Empowering Digital Health: USAID’s Strategic Path Forward to 2030

Emphasize person-centered care: USAID highlights the importance of designing digital systems that prioritize person-centered care, enabling individuals and providers to manage health at the point of care through integrated health information. The goal of person-centered, point-of-care systems is to support decision-making, service delivery, and coordination of care that meets the needs of both patients and healthcare providers.

Shift data source for reporting: By investing in person-centered digital tools, USAID aims to derive reporting data from these systems, reducing the reporting burden on healthcare workers while enhancing data usability for global health funders and health system managers.

Establish standards for interoperability: USAID wants to require standards for all digital health investments, emphasizing standards implementation to ensure efficient data exchange and interoperability at scale–essential for a cohesive, national digital health architecture. Standards and identity systems enable integrated health services by supporting longitudinal records that follow patients across facilities over time, facilitating coordinated care through referrals and interoperability across different systems.

Invest in local advisory structures: Resources should be allocated towards local advisory boards focused on developing and adopting health sector data standards, which are crucial for building a sustainable environment that aligns with national digital health frameworks.

Direct investment in ministry-led digital health governance: USAID should deepen financial and technical support for country-led digital health governance by investing in ministries of health and governmental offices. Such investment is essential for a strong and long-lasting digital health environment.

Enable long-term sustainability and resilience: Effective governance allows countries to set a vision, prioritize investments, and ensure resilience and continuity of digital health systems during disruptions. It also creates opportunities for sustainable partnerships involving multiple funders, supports continuity of operations, and fosters market creation to sustain digital health initiatives beyond donor funding.

Promote inclusive and collaborative governance: Governance structures should include public and private stakeholders to promote equity, facilitate data sovereignty, and implement data sharing agreements. Such structures will help ensure appropriate data protection and encourage broad collaboration across sectors. USAID will also participate in these governance structures where appropriate, supporting cohesive governance.

Ensure robust data protection: USAID should require digital systems to implement strong data protection measures, such as encryption and secure storage, and to safeguard health data against cyber threats, especially in high-risk environments such as conflict zones.

Support compliance with local regulations: Resource allocation should ensure that funded digital systems comply with the legal, policy, and regulatory requirements of the jurisdictions where they operate. Funding for system maintenance should also be provided, potentially requiring budget adjustments.

Promote responsible data governance: USAID should support countries in developing and enforcing policies on data privacy, cybersecurity, and responsible data use, with additional safeguards for vulnerable populations. This includes harmonizing regulatory frameworks to guide safe, responsible applications of AI in the health sector.

Invest in local ecosystems: USAID should strengthen investments in local ecosystems, including the private sector, to support local partners as effective long-term collaborators with ministries of health, aligning with national digital health strategies. Local engagement can sustain a range of activities, from research to implementation support and software development, including the use of open code bases, thereby enhancing the effectiveness and sustainability of digital health solutions.

Enhance inclusive community engagement: Engaging local academic institutions, community-based organizations, and groups representing women and minority perspectives helps USAID better address the health needs of targeted populations. By doing so, USAID makes global programs more responsive and inclusive.

Build local capacity: Local partners can support cybersecurity, data management, and other capacity-building efforts, promoting sustainable development through open source tools and infrastructure that addresses the social determinants of health and enhances interoperability.

Support global collaboration and capacity building: USAID should continue to engage with global coalitions and networks that facilitate knowledge sharing, research, and capacity building. In doing so, USAID will have a robust pool of shared digital capabilities and a global digital health commons across technical fields.

Leverage open source and shared resources: The foundational role of open source software and shared digital tools in public service delivery should be acknowledged, while promoting their use as durable and adaptable resources within digital health ecosystems.

Contribute to evidence-based digital health advancements: Support research agendas that advance evidence-based practices in digital health, including emerging technologies like AI, ensuring that innovations are grounded in safe, responsible, and effective applications.

Smisha Agarwal: We’d love to hear your perspective on how digital health has evolved over the past decade. Also, from USAID’s perspective, how has this evolution impacted its strategy?

