This study aims to examine the spatiotemporal characteristics of China’s total health expenditure structure from 2012 to 2020, and to observe the healthcare economic burden on the population in urban and rural areas across different provinces. The data were obtained from the China Health Statistics Yearbook, the China Statistical Yearbook, and publicly available statistical data from various provinces, autonomous regions, and municipalities from 2012 to 2020. Joinpoint regression was employed to investigate the temporal trends of the three financing sources of total health expenditure (THE) and the total expenditure on health as percentage of gross domestic product (GDP). The elasticity coefficient of health consumption was calculated to measure whether there is a correlation between the growth of the health sector and that of the national economy. Furthermore, the global and local Moran’s I indices were used to examine the spatial characteristics of THE and its three financing sources in China from 2012 to 2020. A descriptive analysis was conducted to explore the characteristics of the healthcare economic burden in China and its provinces. From 2012 to 2022, China’s THE increased from 2,811.9 billion yuan to 7,217.5 billion yuan. The total expenditure on health as percentage of GDP exhibited a consistent upward trajectory, rising from 5.41

Background:The implementation of digital health technology (DHT) has not reached its full potential. Research on the factors influencing the acceptance and use of DHTs in low- and middle-income countries (LMICs) is fragmented and sparse. This study aimed to identify the facilitators and barriers to DHT acceptance and use in healthcare consumers. Methods:The systematic review and meta-analysis were conducted using PubMed, Embase, and Web of Science from inception to July 1st, 2025. Facilitators and barriers to the acceptance and use of DHT were extracted, and a modified framework was developed based on the Unified Theory of Acceptance and Use of Technology. The strength of each pathway recorded in the framework was estimated through meta-analysis. Findings:A total of 78 publications were included in the systematic review, comprising 64 quantitative studies and 14 qualitative studies. Twelve dimensions were summarized. Factors demonstrating the highest positive associations with intentions to use DHTs included attitude (r = 0.5644; 95% CI: 0.4498, 0.6607), trust (r = 0.5239; 95% CI: 0.4243, 0.6109), performance expectancy (r = 0.4851; 95% CI: 0.4335, 0.5335), technology self-efficacy (r = 0.4430; 95% CI: 0.2504, 0.6018), facilitating conditions (r = 0.4345; 95% CI: 0.3526, 0.5098), effort expectancy (r = 0.4171; 95% CI: 0.3508, 0.4793), and habit (r = 0.4213; 95% CI: 0.1684, 0.6222). Social influence was also positively associated (r = 0.3582; 95% CI: 0.2823, 0.4297), as well as hedonic motivation (r = 0.3963, 95% CI: 0.2280, 0.5416). Price value showed a near-null, imprecise association (r = 0.0304; 95% CI: -0.1483, 0.2072). Perceived risk to patient privacy, patient security and telemedicine systems security, showed a small negative but imprecise association with intentions (r = -0.0402; 95% CI: -0.2169, 0.1391). Anxiety showed a non-significant negative association (r = -0.2071; 95% CI: -0.5108, 0.1426). Interpretation:The barriers identified in this analysis highlight the necessity of establishing and sustaining an integrated enabling environment as well as investing in digital health literacy to enhance healthcare consumers' self-efficacy. Findings of the study will facilitate the improvement of DHT implementation to address health concerns. Funding:This study was funded by Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0524500, 2024ZD0524501), National Natural Science Foundation of China (72274005 and 72304013), Beijing Nova Program (20230484284).

The World Health Organization (WHO) has shown systemic vulnerabilities in pandemic response, resource mobilization and allocation, and political coordination, prompting strong demands for reform from member states and the international community. Against the background of global health system restructuring, WHO reform should be carried out in four aspects: adapting to changes in global disease burden and demographic structure, conforming to the trend of multipolar health governance, building an agile and efficient modern governance framework, and improving sustainable financing mechanisms. This paper constructs a hierarchy-function coupling model integrating horizontal core functions and vertical organizational hierarchies (headquarters, regional offices, and country offices) to analyze the challenges of WHO in three core functions: global health leadership, norms and standards setting, and national health capacity-building and partnership promotion. It proposes targeted reform strategies at headquarters, regional, and national levels to streamline management, decentralize authority, promote the localization of norms and standards, and shift from vertical aid to sovereign empowerment. The reform of WHO is not only an institutional adjustment but also a strategic transformation to adapt to the paradigm shift of global health governance, aiming to enhance its leadership and build a more agile, equitable, and resilient global health architecture.

