A Paradox of Readiness?: Diagnosing Strategic Implementation Gaps for Digital Mental Health in Lagos, Nigeria

Background Many low- and middle-income countries (LMICs) face a vast mental health treatment gap. Digital health offers scalable solutions, but successful implementation requires assessing health system readiness. This study developed and applied an integrated framework to assess this readiness in an urban LMIC.Methods In Lagos, Nigeria, our mixed methods study used an integrated framework combining systematic policy appraisal (adapted Appraisal of Guidelines for Research and Evaluation II) with granular ecosystem mapping of national repositories and local infrastructure.Results The assessment revealed a strategic implementation gap. Lagos State has strong policy readiness (score: 75.8/100) and a robust technology ecosystem with Nigeria's highest mobile density (nearly 26 million active lines). However, readiness was misaligned with implementation: a granular analysis of 45 national digital health projects found mental health constitutes only an estimated 2-3% of the portfolio's focus, with no dedicated platforms. This strategic oversight persists in new national digital health architecture.Conclusions Health system readiness is multidimensional and assessments focused on isolated components can be misleading. Our findings highlight a strategic gap between an enabling policy environment and actual implementation. The integrated framework offers a replicable model for LMIC policymakers to diagnose these gaps and guide evidence-based digital health investments to bridge the mental health treatment gap.