Adele Waugaman: Taking a step back, if we look at USAID’s digital health policy, we see self-reflection by USAID as one of the world’s largest global health funders and a major investor in digital health systems worldwide. We see USAID exploring the question: In our digital health investment approach, how can we move from silos to systems? How do we shift from focusing primarily on individual digital systems in specific health areas, to designing our investments to meet the needs of individual health program while strengthening the health system as a whole? How do we facilitate data exchange that enables integrated care across a patient’s life course, meeting diverse health needs over time and across geographies? 

This is a significant transformation. What makes me hopeful is the recent shift within the global health funding community toward systems-level thinking in health sector digital transformation. 

This shift is also evident in a growing number of countries that now have national digital health strategies, some at a mature stage of implementation. A number of these national plans demonstrate the potential for digitally-enabled integrated care delivery. These systems are being reimagined with the patient’s journey in mind.

Smisha Agarwal: The position paper emphasizes the need for person-centered care. From USAID’s perspective, why is this approach essential, and how do you see it impacting both patient care and the workflow of healthcare workers?

Adele Waugaman: One core challenge that the Digital Health Position Paper aims to address is that the global health infrastructure is primarily designed to support specific health areas—HIV, malaria, maternal and child health, and so on. This creates fragmentation and siloing, reflected in digital systems used by countries. We know this structure can complicate the effective delivery of health care, and we know that the burden of fragmentation often falls on healthcare workers who must enter the same data into multiple systems. This issue exists globally, not only in the countries where USAID operates.

By centering people in the design of digital systems, particularly point-of-care systems, we believe we can unlock the full potential of these technologies to improve both patient-provider interactions and the overall healthcare experience.

Smisha Agarwal: It’s clear that data from across health areas—like HIV or RMNCH—need to connect. The global funding environment often mirrors how countries operationalize health programs. Given this reality, where do you see a practical starting point for digitization to connect across these verticals? Digitization can’t fix a broken system—it can replicate it. So, where should we start to bridge these silos?

Adele Waugaman: I agree with you—digital transformation isn’t just about translating existing processes into digital systems. It’s an opportunity to reimagine those systems. If we view digital transformation as a chance to redefine the future of global health, it creates room to address inefficiencies and leverage new opportunities that aren’t possible with paper-based systems. We have guidance on building sustainable digital health architecture, along with necessary policies and regulatory environments. But I like the idea of creatively reimagining what’s possible through digital transformation.

Smisha Agarwal: USAID has led conversations on standards for integrated service delivery, which relates to person-centered care. Given the intangibility of standards, could you discuss the challenges you’ve encountered with implementing standards, considering factors like cost, training, technical capacity, and advocacy?

Adele Waugaman: They require new ways of thinking and technical skills, and there’s been a push to build technical capacity among funding organizations, host governments, and development partners. Still, there’s room for growth, especially in training digital health experts who can drive this work forward. There’s a solid appreciation in the global health sector for standards, but digital transformation creates continuing demand for evolution of these standards. For example, while standards like FHIR, ICD, and LOINC are widely adopted for health data exchange, recent advances in generative AI prompt us to think about how they may need to be adapted.

We also see the importance of standards during health emergencies—like Ebola or COVID-19—when rapid access to diverse data sources is essential. Without widely-used standards, we face repeated challenges in mobilizing effective responses during global health crises. So we see that standards are important in routine healthcare and especially in emergencies, where rapid access to diverse data sets are critical to enable a timely response.

Smisha Agarwal: You mentioned building technical capacity. Is this aspect embedded within the Position Paper as a priority for both global and in-country capacity for digitization? 

Adele Waugaman: In the Digital Health Position Paper, USAID discusses both how it can help countries build capacity for health sector digital transformation, as well as what USAID should do to build its own capacity. For USAID’s external work in support of countries, this includes strengthening governance of digital systems and data, such as through national-level policies, legislation, and regulation. At the close of the Position Paper, as with the Digital Health Vision that preceded it, there is also internal reflection. We recognize that USAID, like other major actors, needs to assess its current capacities and consider if they need further development to keep pace with digital transformation and the new opportunities it brings. USAID also acknowledges this need for internal capacity building in our multisectoral Digital Policy, 2024-2034.

