Nigel Cory Philip Stevens
KEY TAKEAWAYS
Information and communications technologies can improve the quality and delivery of health care services around the world—particularly in low- and middle-income countries that face staffing and other physical resource constraints.
ICT-driven “digital health” products and services leverage technologies such as electronic health records, mobile computing, AI, big data, and genomics to deliver more personalized and coordinated care, and better, faster treatments at lower cost.
Many digital health products are already proven, available, and adaptable to all countries, yet a global framework that marshals resources, expertise, and strategies to realize the true potential of digital health is only at a nascent stage.
Policymakers are struggling to adapt technology to their domestic health systems, while international bodies are only just starting to develop the principles, practices, and tools to help late adaptors and developing nations catch up.
Domestic technology standards and data protections risk fragmenting away from global interoperability, preventing health companies and researchers from leveraging health data and technologies to provide new and better services internationally.
A global digital health framework requires low- and middle-income countries to work with international partners on key foundations: national strategies, skills, ICT infrastructure, and governance that balances innovation and data protection.
OVERVIEW
Digital health—the use of information and communications technology (ICT) to provide and improve health services—holds transformational potential for health care around the world. Many digital health products are already proven, readily available, and adaptable to all kinds of countries. Digital health can help low and middle-income countries (LMICs), in particular, overcome traditional barriers to better health care, especially staffing and other physical resource constraints. Digital technologies are showing their potential during the current coronavirus crisis by facilitating collaboration between health-care researchers and reducing the need for in-person care. While health data and digital technologies are not a silver bullet to COVID-19 and other health issues, they will be crucial to improving overall health outcomes in countries around the world. LMICs need to work with international partners, such as the World Health Organization (WHO) and development banks, to marshal the resources, expertise, and strategies to help them realize the true potential of digital health.
COVID-19 underlines the importance of international cooperation and collaboration to global health.
A global digital health framework is only at a nascent stage. Understandably, policymakers in all countries are first dealing with the considerable challenge of adapting technology to their own domestic health frameworks. And international organizations are only just starting to develop the common principles, best practices, and tools to help late adaptors and developing countries catch up with leading countries. The risk is domestic frameworks will fragment away from international standards, thereby preventing health companies and research organizations from leveraging health data and digital technologies in order to provide new and better services across different countries. COVID-19 has underlined the importance of international cooperation and collaboration to global health.
LMIC policymakers and their international health and development partners must focus on foundational issues—namely, a national digital health strategy, digital skills, ICT infrastructure, and data governance—to build effective domestic and global digital health frameworks. This report aims to support these policymakers in doing this. The first section outlines the promise of digital health (the appendix includes case studies from several regions that illustrate how this is working in practice). The paper then gives an overview of core enablers for digital health, including an analysis of the importance of ICT infrastructure and digital skills, and domestic and international data governance. The paper then reviews the growing focus on digital health by multilateral organizations and other nongovernmental organizations (NGOs).
The paper concludes with general findings and recommendations, summarized below:
Countries should develop holistic national digital health strategies. There is wide disparity in progress in this area among LMICs, with several important countries having no formal national plans. Digital technologies will not achieve anywhere near their full potential absent a plan that provides the necessary resources, coordination, cooperation, and leadership. These plans need to be holistic, in part, as each country’s situation will be somewhat different, including the considerable complexity that comes from integrating digital technologies with legacy health systems.
Several multilateral organizations and private-sector initiatives have elevated the focus on digital health at the international level, such as the WHO-backed global digital health strategy. LMICs should work with WHO and other actors to mobilize the resources and expertise to help develop and implement—or improve—their own digital health strategies.1
Training and education to use digital technologies is critical, but few LMICs have integrated digital skills into their health-workforce training. Regional and multilateral health organizations, donors, and other stakeholders should prioritize efforts to help LMICs address the most pressing skills gaps.
There are particularly acute gaps in ICT infrastructure in LMICs, which are home to most of the people that remain disconnected from the Internet. Poor ICT infrastructure severely limits the potential of digital health. Regional and multilateral development agencies, and other donors, should fill these gaps to cover private-sector shortfalls—for example, with regard to wireless mobile coverage in rural areas.
LMICs need to enact a data governance framework that balances data privacy and protection with innovation. The generation, protection, use, sharing, and international transfer of high-quality data is fundamental to an effective and innovative digital health program. An overly restrictive data governance framework will limit the potential of digital health technologies.
Policymakers need to build interoperability into their frameworks from the start, as many of the benefits of digital health technologies require cross-border transfers of data. This is critical, as many firms and research organizations involved in digital health rely on the Internet, the free flow of data, and centralized IT facilities to easily, cheaply, and reliably access data, patients, and health-care providers around the world. The emergence of a meaningful, integrated global digital health framework will depend on national governments enabling cross-border flows of data.
