Towards a Digital Health Curriculum for Health Workforce for the African Region

Digital technologies are fast gaining space in health. A skilled workforce is required to use existing and emerging technologies that support healthcare. However, existing medical informatics curriculum from the USA, UK, and African region reveal gaps in required competencies for a digital health worker, especially for the African region. Only a few health workers possess digital competencies required to optimally use existing technologies. Therefore, the aim of this study was to identify the need for and propose a structure of the digital health curriculum for the African region.Methods The study retrieved 42 peer-reviewed articles and reports published in English between 2005 and 2019 from PubMed Central, Google Scholar, and Biomedical Central. Only articles that addressed any form of pre-service and or in-service training of digital health workers were included in the review. In addition, 13 medical informatics curricula from the USA, UK, and African region were reviewed to determine the structure of the Digital Health curriculum suitable for the African region.Results Many countries in the African region have developed ehealth strategies that clearly highlight the need to train DH workforce. Results showed knowledge gaps of a communicator, a collaborator, a professional technologist, an advocate, and a manager required of digital health worker in the African region. However, existing digital/health informatics programmes in the region lack balanced course programmes to develop these core competencies. Besides, corresponding online training is modeled after traditional face-to-face training, thus limiting the opportunity for in-service health workers. Validation of the Lesotho curriculum confirmed only 10 modules as suitable to develop a rounded digital health worker (particularly for health leaders) for the African region.Conclusions


Abstract
Background Digital technologies are fast gaining space in health. A skilled workforce is required to use existing and emerging technologies that support healthcare. However, existing medical informatics curriculum from the USA, UK, and African region reveal gaps in required competencies for a digital health worker, especially for the African region. Only a few health workers possess digital competencies required to optimally use existing technologies. Therefore, the aim of this study was to identify the need for and propose a structure of the digital health curriculum for the African region.Methods The study retrieved 42 peer-reviewed articles and reports published in English between 2005 and 2019 from PubMed Central, Google Scholar, and Biomedical Central. Only articles that addressed any form of pre-service and or in-service training of digital health workers were included in the review. In addition, 13 medical informatics curricula from the USA, UK, and African region were reviewed to determine the structure of the Digital Health curriculum suitable for the African region.Results Many countries in the African region have developed ehealth strategies that clearly highlight the need to train DH workforce. Results showed knowledge gaps of a communicator, a collaborator, a professional technologist, an advocate, and a manager required of digital health worker in the African region. However, existing digital/health informatics programmes in the region lack balanced course programmes to develop these core competencies. Besides, corresponding online training is modeled after traditional face-to-face training, thus limiting the opportunity for in-service health workers.
Validation of the Lesotho curriculum confirmed only 10 modules as suitable to develop a rounded digital health worker (particularly for health leaders) for the African

region.Conclusions
Since it is important to develop competencies consistent with the local health systems to realize the full benefits of ehealth technologies, the African region needs to bridge their human resource gaps. Thus, African countries need to first develop or adopt a digital health worker competency framework and then re-organize their national health training curriculum to ensure a standardized / universal curriculum for training the digital health workforce. Future works will assess the DH worker competencies and expected outcomes for the African region.

