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A “one-size-fits-all” digital health solution is not sustainable for lower-middle-income countries

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Richard Dzikunu
Mar 15, 2021

The COVID-19 pandemic continues to demand that data collection and digital health technologies hold the forefront of agendas for various national, regional, and international forums. Meanwhile, the academic and media landscape is currently exploding with articles, blogs, video broadcast preaching phases such as “Either no data or no progress”. 

New technologies using data to fight COVID-19, or using data to help combat health crises. Amid all these conversations, we must, however, also consider whether countries have the technical capacity and relevant policies to support the deployment of digital health interventions in a sustainable way. 

The overarching theme from these ongoing dialogues in academia, the media, civil society, and development partners suggests that digital health, artificial intelligence (AI), and other frontier technologies will accelerate the attainment of universal health coverage (UHC). There is no doubt that new technologies using data can help accelerate quality, affordable, accessible health care for all. 

However, the current approach and dialogues are focused on data collection and introducing digital health solutions without considering the needs on the ground. What is the state of data collection infrastructure and digital health policies in Lower middle-income countries? On what basis do we promise all the benefits of digital health and data when many of these countries either have no or outdated policy guidelines and in some cases lack the technical capacities to understand the fast pace digital evolutions.

Do we instead focus on supporting countries to put in place long-term digital health policies based on specific needs or continue with silo working where each international organization intervenes in Lower middle-income countries with their mostly expert-designed digital health projects, which wraps up when there is no more funding? 

The current approach seems to follow the latter module in the efforts to harness the benefits of digital health technologies. We must learn from how silo working failed us in the Millenium Development Goals (MDGs) and get things right. Before rushing digital health interventions in Lower middle-income countries, a national policy document needs to identify a primary vision, key national priorities, objectives, and indicators to guide any digital health interventions from the government or international organisations.

A 7-step sanity check before deploying digital health interventions 

Our goal must be sustainable impact and to ensure that new technologies benefit everyone. Whatever the starting point, ask the following fundamental questions before deploying digital health solutions. 

  1. How do you ensure that digital health solutions do not limit the development and investment in local health initiatives?
  2. How do you ensure that digital health interventions and solutions do not entrench existing health inequalities?
  3. How do you build the capacity for health workers to use such technologies while providing citizens the ability and skill to use new digital interventions?
  4. How will people access such technologies, and at what cost?
  5. What are the necessary standards and processes for ensuring interoperability, data safety, and information confidentiality in all aspects of electronic data management within the health sector?
  6. How do you ensure collaborations with the private sector and other government institutions and ministries to build an infrastructure that will deliver digital health core elements? 
  7. How do you establish transparent governing bodies to oversee the implementation of digital health strategy and invest in leadership and capacity building?

Without these and many other foundations, the current speed of introducing digital health interventions is likely to fail in the long term. 

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Digital Health Policies in Africa

Africa is continuously touted as the continent where technology will shape the future of healthcare over the coming decades. But on what policy basis will such achievement be made? As we experience the current pandemic, we see the rush to introduce digital solutions as a means of strengthening healthcare provision for the most vulnerable, but to what end? According to the World Health Organization's Global Observatory for eHealth, not all 54 African countries have a national eHealth policy or digital health information architecture. The few countries with strategies either have them outdated or do not have useful implementation timelines and budget support.

Any digital health interventions in African countries should first seek to support digital health policies through a multistakeholder approach. Where policy guidelines exist but are outdated, stakeholders must support reviews to ensure the policy document addresses the fast-paced development of technologies. Only when policy documents are in place can we confidently begin conversations around harnessing digital technologies for sustainable health outcomes. 

Beyond policy documentation, there is the need for implementation frameworks and accountability measures, which should have room for periodic review of digital health policies to match the pace of evolving digital space.


What is the best approach to introducing digital health interventions?  

Transform Health is one of the leading coalitions dedicated to achieving universal health coverage in the digital age. In their campaign to collaborate with individuals and communities who benefit the most from digital health transformation, they seek to support and invest in health strategies. The coalition believes in the fundamental approach that for digital hearth intervention to be effective and sustainable; it must be fully integrated into a broader health system and aligned to agreed health strategies and policies.

In their soon-to-be rolled-out campaigns in some selected Lower middle-income countries, the coalitions aim to organise advocacy around national platforms that will work together to influence their governments and others to bring about the changes identified in their national strategies. The underlying approach is working within a national strategy or supporting to create or design one. The current haste to collect massive data and export digital health technologies to countries where systems are not ready to receive and integrate them is not sustainable.

Building (digital health) back better?

Countries must be guided by evidence and policies to establish sustainable harmonised digital policies and systems, not fascinated by going digital for the sake of it. 

While digital technologies and data present opportunities to achieve universal health coverage and strengthen health systems, countries must be supported to manage their digital health experience through a policy framework that enhances digital health services' quality and coverage and reduces inequities. 

Stronger political will and concerted action are needed at the country level to initiate such policy processes where all stakeholders and communities, particularly marginalised and under-represented groups, are involved. 

Digital health interventions should also work with health training institutions to incorporate these technologies at the training level. The early introduction and exposure to e-systems will create a strong foundation even for future e-health solutions.

Without the needed policy framework to guide investment and coordinate digital health interventions in low and middle-income countries, we risk repeating the same mistake of a multiplicity of pilot projects that will fail to make it to scale. 

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Richard Dzikunu

Richard Dzikunu is a United Nations award-winning youth activist with a track record for influencing adolescent health policy and proven strategic communications, grassroots mobilization, and advocacy skills. In 2018, he received the Sustainable Development Goals (SDGs) Action Campaign Award, the first of its kind, from the United Nations at the Global Festival of Action for Sustainable Development in Bonn, Germany. Richard has a unique combination of advocacy work experience at the community, national and international level for reproductive health and rights, primary health care, and youth-led engagement. He currently serves as a facilitator for the Young Experts: Tech 4 Health. Follow him on Twitter.

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