, strong government leadership, and multisectorial collaboration. Mainstreaming the SMART Guidelines approach highlights the importance of robust governance and contextual adaptation in sustaining and scaling digital solutions that align with global standards.