May 2024: Digital-In-Health–World Bank Report

Choose digital solutions that respond to people’s health needs and are evidence-based

Promoting digital solutions that are people-centered and evidence-based should be the primary goal. Involving stakeholders, particularly users, in the design process ensures these solutions address actual health needs effectively. Montenegro's transformation of its e-health system highlights the advantages of aligning digital investments with health system reforms, enhancing both efficiency and integration. Additionally, a comprehensive master plan is essential to prevent siloed systems and fragmentation, thereby maximizing the value of digital investments. The UK's approach shows that evidence standards specific to the purpose of digital solutions are critical for ensuring their safety and effectiveness. Regulatory frameworks need to adapt to accommodate innovations like AI, ensuring their ethical use and the protection of patient data. This comprehensive strategy ensures that digital health solutions provide measurable benefits and significantly improve healthcare systems globally.

Choose digital health solutions that improve access to, and increase the availability of, health care services among vulnerable and marginalized groups

The transformative power of digital health technologies in reducing disparities for underserved populations is undeniable. Telemedicine exemplifies this by connecting remote patients with specialists, thereby enhancing access to vital health services. To fully leverage this potential, addressing the digital divide is crucial. Adding translation services and culturally relevant content to digital platforms can greatly reduce language and cultural barriers. Furthermore, digital health tools offering health education and real-time management of chronic diseases are essential for marginalized communities. Tailoring these solutions to individual needs and backing them with robust data collection will lead to significant advancements in health equity and access in the future.

 Drive digital health action within and across sectors through strong country leadership

It is essential to highlight the role of robust national leadership in advancing digital health initiatives. Effective governance is necessary to establish the rights, standards, responsibilities, and risks related to digital health technologies and data usage. As digital health systems mature, governance must adapt to address disparities and improve health outcomes for vulnerable populations. Creating a comprehensive national digital health strategy, similar to the WHO Global Strategy on Digital Health, is crucial. These strategies should incorporate costing road maps and phased investments, as demonstrated by Tanzania's approach, to ensure well-coordinated and impactful digital health transformations. Engaging stakeholders actively and ensuring their co-ownership are critical for the successful implementation of these strategic plans and achieving significant health improvements.

Reinforce ethical standards and regulatory systems for equitable and trustworthy digital solutions

We need to emphasize the critical role of strong data governance and ethical standards in ensuring reliable digital health solutions. Enhancing health data governance, such as Finland's Act on Secondary Use of Health and Social Data, is vital for the safe and effective use of data. As AI technologies evolve, governance frameworks must rapidly adapt to prevent biases and misuse while ensuring equitable benefits. Initiatives like the European Health Data Space highlight the importance of cross-border data exchange in advancing research and patient care. Additionally, addressing cybersecurity threats is crucial for protecting health data and ensuring uninterrupted service. Combining innovation with rigorous safeguards is essential to fully realize the potential of digital health for everyone.

Connect facilities, services, information, and people, fill in health information gaps, and connect siloed health information systems

Ensuring connectivity and data integration is crucial for advancing digital health initiatives. The importance of digital connectivity is highlighted in Connect Humanity’s 2023 State of Digital Inequity Report, which shows how the lack of affordable and reliable connectivity can limit access to the digital economy and health services for vulnerable populations. With 50 to 75 percent of health facilities lacking sufficient connectivity, providing meaningful access is essential to reap health system improvements through digital health.

Bridging health information gaps and integrating disparate systems is vital for developing health-focused digital public infrastructure (DPI). India’s Ayushman Bharat Digital Health Mission illustrates this well, having generated 442 million unique identifiers (ABHA numbers) and linked 293 million patient health records, creating a more efficient health data ecosystem.

Moving from paper to digital health records is key to enhancing efficiency and data quality. According to Jousset et al. (2023), going paperless could achieve approximately 30 percent efficiency gains for health systems. Additionally, integrating health information systems (HISs) to ensure interoperability and standardization, as seen in Rwanda and Tanzania, is fundamental for a unified digital health strategy.

To support these initiatives, the use of regulatory sandboxes—successfully utilized in the FinTech sector—can help test and certify digital health interventions. This method, adopted by countries like India, Indonesia, and Kenya, fosters innovation while ensuring adherence to national standards.

