Maternal and child health (MCH) outcomes remain suboptimal in many low- and middle-income countries (LMICs), contributing to reduced national life expectancy. Telehealth has emerged as a potential solution to address these service delivery gaps, yet limited evidence exists on its impact in LMIC contexts. The present study draws motivation from the United Nations Sustainable Development Goals-(UNSDG-3), that highlights on good health and well-being. A comparative mixed-methods study was conducted across Nigeria, Kenya, India, and South Africa for the period 2015-2023. Quantitative analysis included maternal mortality ratio, under-five mortality, antenatal care coverage, skilled birth attendance, immunization rates, and life expectancy, alongside a composite Telehealth Readiness Index. Correlations between digital readiness and MCH outcomes were explored using Pearson coefficients. Also document analysis was guided by the Consolidated Framework for Implementation Research (CFIR), assessing policy strategies, infrastructure, workforce readiness, and cultural acceptability.

Substantial variation was observed in telehealth integration and MCH outcomes across countries. India and South Africa exhibited higher digital readiness scores (India: 61; South Africa: 69) and MCH performance indices (India: 77; South Africa: 82), alongside lower maternal mortality (India: 103; South Africa: 119 per 100,000). A strong inverse correlation (r = -0.97, 95% CI: -0.99 to -0.78, p = 0.030) was found between telehealth maturity and maternal mortality. In contrast, Nigeria and Kenya had lower readiness scores (Nigeria: 28; Kenya: 39) and faced implementation barriers such as weak infrastructure, low digital literacy, and fragmented policy execution.

Telehealth can enhance maternal and child health outcomes when implemented within supportive structural, policy, and sociocultural environments.