Background
Digital health is considered to be an umbrella term encompassing eHealth and mHealth, as well as emerging and developing computing areas such as artificial intelligence and internet of things that support healthcare [1,2]. Digital health technologies are widely referred to as ehealth technologies and present new or improved ways of delivering health care, conducting health promotion activities and monitoring public health [2,3]. The technologies are geared toward meeting the growing demand for healthcare [3,4]. The human resources required to design, deploy, manage and/or use these technologies in support of healthcare need to be properly equipped with ICT skills [5]. They are categorised as health workforce skills, which include skills, experience, and knowledge to apply eHealth in the management and delivery of care to individuals and health ICT workforce, which include skills for design, building, operating and supporting eHealth services [6]. Thus, a diverse workforce herein referred to as Digital Health Worker, needs to be engaged holistically in order to develop, operate and support the national eHealth environment [6]. This workforce can be drawn from multiple professional backgrounds and diverse service providers [4]such as clinicians, health informatics professionals, IT professionals and professional managers [7], some of which lack the basic ICT skills required for them to fully use the digital tools and technologies at their disposal and to carry out their healthcare responsibilities. It takes the right professionals with the right combination of skills to work together to meet the challenges of obtaining data, make meaning and derive useful decisions from it. The social communication skills of digital natives differ from the type of information exchange required in healthcare [8]. In their study, Ahonen et al [9] pointed to the need for a multi-professional curriculum and a combination of trainable competencies for quality digital health and welfare service development. These are greatly lacking not only in the African region but across the world [10].
Academic institutions have continued to have traditional professional curricula without integrated formal coursework or clinical practice specific to using digital technologies for patient care in the professional curricula [8]. However, they lack the multi-professional requirement for a digital health worker skill in the use of digital technology to support healthcare. Consequently, Barakat et al [4], argue for education and training of healthcare professionals in the latest tools and methods to accelerate acceptance and use of digital technologies to collect, use and share information to support healthcare delivery. In addition, as more digital health technologies evolve health workers need more training to use them.
The term digital technology has also been defined as "… any product that can be used to create, view, distribute, modify, store, retrieve, transmit and receive information electronically in a digital form" [11]. Some of the digital health stakeholders are technology innovators, technology providers, and technology users, etc. The technology innovators provide the digital health tools and technologies for which the technology providers supply and / or provide, such as services to the technology users, who apply them or use them in their day-to-day healthcare services. The users need to participate to some extent in the design process. It should be realised that the technology users exist at all levels of the healthcare planning and service delivery including, strategic, tactical and operational [12]. In the African region, the strategic level consists of the Permanent persons working at these three levels require specialised skills in using digital technologies to support healthcare. In fact, the World Health Organisation (WHO) suggest that training and education programmes will need to ensure that the workforce can use digital technologies proficiently in many settings, whether in the delivery of care (operational level), its management and administration (tactical level), or in health systems planning and management (strategic level) [3]. However, most of the health workforce, especially in the African region, lack core competencies that are required to use digital technologies. Thus, the benefits of digital health are not fully realised.
Attaining a competent workforce is strained by limited or lack of capacity to develop and sustain such a workforce. Therefore, a curriculum is required to guide the required training of health workers in order to equip them with required competencies to implement, operate and use ehealth technologies [13]. The curriculum can be tailored to train pre-service or in-service health workers. Furthermore, training modules and online courses are suggested for digital health workers who may be remote from training institutions [3].
According to Lynott et al [14] current health systems training is not standardized and lacks content that may be required to address digital health worker needs. They identified the need for a training model that incorporates almost universal ehealth components like electronic health records. Therefore, there is a need to identify and structure the core competencies that a digital health worker should acquire to effectively use technology in support of healthcare services. In this regard, [15] argued for strengthening training programs for health workers to increase the number of qualified providers and hence improve health service quality.