Global and regional solidarity to support countries as they lead in digital health investments

Support for enhanced global and regional collaboration in digital health should be promoted. Initiatives like the Digital Health Atlas and the Principles of Donor Alignment on Digital Health are commendable but need stronger country leadership. The African Union's development of a continent-wide digital health strategy and the Africa CDC's coordination of health data during the COVID-19 pandemic are exemplary regional efforts. These initiatives emphasize the importance of cohesive strategies and avoiding duplication. The principle of "decentering, sharing, and togetherness" shifts away from the traditional North-South dynamic, promoting equitable partnerships. The World Bank advocates for a framework that empowers governments to lead digital health innovation, supported by international partners. This approach ensures that investments align with national priorities, enhancing impact and sustainability, as well as fostering an integrated global digital health ecosystem.

Help patients and providers understand, trust, and confidently use new technology and data

Developing digital skills, literacy, and trust among patients and providers should be of utmost importance. Governments should invest in stable mechanisms like preservice and in-service training to build capacity. Training programs for new cadres of technicians demonstrate how enhancing digital literacy among the general population and how empowering patients and healthcare providers with specific digital skills can drive effective use of technology. Ethical considerations, including transparency in data acquisition and user control over health data, are essential to foster trust. Addressing gender and social inclusion ensures that digital health solutions are inclusive and accessible, preventing the digital divide from exacerbating existing health disparities.

Innovate in how the private and public sectors work together to design, deliver, and fund digital health solutions

Strong advocacy for innovative public-private and private-private partnerships is needed to advance digital health solutions. Effective collaboration between these sectors can significantly enhance health system capabilities and service delivery. The Africa CDC's coordination during the COVID-19 pandemic exemplifies successful regional collaboration, highlighting the potential for public-private synergies. However, traditional contracting models often fall short. Governments must adopt innovative contracting approaches, such as performance-based models and longer-term contracts, to incentivize private sector participation and ensure value for money. For instance, Rwanda and Tanzania have made significant strides by integrating digital health standards into a national health enterprise architecture, demonstrating the benefits of public-private partnerships.

Moreover, incorporating private-private partnerships, facilitated by government or private sector incubators, can align the incentives of homegrown solution providers and larger digital health companies. This collaboration can foster scalable and sustainable digital health innovations. Ultimately, governments need to create a conducive regulatory environment, perform detailed needs assessments, and engage in transparent procurement processes to build trust and ensure the successful implementation of digital health solutions. By embracing these strategies, we can collectively achieve a more integrated and effective digital health ecosystem that benefits all stakeholders.

Create synergy between the health system’s efforts and a country’s wider digital ecosystem and digital transformation agenda

We need to have conversations around integrating digital health initiatives with a country's broader digital transformation agenda. Linking health efforts with the wider digital ecosystem enhances synergy and ensures sustainable impact. The UN Secretary-General's High-Level Panel on Digital Cooperation highlights the necessity of interdependence and collaborative management of digital developments. The World Bank's findings that nearly half of digital health investments span multiple sectors underscore the effectiveness of a collaborative and holistic approach. Governments should adopt a multisectoral strategy, co-design digital health initiatives, and foster citizen engagement through patient feedback mechanisms. This coordinated effort will enhance political support and ensure that digital health solutions are truly impactful.

Finance incrementally at the proper time, monitor implementation progress, and track outcomes

Digital health investments must align with a country's digital health maturity. Incremental financing ensures that both demand and supply grow in tandem, preventing mismatches that could lead to implementation failures. Ethiopia's reliance on donor contracts for digital health highlights the need for integrating digital health into national health financing mechanisms. It is crucial to plan for both capital and maintenance costs from the outset, as maintenance can constitute up to 30% of capital costs. Additionally, innovative reimbursement strategies, including health insurance and direct payments, must be considered. The World Bank's commitment to increasing digital health spending from 6% to 8% by 2030 reflects the growing importance of digital health in global health systems. Robust monitoring and evaluation, using WHO guidelines and Global Digital Health Monitor indicators, can ensure that investments are effectively tracked and contribute to digital health maturity as well as overall health system improvement.