With the deepening of globalization and the growing severity of public health challenges,regional and cross-regional health cooperation has become crucial for safeguarding global health security and promoting sustainable development.The successful first summit among the Association of Southeast Asian Nations,China,and the Gulf Cooperation Council(ASEAN-China-GCC)on May 27,2025,has opened new prospects for trilateral cooperation across various fields,including health.This paper aims to analyze the strategic necessity and common foundations for strengthening health cooperation among China,ASEAN,and the GCC;interpret the profound implications of the inaugural trilateral summit on health collaboration;and systematically elaborate the core pillars for constructing new pathways in trilateral health cooperation.These pillars include joint prevention and control of infectious diseases,innovation in traditional medicine,digital health connectivity,synergy in the pharmaceutical industry,and resilience building of health systems.The findings indicate that,given its high social recognition,direct benefits to people's livelihoods,and close ties with economic development,health and pharmaceutical cooperation possesses a solid foundation and significant potential to become a core area of future collaboration among ASEAN,China,and the GCC.Furthermore,this study proposes policy recommendations for deepening trilateral health cooperation and highlights its potential positive role in global and cross-regional health governance.

Southeast Asia's regional health governance has evolved into a dense but weakly integrated system of overlapping institutions. This Health Policy paper maps the regional health governance of the Association of Southeast Asian Nations (ASEAN) as an evolving health regime complex, tracing the historical origins of regional health governance to the early 20th century and examining developments from 1980 to 2024. The study also identifies two structural features: functional specialisation along with persistent fragmentation and structural asymmetry, in which external actors dominate technical and agenda-setting roles while ASEAN retains coordination authority. Although recent reforms under the ASEAN Post-2015 Health Development Agenda have improved institutional alignment, system-wide coherence remains poor. Strengthening regional health governance will require institutional rationalisation to reduce duplication and strengthen underdeveloped functions, alongside a rebalancing of external engagement to restore regional ownership of policy priorities. The analytical approach developed in this Health Policy paper offers a transferable framework for other regions facing institutional proliferation. Policy efforts should shift from expanding arrangements towards managing complexity through coordination, functional differentiation, and clearer authority structures.

Background:Mental and behavioural disorders account for a large and growing share of the global disease burden, yet evidence on hazard-specific mental health risks and adaptation remains limited. We aimed to systematically evaluate disease-specific hospitalization risks and attributable burdens following multiple climate hazards in China, and examined whether socioeconomic conditions, demographic change, and historical hazard experience modified these risks. Methods:We conducted a retrospective observational study in 955 counties in China (2016-2023) using 392,924 daily disease-specific hospitalizations for mental and behavioural disorders from the Chinese Multiple County (CMC) Hospital Network. Storm, flood, and tropical cyclone events were linked to hospitalizations, and propensity score matching aided difference-in-differences (PSM-DID) models were used to estimate post-hazard excess relative risks across eight diagnostic categories. We then estimated hazard-attributable mental health hospitalizations and used counterfactual decomposition analysis to quantify the contribution of population aging and growth to hazard-attributable burden. Findings:Schizophrenia and delusion, mood disorders, and stress-related disorders showed stronger associations with climate hazards. Floods were associated with broader and longer-lasting increases in mental health hospitalizations, with elevated admissions persisting for 6-8 weeks after events. Averaged across 2016-2023, storms, floods, and tropical cyclones collectively generated approximately 117,717 (93,667, 147,158) additional mental and behavioural hospitalizations per year in China, 41.05% of which occurred in children, adolescents, and older adults. Population aging and growth accounted for 1.20-5.81% of hazard-attributable hospitalizations, depending on hazard type. Socioeconomically developed counties (quartile 4) experienced 16.18-24.96% lower hazard-attributable hospitalization risks than less developed counties (quartiles 1-3). Counties with the highest historical hazard frequency (quartile 4) showed 11.30-14.29% lower impacts from storms and tropical cyclones than counties with lower historical frequency (quartiles 1-3), whereas no such adaptive advantage was observed for floods. This adaptation observation was more pronounced in socioeconomically developed settings. Interpretation:Storms, floods, and tropical cyclones imposed substantial and inequitably distributed mental health burdens. Climate adaptation policies should prioritize vulnerable populations and less developed regions, leveraging both socioeconomic development and hazard preparedness to promote mental health equity and sustainability under escalating climate threats. Funding:National Natural Science Foundation of China, National Key Research & Development Program of Ministry of Science and Technology of China, Beijing Municipal Ecology and Environment Bureau.