The African Region Digital Health Situation
Besides the shortage of trained healthcare professionals working in Africa, less than 50% of Africans have access to good health facilities [16]. This situation can be improved by digital health technologies. Digital health can find broad applications in developing countries such as those in the African region, where the healthcare workforce and skills are limited. The healthcare service environment continues to experience challenges in the use of ICTs. However, these innovations are not matched to the requisite health worker usage skills [5]. The required ICT skills are needed and should be matched to appropriate Digital Health applications. These ICT applications include healthcare professional skills in mhealth services such as the use of mobile phones and wireless technology in public health education, supportive diagnostics, remote patient monitoring, data collection, helplines, etc., wearable technology/devices to track patient activities, personalised treatment, specific health issue monitoring, etc., and 3D printing in healthcare to produce a three dimensional solid objects like splints for children, 3D printed skin for burn victims.
There are lack of skills among health workers for mHealth, eHealth, telehealth, health information technology, and telemedicine applications as well as wearable technologies, big data and use of artificial intelligence in healthcare [7]. The lack of skills exists also for the design, deployment, and management of digital health systems [5]. In fact, all the reviewed ehealth strategies for countries in the African region identified lack of skilled Digital Health (DH) workforce among the challenges to their ehealth strategic objectives [13,[17][18][19][20][21][22][23]. One way to solve these gaps is by way of appropriate training of digital health workers.
Actually, countries across the African region are at different stages of implementation of Digital systems. They have identified the need to train a digital health workforce as one of the key components of their digital health programs [17][18][19][20][21]. The last survey on ehealth conducted in 2015/2016 in the region, showed that 18 out of 33 countries were offering pre-service training in ehealth, while 19 out of 33 countries were implementing ehealth capacity building for in-service health professionals [24]. From this survey, it is clear that countries in the African region lack trained health workers with the capacity to design, deploy and manage ehealth projects and programmes [5,6]. The lack of well-trained ICT professionals, insufficient awareness and experience in the use of ICTs remain important challenges to ehealth success in a developing country [5,25]. The problem is aggravated by limited opportunities for education in eHealth with most courses available only at the post-graduate level [19]. For example, Uganda's ehealth strategy expresses this as a deficit of adequate health informatics skills that need to be addressed [20]. Generally, the African region lacks a standard digital health curriculum to guide the training of the health workforce in the region; this poses a risk for fragmented and uncoordinated digital health skills workforce development. Workforce training are activities planned to make digital health knowledge and skills available through internal expertise, technical cooperation, or the private sector [26]. It includes establishing eHealth education and training programs for the digital health capacity building.
Largely, the above problem can be addressed through a mix of continuing education programmes like in-service training and pre-service training courses embedded in the main training curriculum as previously recommended [27]. Specialized ehealth technology training, short ehealth training programmes or online courses should be provided as part of continuing education for health workers; relevant ICT courses can be introduced in the curricula of all healthcare training institutions [5,27]. To address the lack of ICT skills among the digital health workforce, ITU's report on ICT for health recommends that a basic start is the adaption of medical students' curricula to include more courses about the new advancements of ICTs and eHealth [28]. Moreover one of the recommendations of the WHO World Health Assembly A71 resolution on digital health relates to health workforce development and skills in digital health, i.e. "to build, especially through digital means, capacity for human resources for digital health, as appropriate, across both health and technology sectors, and to communicate areas of specific need to the World Health Organization in order to receive appropriate technology assistance" [29]. Ultimately, to address this gap, some countries in the region such as Kenya, Ghana, Rwanda, South Africa, Uganda and Zambia among others embarked on implementing this resolution through the development of ehealth strategies. For example, Uganda's ehealth strategy identified the need to 'develop and enforce an eHealth Curriculum Framework to be followed by different training providers in developing and delivering Health training' [20].
A standardized structure for digital health worker curriculum is expected to produce professionals who can adapt to the fast-changing ehealth technological environment and thus, can work across the board.
According to McNay [30], as summarised in Alunyu et al [31], a curriculum can be considered to be a written plan of a degree programme, a syllabus, a course outline, a course study, a course guide, or a learning package. Thus, the digital health curriculum may be a dedicated bio medical/health informatics degree programme or syllabus [27], a course within medical professional pre-service training programme, a specialised ehealth technology study programme, a learning package for the in-service staff or an online ehealth technology training package which must be properly structured and documented.
Whether they are in or outside the school, any planned training is considered part of a curriculum [32]. Consequently, this research paper focused on assessing the digital health (DH) worker learning needs and curriculum competencies in the African region, and to propose a structure for in-service health and ICT professional curriculum for the region.
The proposed DH curriculum for the African region should be able to produce workforce both health and ICT that satisfy needs of the priority focus areas for ehealth highlighted in many of the human resource needs identified in the ehealth strategies of African countries. We thus discuss some of the current global DH training programmes with an aim to examine how these can easily be adopted for the African region and/or what adjustments and contextualisation should be made to suit the African region settings.
The rest of the paper is organized into sections that discuss the concept of the digital health worker, required competencies and curriculum; the methodology followed to generate the requirements for the digital health curriculum and guidelines for designing the curriculum; a discussion of the results on digital health training; and proposal of the structure of core competencies for the digital health worker curriculum for the African region as well as the Lesotho in-service (particularly health leaders) digital health worker curriculum for the African region and its validation. The paper concludes with recommendations for future work.

The BioMedical/Health Informatics Training Curriculum
In order to produce professionals with the required competencies to perform particular tasks, formal training institutions have used the model of a training curriculum. A curriculum outlines the what, how, why and when learning should happen, that is, a curriculum presents a structured plan for what contents to be delivered, how they should be delivered, the purpose for such training, and when to attain desired learning outcomes [32]. This learning process involves formal or informal interactions of the instructor (professional person) and the learner, personal initiatives of the learner, and or mentorship of a trainee.
The existing medical training curriculum offers formal and informal aspects of training.
Whereas, informal training is unintended, i.e., can take place at any time or anywhere; formal training is guided by a structured curriculum. Although evaluating the quality of informal learning may be difficult, [33] argues that the quality of formal training is dependent on the quality of the curriculum. However, this author suggests that the quality of a curriculum should be judged in relation to the processes of curriculum development, implementation, and evaluation [33]. Therefore, to expect the quality of training from a digital health worker curriculum, the due process must be followed, that is, properly planned, consultative and inclusive development led by curriculum professionals, cyclical and sustainable. In this research, as a benchmark, we reviewed existing digital health curricula or programmes that offer components of Digital Health training to establish a basis for future digital health curriculum for the African region.