THE PROMISE OF DIGITAL HEALTH
Simply put, “digital health” refers to the use of digital technologies for health. It is an umbrella term that includes electronic health (eHealth), mobile health (mHealth) and emerging areas such as the use of artificial intelligence (AI), big data, and genomics.2 As populations age and noncommunicable disease burdens rise, there will be even greater pressure on health-care systems, underscoring the need to deploy current and new technological solutions.3 WHO has stated that “universal health coverage cannot be achieved without the support of eHealth.”4
Digital health holds considerable promise.5 It can make health information, care, and diagnosis more accessible, such as through telemedicine.6 This is especially true for people in hard-to-reach places, given the proliferation of low-cost smart phones and medical devices. Digital health can enable health-care providers and services to become more efficient and of higher quality. In particular, the enhanced use of health data offers the prospect of more personalized and coordinated care, and better, faster treatment at a lower cost.7 AI has advanced to the stage where it can mitigate shortages of specialists, providing reliable diagnosis and lower-cost services in fields ranging from tuberculosis to diabetic retinopathy. Similarly, AI can use the greater availability of health data to identify and prevent emerging health issues, such as epidemics. When combined with software, better, richer datasets allow health system managers to identify, plan, and allocate resources more efficiently. Digital health can also accelerate the drug development process.8 For example, AI can integrate and analyze a broader range of “real-world” data from mobile and wearable technologies and social media, and combine it with traditional lab and clinical data.9
Many of these benefits are already evident, and hold particular promise for LMICs given they can be deployed at significantly lower cost than traditional brick-and-mortar health services. Indicative of this, digital health technologies are currently undergoing a surge in uptake. Globally, 44 percent of mobile users have seen a medical professional for diagnosis or treatment via their mobile device.10 According to IQVIA (a U.S. health technology firm), the number of mHealth products and services has doubled in the past 5 years in LMICs, and there are now over 165,000 mobile applications for health services.11 In fact, mobile health services are more popular in LMICs, with 59 percent of patients in LMICs using mHealth applications and services, compared with 35 percent in high-income countries.12
As populations age and noncommunicable disease burdens rise, there will be even greater pressure on health-care systems, underscoring the need to deploy current and new technological solutions.
There is potential for digital health to benefit the wider economy, not only through significant cost savings but also via increases in productivity as patients receive faster, more accurate diagnoses and treatment.13 For example, Canada measured the cost savings generated by its digital health investments and reported an aggregate saving of US$11.2 billion since 2007.14 Many studies anticipate considerable cost savings from digital health, such as a 2013 GSMA study that estimated mHealth technology could result in $400 billion worth of cost savings over a 5-year period in high-income countries.15 A review of 14 evaluations of digital health interventions across a range of high-income countries found them all to be cost effective and an improvement over existing interventions.16
THE BUILDING BLOCKS FOR DIGITAL HEALTH
Despite the potential benefits of digital health, few nations have put in place the policies, programs, or strategies needed to take full advantage of it. The 2019 Global Digital Health Index assesses the state of preparedness and adoption of digital health in 22 countries of varying stages of economic development (see figure 1).17 It also measures the readiness of the wider health system to successfully adopt and deploy digital health interventions. The Index is benchmarked according to components of the WHO and International Telecommunications Union (ITU) eHealth Strategy Framework, which uses 19 indicators in 7 policy areas: leadership and governance; strategy and investment; services and applications; standards and interoperability; infrastructure; legislation, policy and compliance; and workforce.
The Index notes that while many countries have national digital health strategies, most lack national digital health architectures, health information exchanges, and data standards, all of which undermine the potential benefits of digital technologies.18 This section explores some of the core enablers of the Index—education and workforce training, infrastructure, and governance—in explaining what makes an effective digital health strategy.
National Digital Health Strategies
Developing a national digital health strategy is a critical first step for identifying, prioritizing, and addressing barriers and shortfalls in key enablers for digital health. A comprehensive local assessment is crucial to developing a long-term plan, coordinating with development and other partners, and mobilizing the political support necessary for resourcing and implementation.20
An effective digital health strategy requires leadership and buy-in from federal (and regional) governments, supported by representatives from all relevant government agencies and nongovernment stakeholders, including the private sector, nonprofit organizations, and overseas development agencies. A whole-of-government approach is needed as health agencies cannot operate in a silo disconnected from ICT, economic, science, health, and innovation agencies, as well as data privacy and protection agencies.
Proper financial support is essential, especially given new programs and technologies will be layered on top of existing IT systems and organizational structures, which often means significant up-front costs. This also highlights the need for governments, development partners, and other stakeholders to invest in coordinated plans rather than ad hoc projects and policies. Unfortunately, many LMICs have already succumbed to the latter approach and face a proliferation of uncoordinated digital health projects, which is more likely to lead to unsustainable and ineffective uses of digital health tools.21
While many countries have recognized the importance of national digital health strategies, there are significant gaps in many regions around the world. WHO’s 2015 survey of eHealth policies revealed that 72 countries (58 percent) of the 125 member countries (that responded) have defined national digital health strategies and corresponding plans to implement them (see figure 2).22 Notable exceptions include Brazil, India, Indonesia, and Mexico. The Global Digital Health Index observes that Malaysia, the Philippines, and Jordan are well advanced in this area, with fully costed national plans currently being implemented.23 Malaysia in particular is lauded for its integrated digital health strategy, which has been ongoing for 15 years and is linked to the national 5-year rolling Malaysia Plans for social and economic transformation.
Thankfully, international agencies are working to help countries that have yet to develop a national strategy. For example, WHO’s International Telecommunications Union (ITU) National E-Health Strategy Toolkit aims to assist member states in the development and implementation of digital health policies and strategies, and subsequent integration with their national health-care systems. The toolkit is an expert, practical guide that provides a solid foundation and method for developing and implementing a national digital health vision, action plan, and monitoring framework.
People Need the Right Skills to Leverage Digital Health
Using data and digital technologies for better health outcomes is contingent on a nation having a digitally competent workforce. The lack of digital skills is obviously not unique to the health-care sector in LMICs, but given the impact on people’s well-being, requires special attention. Skills shortages directly undermine the use of digital health interventions.25
Unsurprisingly, in many LMICs, there are basic digital skills shortages across both the health workforce and patients, especially in rural and remote areas. According to the 2019 Global Digital Health Index, the skills base among health-care professionals is generally low. Only 2 of the 22 countries surveyed by the Index include digital health in training for health-care professionals, with less-significant gaps among physicians, and more-significant gaps in training for nurses and community health workers. Skills gaps are particularly pronounced in WHO’s Eastern Mediterranean region, with Southeast Asia having the strongest base of skills to enable digital health.26
No comments:
Post a Comment