Background: The misalignment between cancer burden and drug innovation poses significant challenges for global health. However, the global scope, temporal trends, and underlying factors contributing to this mismatch remain underexplored. We aim to evaluate the extent, trends, and driving forces behind the disparity between early drug development and cancer burden. Methods: This retrospective cohort study encompasses a total of 9473 early phase cancer drug trials from 1990 to 2023. Concentration curves and concentration indices (CIs) were employed to measure and track the mismatch over time. Residual analysis derived from a regression model identified cancers that may be either overlooked or overly focused upon. Decomposition of CIs was applied to ascertain the contributors to this mismatch and its evolution. Results: The CI between early drug development and cancer burden exhibited an upward trend over time, rising from 0.105 (95 % CI: 0.015 to 0.225) in the 1990s to 0.208 (95 % CI: 0.092 to 0.326) in the 2020s. Early drug development activities had disproportionately favored high-burden cancers. Demandside factors, such as disease burden (average contribution: 53.35 %) and market size (average contribution: 25.16 %), were the primary drivers of both the mismatch and its growth. Conclusions: The primary drivers of early drug development are medical and market demands, which lead to disproportionate focus on more prevalent or commercially attractive cancers. To address these disparities, targeted initiatives and policy reforms are necessary to ensure that drug development aligns more closely with global health needs, especially for cancers that receive insufficient attention. (c) 2025 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Colonial legacies in global health have entrenched structural inequities through unequal resource distribution, Western epistemic dominance, and the marginalization of Global South voices. Although implementation science aims to close the evidence–practice gap, its dominant frameworks often reinforce these hierarchies rather than dismantle them. Current approaches insufficiently consider communities’ positionality within global power structures, emphasize provider-level factors over social determinants, and overlook colonial histories and epistemic hierarchies. To advance decolonization, we propose a community-centred and equity-oriented recalibration of established implementation science frameworks. Specifically, CREAIM is presented as an adaptation of the RE-AIM framework, adding “Community” as a cross-cutting foundation that contextualizes Reach, Effectiveness, Adoption, Implementation, and Maintenance through explicit reflection on power, agency, and justice. In parallel, a decolonial recalibration of CFIR emphasizes political economy analysis, locally led adaptation, equitable resource control, and co-created implementation processes. Together, these adaptations reposition implementation science from a technical instrument for intervention delivery into a vehicle for structural change. Embedding decolonial principles within implementation frameworks can reorient the field toward community leadership, epistemic justice, and sustainable global health equity.

BACKGROUND:Food security systems are central to nutritional health and Sustainable Development Goal 2 (SDG 2), yet existing assessments have paid limited attention to cross-dimensional coordination within food security systems. This study assessed both system performance and coordination in low- and middle-income countries (LMICs) during 2019-2021. METHODS:Based on a multidimensional 25-indicator framework, the entropy-weighted Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) approach was used to evaluate system performance. Spearman's rank correlation and Bland-Altman agreement analyses against the SDG 2 Index and the Under-Five Mortality Rate (U5MR) were used to examine the validity. The coupling coordination degree (CCD) model was used to assess coordination across the four dimensions of food security: availability, access, utilization, and stability. RESULTS:Among all included LMICs, composite scores ranged from 0.103 to 0.698. Regionally, Europe and Central Asia showed the strongest overall performance (mean = 0.54), whereas Sub-Saharan Africa exhibited the lowest levels (mean = 0.27). The dimensions of access and stability were identified as the principal global bottlenecks of overall food security system development. The proposed index correlated positively with the SDG 2 Index (R = 0.662, p < 0.001) and inversely with the U5MR (R = -0.769, p < 0.001). The coupling degrees were consistently high but exceeded coordination levels across regions, indicating that strong interdependence among dimensions did not necessarily translate into balanced or synergistic system development. CONCLUSIONS:Food security systems in LMICs are constrained by weaknesses in the access and stability dimensions, as well as by insufficient cross-dimensional coordination. Strengthening them requires integrated, cross-sectoral strategies that enhance both system performance and interdimensional coordination.