Types of Training in the Healthcare Profession
Commonly used modes of health worker training include pre-service training and continuing training [34], which were suggested by Asamoah-Odei, et al [5] as part of the systematic education for health workers in Digital Health. Pre-service training is the formal training provided by the health institution. Pre-service training introduces core skills much earlier to health workers especially during formal training [35]. It is integrated as part of the formal health education curricula. Continuing training embodies in-service training, refresher training, and or supportive supervision [36,37]. In-service training or refresher training is training received by existing staff after their formal/initial professional training. The purpose of in-service is to acquaint employees with new skills, methods, procedures and or processes required to better their work performance [38].
Although in-service training is considered to be expensive requiring the trainees to leave their work places [35,36], it is also considered to be very effective in healthcare cycles and has greatly facilitated the transfer to ICT-based work skills and routines among health professionals [39]. In addition, supportive supervision is sometimes recommended for healthcare in cases where help to improve staff work performance is tailored by using supervisory visits as opportunities to improve work knowledge and skills [37]. However, Asamoah-Odei, et al [5] argue that such systematic education must be at the heart of any strategy designed to facilitate ehealth. Therefore, the African region will reap the benefits of continuing training and pre-service training. Accordingly, with the need to develop or adopt diverse digital health training programmes such as the academic institutional DH curriculum, the GEEKS and I-LEAD programmes from the Centres for Disease Control (CDC) proposed learning exchange visits. These would provide support for (i) pre-service training, (ii) conduct of in-service training to acquaint employees with new skills, methods, procedures and / or processes, and (iii) structured supportive supervision and sharing of expertise and experiences by digital health practitioners, hence providing broad learning opportunities for Digital Health workers.
As opposed to other training, healthcare training is very demanding and involves the use of humans as study subjects. Besides, new techniques, methods, procedures, and innovations are being frequently discovered or improved for the detection, treatment, and management of conditions, illness, and diseases that affect humanity [4]. To ensure the quality of service to patients/clients, practitioners need to acquaint themselves with these new innovations. Based on the principal objective of a quality curriculum by Stabback [33], the process of such acquaintance should be embedded as part of the healthcare training curriculum to streamline the development of practitioner's competencies (knowledge, skills, values, and associated capabilities) that make them professionally productive. Such inclusion is required for the new wave of digital health. If careful steps are taken, it may be suitably included in the in-service training curriculum for healthcare practitioners. This continuing education is crucial for quality improvement in healthcare [40]. In addition, Kyabayinze [41] argue for refresher training of new staff to fill gaps created by the high rate of staff turnover. Professional healthcare training continues throughout the life of a healthcare practitioner. Digital health worker training programmes can complement professional healthcare training to produce a competent digital health workforce. To achieve this, we explore competencies that qualify healthcare workers and discuss the need to impart similar competencies to a digital health worker.

Healthcare Professional Competencies
This research used the CanMEDs framework [42], education model for equipping health professionals (with a focus on in-service personnel) with mHealth skills [8] and the European Digital Competence Framework [11,43] to discuss the professional competencies required for healthcare personnel / health worker.

The CanMEDS Framework
The CanMEDS framework [42] has been widely used across countries to guide training in the different branches of medical education including nursing education [4]. The framework in supplementary Figure 1. online, stipulates six integrated sets of roles to qualify as a medical expert, which covers the medical knowledge, clinical skills, and professional attitudes in the provision of patient-centered care [42]. The competencies of a medical expert draw from the competencies of the roles of a communicator, collaborator, manager, health advocate, scholar and professional. In we summarise the key competencies for the different roles of a medical expert.

