Scaling digital health in low- and middle-income countries: lessons from Malaysia's cross-sector capacity-building approach.

The COVID-19 pandemic catalysed the development of digital health interventions across the globe, including low- and middle-income countries (LMICs) such as Malaysia. However, moving from pockets of innovation to sustainable implementation at scale remains a major challenge. This viewpoint presents insights from a digital health training programme using a multi-stakeholder engagement series convened by the National Institute for Health and Care Research Global Health Research Unit on Respiratory Health (RESPIRE) during the pandemic. Through co-designed workshops involving policymakers, healthcare providers, small and medium-sized enterprises, and academic researchers, participants examined systemic barriers to scaling digital health innovations in Malaysia, including issues with infrastructure, regulation, and workforce readiness. We used a home-based pulmonary rehabilitation initiative as a case study to explore these dynamics in practice. Broader lessons include the importance of ecosystem-building, capacity development, regulatory clarity, and inclusive design. Our findings offer transferable insights for strengthening digital health systems in LMICs.