This commentary is dedicated to the memory of Diamantino de Jesus from the Universidade Nacional de Timor Loro-Sae who was an active member of the community of practice (CoP) until his untimely death on 8 September 2021.

Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

Objective: This study aimed to investigate how COVID-19 prevention policies influenced the COVID-19 incidence in men and women.Methods: We conducted a retrospective longitudinal study using the Swiss Federal Office of Public Health and the Spanish Ministry of Health surveillance data for February 2020–June 2021 to explore sex and age differences in COVID-19 cases and testing. The female-male incidence rate ratios (IRR) were estimated for each week of the pandemic. We complemented our analysis with qualitative information on relevant containment measures in each country.Results: In Switzerland and in Spain, there was an excess of cases in women of 20–59 years old and 80+. This excess of cases was significant during the waves of the pandemic in both countries. In Switzerland, the biggest difference was observed for the age group 20–29, reaching an excess of 94% of cases compared to men during the first wave of COVID-19 (March–May 2020). The excess of cases in women was greater in Spain than in Switzerland, where it reached 159% for women aged 20–29 during the first wave (March–June 2020). In both countries, the age groups 60–79 had a significant excess of cases in men during the pandemic.Conclusion: COVID-19 public health policies affect men and women in different ways. Our findings highlight the importance of gender-sensitive responses to address a public health crisis.