Over the past five years, one of our efforts, led from USAID’s side by Merrick Schaefer, has been the co-creation of the WHO and ITU-led "Digital Health Planning National Systems" course. It has now trained over 1,000 people globally, including many Ministry of Health representatives and over 100 USAID staff. We’re constantly looking for ways to enhance capabilities, including by supporting  both internal and external communities of practice focused on peer knowledge exchange.

Smisha Agarwal: Could you share some experiences or lessons learned about working with local governments on digital health governance, and the challenges faced in countries where you work?

Adele Waugaman: From the start, when we developed the Digital Health Vision [published in 2020], we understood there’s no one-size-fits-all approach to supporting countries in their digital transformations. It’s essential to understand where each country currently stands. We use the WHO and ITU eHealth building blocks from 2012 as a structured approach to assess country digital health maturity, which has proven durable over time. The Global Digital Health Monitor is a maturity model we rely on to guide this process.

Each country’s journey presents unique opportunities and pathways, ideally supported by USAID – alongside other funders and development partners – and host country governments. For instance, we recently highlighted work in Kenya and Indonesia in a webinar launching the Digital Health Position Paper. In both countries, political will and enthusiasm have driven specific legislation enabling the establishment of new governance bodies to lead digital transformation. It's a complex process, particularly in the health sector, but in a few short years, we’ve seen significant progress—such as developing national data exchanges and prioritizing interoperability to support integrated, patient-centered ecosystems.

Smisha Agarwal: With the rapid growth of digital health, privacy and cybersecurity seem to be some of the biggest challenges ahead. How is USAID balancing data protection and privacy as digital programs expand, particularly in conflict areas?

Adele Waugaman: In health, the sensitivity of data is paramount, including in conflict environments, because it directly impacts well-being. This sector has had to carefully consider data collection, management, access, and longevity. Now, with advanced technologies, including AI, these questions are even more crucial. USAID’s Digital Health Position Paper—and our broader work—emphasizes governance, especially data governance, to ensure digital systems are secure and protect people’s privacy.

In conflict settings, data misuse risks are heightened, underscoring the importance of anticipating the needs of vulnerable populations. These considerations should always influence data collection, sharing, and use in digital systems, but especially in conflict-prone areas where the stakes are higher.

Smisha Agarwal: Could you share some challenges and experiences in developing this Position Paper? 

Adele Waugaman: When we began working on the Digital Health Position Paper, we had nearly five years of experience with its predecessor, the Digital Health Vision. My colleague, Amarynth Sichel, led us in gathering feedback from our USAID health officers around the world who manage large digital health programs. We asked them about their experiences in using this policy, namely did they find it actionable?  We received valuable feedback, which is reflected in the six practices recommended in the Position Paper.

The main themes of the Digital Health Vision—advancing a country's digital health capacity, strengthening national digital health policies and architecture, and focusing on global goods—remain relevant. However, we had the opportunity to incorporate user perspectives more directly this time, as well as to design with the needs of those ultimately tasked with implementing policy in mind.

Smisha Agarwal: What ideas do you see coming up for USAID, and what are your hopes more broadly?

Adele Waugaman: I feel we’re on a positive trajectory. The wild card now is the rapid evolution of AI, particularly generative AI. Even without established policies on responsible use, people are using these tools out of curiosity, and to explore how they might improve their work. This creates a tremendous opportunity, but also reinforces the need to think about how we create an enabling environment that supports optimal digital tool use for development outcomes and global health.

I’m excited that we have a solid framework for planning digital transformation at scale, looking beyond individual solutions to how they integrate into systems that add value. Advances in AI are broadening this opportunity space. Digital technology should serve the global health context by adding value. Beyond ensuring rights-based approaches to using novel digital tools, we need to gather evidence from these tools’ use. We also need to continuously assess how to strengthen the environments in which these tools are used to ensure they achieve the intended health outcomes.

Smisha Agarwal: I can see a similar evolution with AI as we had with digital health. We’ll start with small pilots and fragmented learning experiences to determine the infrastructure we need. Although there’s a push to build the foundation first, implementation often helps shape that foundation, and both are essential in parallel.

Adele Waugaman: Absolutely. I think openness to continual learning and adaptation is essential in digital health. Having both the courage to try new approaches and the humility to learn through experience is key to doing this well.