## 4 Discussion
The COVID-19 pandemic has highlighted the opportunity digital health offers health systems with many countries accelerating the roll-out of technology-enabled applications--including telemedicine, direct and indirect client communication, and e-learning--to overcome access and delivery issues that have arisen. Recent infrastructure improvements across the Pacific, including the opportunity for high-speed internet due to the laying of submarine fiberoptic cables, and increasing internet connectivity (primarily due to increasing smartphone ownership) have created opportunities to integrate and capitalize on digital health for the delivery of PHC in the islands. Early examples of digital health adoption in the Pacific Islands include the development of an electronic health information system, and the gradual transition from paper to electronic records in the Solomon Islands [49], use of internet-connected tablets for data collection, information sharing, and clinical decision support in PNG [50], and installation of very small aperture terminals that allow health facilities across the islands of Tuvalu to be 'digitally linked' through satellite communication (personal communication, [PERSON], 18 November 2021). These examples, as well as an increased attention to building information technology and data analysis skills through initiatives such as the Strengthening Health Interventions in the Pacific (SHIP) initiative and the field epidemiology training programs, showcase the opportunity that prudent adoption of digital technology for health service delivery offers efforts to achieve UHC in resource constrained and challenging contexts. The Public Health Information Network (PHIN) provides direction for adopting digital technologies for health in the Pacific. While advocates for digital health, the PHIN note that the adoption of technology is complex and should not be seen as a panacea for UHC challenges. Health authorities must weigh up the costs in developing and maintaining digital health applications with the long-term savings and improvements on offer. To ensure value is achieved, the process of digital adoption should be framed as an integral part of health sector reform and not a series of discrete program-specific interventions. This has been demonstrated by the staged adoption of digital health information systems in many PICTs and integration of mHealth approaches to specific surveillance programs, such as the Pacific Syndromic Surveillance System. Our review is not without limitation. Most notably, the review's scope was limited to analyzing the final reports from senior health meeting fora and peer-reviewed literature in which UHC was discussed. Furthermore, our data extraction process relied on there being a combination of terms related to UHC and the Pacific islands which--while broad--likely missed discussion relevant to UHC but not specifically identified as such (e.g., leadership or health sector reform) or for which PICT delegate contributions was not recorded. While our search strategy included the French language names of the three French PICTs, we excluded articles not available in English and, therefore, may have overlooked some literature. Our