Abundance Potential

Assessment scope

Development

Integrating digital point-of-care diagnostics for febrile illness into routine African health systems, including connected and molecular platforms.

Baseline

Fever care in the reviewed settings, where access to diagnostics is uneven and symptom-based or presumptive treatment remains common.

Population

People seeking care for febrile illness, health workers using the diagnostics, and health services that may use resulting data.

Geography

Multiple African countries represented in the 17 reviewed studies; five studies were from South Africa.

Target assumptions

The tests produce clinically useful results, and facilities can support workflow fit, trained staff, reliable infrastructure and supplies, sustained financing, and actionable data systems. The review does not establish test effectiveness or universal readiness.

Five dimensions

Human wellbeing

2/4 · If integrated and acted on, the tests may support clinical decisions and improve diagnostic pathways for febrile illness. The review synthesizes implementation pathways rather than establishing effects on patient outcomes, so the potential is meaningful but bounded. Sources: evidence-1643, evidence-1641

Affordability and access

1/4 · Routine use could make diagnostic services more available in facilities where conditions support integration. The review does not establish affordability, costs, or broad access gains, so the supported potential is limited. Sources: evidence-1643, evidence-1647

Reach and fairness

Unknown · The review does not establish whether digital diagnostics narrow or widen access gaps. Its evidence may lean toward settings with stronger infrastructure, and it calls for further study of underserved communities. Sources: evidence-1645, evidence-1647

Environment and resources

Unknown · The supplied evidence does not establish environmental effects or the overall resource footprint; it identifies sustainability and financing as areas needing further study. Sources: evidence-1647

Scientific capability

2/4 · When data systems can turn results into timely action, diagnostic data may support disease surveillance and health service decisions. This is a useful but conditional capability, not evidence of a broad or universal improvement. Sources: evidence-1643, evidence-1642

Evidence, confidence and timing

Evidence maturity

Finding: Deployed. The review synthesizes 17 studies addressing implementation, integration, or readiness, including reported sustained use and discontinuation in health systems. Its explanatory pathways still need prospective testing across diverse settings.

Societal benefit: Prototype pilot. Potential benefits such as improved diagnostic pathways and surveillance are reported in implementation contexts, but population-level effects, affordability, and sustained equitable reach are not established.

Confidence: Low. The review supports the proposed system conditions, but it is a synthesis rather than an effectiveness trial; study designs vary, five of 17 studies were from South Africa, and evidence on newer molecular platforms and equity is limited.

Conditional time horizon: Unknown. The evidence gives no implementation timeline. Timing would depend on local infrastructure, staffing, procurement, financing, and data capacity.

Possible benefits

• Where system conditions align, routine diagnostic use may support clinical decisions and improve diagnostic pathways for febrile illness. Sources: evidence-1643
• Actionable diagnostic data may support supply decisions and disease surveillance. Sources: evidence-1643

Risks and possible harms

• Added workflow steps, staff workload, staffing shortages, unreliable infrastructure, interrupted supplies, or unusable data may weaken trust and lead to non-use or a return to paper-based or presumptive practices. Affected groups: Patients and health workers in facilities with limited staff, infrastructure, supplies, or data response capacity. Sources: evidence-1644
• If adoption depends on infrastructure and digital capacity that are unevenly available, the tools could reinforce existing inequities rather than reduce them. Affected groups: Underserved communities and facilities with lower infrastructure or digital capacity. Sources: evidence-1641, evidence-1645, evidence-1647

Distribution and adoption

Who might be excluded

• The review does not establish reach for underserved rural communities or facilities with weaker infrastructure; the authors identify these distributional effects as an open research question. Sources: evidence-1645, evidence-1647

Adoption barriers

• Poor workflow fit, limited staff competence or confidence, unreliable electricity or connectivity, maintenance and supply problems, weak policy or financing support, and data that cannot inform action can impede integration. Sources: evidence-1642, evidence-1644
• Heavy workloads and staff shortages may limit the benefit of training and supervision. Sources: evidence-1644

Assumptions and conditions that could change the assessment

• Facilities can align workflows, workforce support, infrastructure, governance and financing, and data systems well enough to sustain use. Sources: evidence-1642
• The diagnostics produce useful results; this review examines integration conditions and does not test technology effectiveness in a new trial. Sources: evidence-1641
• Raise confidence in the benefit assessment if prospective research tests the proposed pathways across diverse settings and longitudinal research clarifies maintenance, supply chains, financing, and sustainability. Sources: evidence-1647
• Revise the reach and fairness assessment when evidence establishes whether these diagnostics narrow or widen access gaps, including for underserved rural communities. Sources: evidence-1647
• Reassess transfer to newer digital molecular diagnostics when more direct evidence on their integration in African health systems is available. Sources: evidence-1646

Citations

1. evidence-1641 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source
2. evidence-1642 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source
3. evidence-1643 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source
4. evidence-1644 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source
5. evidence-1645 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source
6. evidence-1646 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source
7. evidence-1647 · Health system readiness for digital point-of-care diagnostics for febrile illness across Africa: A realist review · S; h; o; l; a; ; M; o; l; e; m; o; d; i; l; e; ; D; e; l; e; -; O; l; o; w; u · 10.1371/journal.pdig.0001820 · Captured publisher article text · Open source