Background Early-onset cancer has become a global public health challenge. Population-based evidence on incidence patterns at the subtype level remains limited. We aimed to estimate incidence patterns, temporal trends, and socioeconomic associations of early-onset cancers by subtype. Methods We used population-based registry data from Cancer Incidence in Five Continents Volume XII (2013-2017), CI5 Plus, and GLOBOCAN 2022. Subtypes were classified by ICD-O-3 morphology and topography codes, and unspecified cases were proportionally redistributed. We estimated case numbers and age-standardized incidence rates (ASR, per 100,000 population) for global, regional, and national levels. Temporal trends were summarized by average annual percentage change (AAPC). Multivariable linear regression examined associations between subtype-specific ASRs and national indicators. Results In 2022, an estimated 3,156,404 early-onset cancer cases occurred globally (female ASR 100.7 per 100,000 population, male ASR 54.4 per 100,000 population). Female breast cancer had the highest burden (668,417 cases; ASR 32.7 per 100,000 population), followed by thyroid cancer (412,628; ASR 9.9 per 100,000 population) and cervix uteri cancer (255,218; ASR 12.5 per 100,000 population). Among subtypes, papillary carcinoma comprised 89.76% of thyroid cancers, with the highest regional ASR in Eastern Asia (29.1 per 100,000 population) and China contributing 62.5% of global cases. Squamous cell carcinoma represented 68.7% of cervical cancers. Hepatocellular carcinoma was the main subtype of early-onset liver and intrahepatic bile duct cancer, accounting for 50.39% of incident cases (ASR 3.49 per 100,000 population in males; 0.84 in females). From 2005–2017, the ASR of papillary thyroid carcinoma increased in 36 countries (highest in China, AAPC, 23.39 [95% CI: 20.87, 25.97]), while the ASR of cervical squamous cell carcinoma decreased in ten countries. Healthcare Access and Quality Index was positively associated with the ASR of female breast cancer, papillary thyroid carcinoma, and rectal cancer, but negatively associated with the ASR of cervical squamous cell carcinoma and cervical adenocarcinoma. Conclusions Early-onset cancers show pronounced heterogeneity by subtype, sex, and region. The predominance of female breast cancer, papillary thyroid carcinoma, and cervical squamous cell carcinoma highlights the need for subtype- and age-specific control strategies. Male-predominant subtypes, including hepatocellular carcinoma and lung cancers, also warrant attention. Strengthening subtype-based surveillance and health system capacity is essential for effective early-onset cancer control.

INTRODUCTION:Despite international efforts to address women's long-term health and well-being, significant gaps in sexual and reproductive health (SRH) services and non-communicable diseases (NCDs) prevention remain, particularly in low-and-middle-income countries (LMICs). METHODS:We analysed data from 726 278 women aged 15-49 from six national surveys (2017-2021, Benin, Cameroon, Gabon, India, Madagascar and Mauritania) on unmet needs for NCD prevention (blood pressure, glucose, cervical cancer screening) and SRH services (contraception, antenatal, postnatal care). Unmet needs prevalence was calculated as the percentage of participants with specific unmet needs and estimated across demographics and socioeconomic groups using multivariable logistic regression models. RESULTS:Unmet needs were strikingly high for NCD prevention: 36.6% for blood pressure, 70.0% for blood glucose and 98.5% for cervical cancer screening. In contrast, unmet needs for contraception, antenatal care and postnatal care were relatively lower: 7.5%, 14.5% and 14.5%, respectively. Significant variations were observed across countries. India had the lowest unmet needs for SRH services: 6.7% for contraception, 13.1% for antenatal care and 13.1% for postnatal care. Gabon had lower unmet needs for prenatal (16.8%) and postnatal care (14.8%) compared with other African countries and the lowest unmet need for cervical screening at 84.7% (95% confidential interval 83.1% to 86.2%), over 10 percentage points lower than others. Furthermore, socioeconomic factors like higher education, better economic status, healthcare access, insurance and internet use significantly lowered unmet needs, especially for antenatal and postnatal care. Employed women had higher unmet needs for antenatal (35.7%) and postnatal (37.3%) care than unemployed women (28.1%, 27.8%) but lower for NCDs prevention (98.9%, 71.8%) under two definitions than unemployed women (99.3%, 79.2%). CONCLUSION:This study highlights the urgent need to address high unmet needs for NCD prevention among women in LMICs, particularly cervical cancer screening. Unmet SRH needs are also a major concern, given significant disparities across countries. Especially, governments should prioritise measures to focus on vulnerable groups.