Education Model for Equipping Health Professionals with mHealth Skills
Slovensky et al [8] proposed skill best learned through the application, feedback, and practice [8] and impacts the encounter in an examination room [14].
Technology literacy and usage skills are required for the digital health worker to use digital technologies and more so, know when to use technology to support healthcare. Rather than the technologies replacing human function in healthcare, it should complement humans such as in-patient consultation.
Deploying telehealth products and services requires a proper understanding of the technology in addition to using technology to manage multiple stakeholders, policies and organizational The health workers must understand the regulatory and compliance issues since they work with personal information regulated by the legislation. The organizational context such as the African region's health systems should have patient health information sharing guidelines that the digital health worker needs to learn and follow in addition to any other technology compliance regulations.
Understanding the telehealth business case is required for a digital health worker to appreciate both the clinical and business perspectives for better outcomes. A proper understanding of the business case can enable the digital health worker to recommend a viable case of digital health intervention for the organization.
The model focuses on professionals with an assumed clinical/professional body of knowledge and skills but lacking some or all of the aforementioned body of knowledge/skills to deploy and use mHealth. In this respect, we recommend the model's suitability to be applied to the training of in-service healthcare professionals especially in the African region where healthcare professionals lack the required ehealth competencies in addition to low levels of basic ICT skills.

The European Digital Competence Framework
The European digital competency framework [11,43] highlights the major areas of any digital competence, which we associate with the needed competency for a digital health worker including; Competency in information and data literacy enables the digital health worker to identify, locate and retrieve relevant health information in addition to storing and managing them in a digital format.
Communication and collaboration competency enables the use of ehealth technologies to interact, exchange information, engaging in citizenship, and collaborate netiquette and managing the digital identity of clients.
Handling of healthcare digital content includes creation and management. Data (clinical, referral, care, patient historical data among others) contributes a greater percentage to the digital content created in a healthcare The need for big data analytics (mining) was previously predicted as important skills for the future (the present) informaticians [44]. Therefore, the present and future digital health worker needs skills in big data analytics including an understanding of how to make improvement and integrate information and content into an existing body of healthcare knowledge while following applicable copyright and licenses (authorization) procedures.
A digital health worker with privacy and safety skills can appropriately enforce protection of digital devices, personal data, and privacy measures. It also covers health protection and wellbeing in addition to protecting the environment. European digital competency framework [11,43] to guide the training of the digital health worker's branch of medical education as per the CanMEDs framework [42] as recommended by [4] (see supplementary Figure 3 Online).
Furthermore, Mantas et al [27] recommend for developing countries to adapt the required knowledge, skills, and competencies with regard to the level of technology. In this regard, we consider competencies for a digital health worker and categorize them (see Association as highlighted by [44] to meet the expectations of a digital health worker.
These expectations include being a good communicator, a collaborator, a professional, an advocate and a manager; analyst of the big health data generated, protect the security and privacy of health data/information in their care and is able to fix minor failures in the technologies they are using. It should be realized that the required levels of competencies might vary according to the expectations of the work position. Some of the training may only be basic/foundational, intermediary, advanced or even specialized / expert [43].
Although Spiget et al [45] identified the content and the duration of the training programme as major considerations in effective training to increase technology literacy regarding the security of mHealth devices and technologies, we argue that any training programme's content and duration are key contributors (among others) to the success of such training. peer review documents and reports on ehealth/digital health human resource capacity needs, digital competency, and health worker training from WHO and regional governments like the European Union, East African community among others; 13 health/medical informatics training curriculum; and 08 national ehealth strategies.

Results And Discussion
As more digital technologies continue to diffuse into the healthcare systems, in-  Table 2). -Develop an ehealth education or training curriculum/program for va health workers.
-Implement health sector e-learning platform.
-Develop digital resources to enable offline learning for areas with li Internet access along with online learning.
Zambia -Lack of ICT skills in healthcare training programmes -Low levels of ehealth practitioners -Include ICT in the pre-service training curriculum, in-service, task shifting of ICT tasks -Integration of all existing eHealth curricula for modular and cadre-b training, e.g., implement changes to vocational and tertiary training programs for the increasing number of eHealth practitioners In order to bridge these human resource gaps, the African countries need to first develop a digital health worker competency framework and then re-organize their national health training curriculum to ensure a standardized / universal ehealth curriculum. Thereafter, the digital health worker can acquire the necessary skills and knowledge in the areas of basic IT, ehealth technology use, technical support and security measures needed to optimize the use of ehealth technologies. To achieve the objectives of technology to deliver healthcare, the interest may be on "how to use" ICT to deliver better healthcare; to conduct health promote, there may be need to understand "ways in which" ICT can be used as a leverage to promote health; and to monitor health, the focus may be on "ways to use" ehealth technologies as a media to monitor public health.
In order to attain the understanding of how to use, ways in which and ways to use, authors have identified competencies that the different professions may bring to the digital health (i.e., ehealth, mHealth, telehealth, electronic records, etc.) and may be instilled in the digital health worker including but not limited to basic IT literacy, communication skills, healthcare physician, management and development, IT guidance/support, range of DH technologies, information privacy and confidentiality, biomedical/health informatics, among others [4,9,47]. In a Delphi-study of competencies required for nursing telehealth to support nursing function, enhancing their ability to combine nursing experience into digital health.

