What’s the way forward for digital health in development?

A panel at the World Health Summit in Berlin takes stock of progress and challenges

Head of GIZ Competence Center Health, Michael Adelhardt, speaks at the WHS

Investments in information technology can strengthen health systems and improve the delivery of health services. But in the rush to digitise, there’s a risk that the careful planning and consultations needed for sustainable solutions get overshadowed. Finding the balance is difficult, but possible.

As the digital revolution gathers pace, information technology is playing an ever greater role in the organisation and delivery of health services around the world. Electronic medical records, clinical consultations over the Internet, mobile-phone based notifications for patients, smartcards to verify health insurance status – the list goes on and on. Many of these approaches appear to hold great promise, particularly in low- and middle-income countries which are looking for cost-effective ways to expand access to quality health services.

Yet as ‘digital solutions’ proliferate, it is becoming increasingly clear that they are not a panacea. On October 17, as part of the World Health Summit in Berlin, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH organised a panel discussion to take stock of the field of digital health in the developing world. Co-convened by the GIZ Competence Center Health and the Sector project Digital Development, the session brought together representatives from government, the private sector, civil society, development cooperation and academia to reflect on the status quo and the way forward.

The promise of digital health

Salif Samake

‘Mali is a country that needs to be at the center of digitalisation,’ remarked Dr Salif Samake, the Permanent Secretary of the Malian Ministry of Health, who kicked off the discussion. With 1.2 million square kilometers of territory – much of it desert – and a large nomadic population, ensuring access to health services is a significant challenge.

‘To achieve the Sustainable Development Goals and Universal Health Coverage, we have to make the health system stronger. Digitalisation is a way to support health system to deliver more in as many areas as possible and as quickly as possible.’ Samake gave examples of recent efforts in Mali to improve Ebola surveillance by providing community health workers with mobile phones and to provide clinical guidance and continuous training to health workers in remote areas through telemedicine link-ups with the capital.

‘Cell phones are everywhere now, and they’re not just for talking,’ he continued. In the face of public health emergencies, the Ministry needs data to make timely decisions. Digital connections between health workers, health facilities, public health officials and other partners improve the work of health systems.

Getting beyond a multitude of non-scalable projects

At the same time, there was general concern among panellists that the promise of digital solutions may be getting lost in a sea of unsustainable pilot projects. The field of digital health is changing quickly, says Heidi Good Boncana, the co-chair of the Global Digital Health Network, and the push to get something done quickly and to generate immediate results means that those planning and financing digital health projects do not always take the time to consider what work is already underway in a given area, or whether the proposed technology is really the best way to reach certain end users.

‘We need to build on each other’s work in an informed way, and also to talk candidly about what didn’t work,’ said Good Boncana, drawing attention to the utility of so-called ‘digital health landscapes’ as resources which can help to guide decision-making and planning around new digital interventions. She also highlighted a set of digital principles which have been endorsed by a number of international organisations, and incorporated into their programme design and contracting procedures, as a helpful framework for moving towards more sustainable approaches to digital health.

We need to ask basic questions and have the right stakeholders at the table

Nadi Koanga

According to Nadi Koanga, an independent consultant who advises non-government organisations on digital health strategies, the key to planning better digital health interventions is to start with some basic questions: What is the vision? Does it make sense for technology to be integrated in this way? Can we expand on something that already exists? And, most importantly: Who needs to be at the table?

Although the situation is improving, Koanga believes there has been a tendency when designing digital health projects not to engage sufficiently with end users (i.e. providers and patients) and with government representatives. If projects have been planned without attention to government priorities, she argues, they are likely to diverge from official health and digitisation strategies and will be less likely to succeed in the long run.

Digitisation is a means to an end

Michael Adelhardt, the head of GIZ’s Competence Center Health, echoed this theme. In his view, digitisation should not be seen as a goal in and of itself, but rather as a tool for realising existing strategies and objectives. When GIZ works with national ministries of health, on behalf of Germany’s Federal Ministry for Economic Cooperation and Development (BMZ), it seeks to strengthen health systems through support for the implementation of national health strategies and plans. The use of information technology is one aspect of health systems strengthening and the way this is deployed needs to be carefully planned and thought through, just like any other type of systems strengthening intervention.

Another challenge for development partners and national governments is to generate evidence of the impact digitisation is having within health systems. ‘Because support for information technology is often integrated into other types of health system strengthening interventions, it’s complex to measure its impact,’ says Adelhardt. In his view there is a need to systematically document how the management of health systems is changing and hopefully improving as a result of data that health system managers now have their disposal.

Digitisation goes mainstream

The discussion at the WHS was particularly timely given the increasingly central role that digitisation is playing in German development cooperation programmes in the area of health and social protection (see below). Investments in information systems are emerging as a key strategy for strengthening health systems and achieving universal health coverage. As Germany’s experience in this area continues to grow, it has much to contribute, and much to learn from other actors in this field.

Karen Birdsall, October 2017

Digital health and social protection in German development cooperation – some examples

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