Prior to the second Trump administration, the United States (US) had consistently maintained its position as the world's largest donor of development assistance for health (DAH) for a long time. However, the factors influencing US DAH remain poorly understood. A comprehensive analysis of the factors potentially determining US DAH allocation in recent decades could provide valuable insights for navigating the evolving global health financing landscape and informing future policy decisions. We analyzed how US DAH was allocated across recipient countries and how country-year allocation of US DAH was associated with a range of factors, covering disease burden, economic condition, diplomatic relationship, bilateral trade, and governance indicators. The study used data from Institute for Health Metrics and Evaluation and other sources covering 2000-2020, a period when data for most variables were available. In addition to our primary regression analysis, we conducted stratified analyses across time periods (2000-2015 vs. 2016-2020). US DAH was positively associated with burden of infectious diseases, maternal and neonatal conditions, and nutritional deficiencies, but was not significantly related to non-communicable diseases and injuries. Nursing and midwifery (per 10000) positively correlated with aid allocation, whereas other human resource variables showed no significant association with aid distribution. Diplomatic distance was negatively associated with US DAH, and trade level was positively associated with US DAH. Corruption was negatively associated with US DAH. The study reveals the complexity of the factors shaping US DAH, raising questions regarding the equity of its distribution. These findings underscore an opportunity for the global health community to shift towards better alignment of funding priorities with the specific need of developing countries, amid the uncertainty brought by the substantial policy shifts of the current US administration.

BACKGROUND:Health-system resilience serves as a key contributor in mitigating adverse health impacts during climate hazards. However, quantitative insights into resilience-associated health-care utilisation patterns and targeted adaptation policies remain scarce. We aimed to capture the spatiotemporal health impacts in disaster-exposed counties and their neighbouring counties in China during storms, floods, tropical cyclones, and blizzards or winter storms; understand the association between health-system resilience metrics and hazard-attributable hospitalisations; and develop evidence-based adaptation policies towards climate extremes. METHODS:In this retrospective, observational analysis of county-level aggregated hospitalisation data, we used a propensity score matching-difference-in-differences framework to assess the spatiotemporal changes of nine types of disease-specific hospitalisations in both disaster-exposed and neighbouring regions during storms, floods, tropical cyclones, and blizzards in China. We quantified the relative importance and health gains of health-system metrics during such hazards through random forest approach with interpretable partial dependence plots to derive evidence-based adaptation recommendations. FINDINGS:We included hospitalisation data from Jan 1, 2016 to Dec 31, 2023. In this period, 3241 county-hazard event combinations and 41 747 482 hospitalisations were recorded across 955 Chinese counties. The disaster-exposed regions experienced an initial decline in hospitalisation rates, followed by admission surges after disasters. For example, infectious disease admissions decreased by 11·92% (95% CI -10·53 to -13·31) during the flood-active period but increased by 7·68% (6·46-8·91) after 1-2 weeks of floods. Neighbouring zones were also affected through spillover effects, with infectious disease admissions increasing by 3·18% (1·76-4·61) after 1-2 weeks of the floods. Cardiovascular disease, injuries, infectious, respiratory, and mental disorders were more sensitive across all regions. Particularly for disaster-exposed counties, cardiovascular hospitalisations increased by 14·31% (7·34-21·29) during the tropical cyclone-active period. Notably, compared with low-resilience counties, high-resilience counties were associated with 19·48-30·03% smaller hazard-related relative changes in hospitalisation rates during the hazard-active period and 27·07-31·08% smaller hazard-related relative changes in hospitalisation rates in post-hazard periods. For instance, during the storm-active period, the increase in respiratory hospitalisations was 7·21% (0·67-13·75) in high-resilience counties versus 12·13% (5·20-19·05) in low-resilience counties. Health workforce (relative importance 14·58% during the hazard-active period and 13·80% during the post-hazard period) and service delivery (14·10% during the hazard-active period and 14·17% during the post-hazard period) were identified as key contributors of health-system resilience. Empirical synergistic effects were observed when combining interventions during the post-hazard period, with the combined effect of service delivery (individual contribution 8%) and workforce (individual contribution 4%) exceeding the sum of their individual contributions (16% reduction in cumulative excess admissions) by 33%. INTERPRETATION:Climate hazards are associated with substantial changes in hospitalisation rates in both disaster-exposed and neighbouring regions. Health-system resilience is essential in addressing disaster-health challenges. Targeted adaptation interventions should be context-appropriate and threshold-aware, thereby maximising the public health benefits relative to resilience-oriented investments in health systems. FUNDING:Gates Foundation and the National Natural Science Foundation of China.