Overview of digital health worker training programmes: assessment of required competencies
Following the revolutionizing effort to digitize healthcare across the globe, health workers adapt the use of enabling technologies in their provision of care. In recognition of the need for healthcare professionals to be digitally competent, the European countries have taken steps to provide the required training/learning in the use of ehealth technologies to health workers [10,43]. A review of how some of the existing DH curriculum/training programmes in the USA, UK, and African countries are geared towards developing the core DH competencies is summarised in Table 3. They can be categorised to develop competencies in bioinformatics, public health informatics, organizational informatics, social informatics, and clinical informatics.
(v) Although data handling has more courses, the reviewed programmes excluded content on block chain technology, which is one of the emerging technologies that ensure the integrity of digital data content. Furthermore, existing courses focus largely on data analytics than security and privacy, which is quite essential to health data. Security and privacy courses are completely missing in most of the programmes. Based on the gaps above, this study proposes a structure for the standard digital health worker-training curriculum for the African region.

Proposed Structure of the Standard DH Worker Curriculum for the African Region
The Digital Health (DH) curriculum for the African region should produce workers that satisfy personnel needs of the priority areas for ehealth highlighted in many of the African countries' ehealth strategies. However, the African region is characterized by multiple but  Table 4 and Table 5 respectively, are summaries for structures of the standard DH pre-service and inservice curricula for the African region. Although studies have suggested that digital health worker training is incorporated into the standardized medical training curriculum [4,10,50], others advocated for training at the workplace (i.e. in-service training) [10].
Both approaches provide a suitable training environment for pre-service trainees and inservice professionals respectively.
Whereas the in-service training curriculum in Table 5 is aimed to prepare digital health leaders in their work practices; the Pre-service training curriculum in Table 4 is based on a benchmark of the different types of DH worker curricula competencies across the globe, the digital health worker needs of the African region and core competencies required of any digital health worker. In fact, there are calls to fill knowledge and skills gaps for health workers using ICT to support healthcare [13,[17][18][19][20][21][22][23]. The competency framework is derived from the CanMEDS framework [42], the education model for equipping health professionals with mHealth skills [8], and the European digital competency framework 2.0 [11,43]. presents a summary of the proposed knowledge areas and competencies by levels of proficiencies that a DH Worker curriculum for the Africa region should have.  Regards the in-service training curriculum, it is guided by the recommendation of the Nigeria ehealth strategy that suggests the need for a nationally scaled health and ICT workforce education/training in addition to incorporating Health ICT into standardized curricula [18]. Table 5 presents a summary of the in-service training curricular for the African region. It is based on the DH leadership curriculum that was designed, executed and validated in Lesotho and assumes that health leaders at the strategic and tactical levels of the healthcare system require knowledge/skills in the use of digital technologies to support their strategic and tactical decision-making. In this curriculum, the ten modules as shown in Table 5  Module 10 deals with data use and analytics. This included how to use data and basic regulations governing data access and use. It also discusses related issues such as techniques for information needs assessment, principles of data harvesting and data visualization and information communication and a broad summary on data-related regulations and policies among others.

Conclusion
In this work, we reviewed the current state of the digital health worker curriculum across the globe with the aim to develop a standard DH training curriculum for the African region.
The study assessed various DH worker-training curricula across the globe in order to identify the digital health worker learning needs and required competencies for the African region. The review showed limited core competencies and lack of common curricula structure across existing digital health worker training programmes. There was also limited focus on the entire life span of the digital health ecosystem. We used relevant health worker training frameworks/models and digital competency frameworks to develop a competency framework for the DH worker curriculum. The assessment of existing curricula across the globe helped to establish the DH curriculum trends, and thus determine what is a recommended curriculum for the African region. We expect the DH curriculum to fill the digital health worker competency gaps that currently exist within the African region. Our future work points to the need to re-assess the key DH worker competencies and expected outcomes for the African region once the in-service curriculum have been implemented, and the evaluation to adopt the use of ehealth technologies in support of decision-making and management at strategic and tactical levels, and its success have been completed. Flow-chart showing the search strategy and inclusion/exclusion criteria