China, once a malaria-endemic country, has developed a comprehensive set of extensive strategies and accumulated practical experience over 70 years of malaria elimination efforts. On June 30, 2021, China was officially certified by the World Health Organization as malaria-free. Substantial research has already summarized China’s malaria control experience from a technical standpoint. This study aims to examine China’s malaria elimination practices from a new perspective of the health system and social development. Semi-structured interviews were conducted with key informants, including national malaria program managers, renowned scholars, and technical personnels from China, international organizations, and high-burden countries in Africa. Interviews were conducted from July 2023 to July 2025, and data were analyzed using the thematic framework method. A total of 42 participants responded to the interview, and 7 key components from social development was proposed. The thematic analysis identified key factors influencing the achievement of malaria elimination in China. Specifically, 57.14

Background:AI is rapidly transforming health systems, expanding from diagnostic imaging and predictive analytics to large language model-enabled clinical decision support. However, significant governance challenges persist, including algorithmic bias, privacy risks, limited transparency, and inequities in access. Despite the proliferation of national AI strategies, global governance remains fragmented, and systematic evidence on how national policies address ethical, regulatory, and implementation requirements is limited. No comprehensive synthesis currently maps national governance approaches against established frameworks or documents or accounts for implementation realities across diverse contexts. Objective:This scoping review aims to (1) characterize national approaches to AI governance in health, (2) assess alignment with established governance frameworks, and (3) identify implementation challenges and enabling factors. Methods:Following the Arksey and O'Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews) guidelines, we searched 6 databases and key gray literature repositories for sources published between January 2015 and April 2025. Eligible documents include national-level policies, empirical analyses, and official reports on AI governance in health. Data extraction is guided by a framework integrating World Health Organization AI ethics and governance guidance and the strategic priorities of the Global Initiative on AI for Health across 4 dimensions-ethics, regulation, implementation, and operations. Descriptive mapping, governance principle coding, thematic synthesis, and subgroup analyses will be conducted. Results:Our systematic search across 6 electronic databases identified 21,278 records: 3409 (16.0%) from PubMed, 5691 (26.7%) from Embase, 3661 (17.2%) from Web of Science, 334 (1.6%) from Latin American and Caribbean Health Sciences Literature, 568 (2.7%) from the China National Knowledge Infrastructure, and 7615 (35.8%) from the WanFang Database. After removing 968 (4.6%) duplicates in EndNote (version V.21; Clarivate), 2 researchers independently screened 20,310 (95.5%) titles and abstracts. From 21,278 database records and 972 gray literature items, 149 (0.7%) sources met the inclusion criteria. Quality assessment and full data extraction will be finalized by June 2026. Conclusions:This review protocol addresses a critical evidence gap by providing a comprehensive mapping of national AI governance policies in health against an established governance framework. The planned review will inform evidence-based, equitable, and context-specific governance frameworks essential for safe and trustworthy AI integration in health systems.

In this study, we review the application of digital technologies for health in China, examining the structure of its digital health governance. China's digital health governance is of political commitment, cross-sectoral collaboration, and a comprehensive, all-encompassing approach that engages the entire society. However, the fragmentation of data remains a fundamental obstacle. The whole-of-society approach offers a valuable example for other low- and middle-income countries in promoting digital transformation.