The panel © World Health Summit

During a panel discussion on the third day of the 2022 World Health Summit in Berlin health and development experts, along with government and private sector representatives, discussed how additional, aligned funding in digital health can help accelerate Universal Health Coverage (UHC) progress and the role of different stakeholders in advancing this agenda. The session, was organised by the Transform Health Global Coalition to launch their new Conceptual Framework ‘Closing the digital divide: More and better funding for the digital Transformation of health’ and to discuss guiding principles of aligned funding for digital health.

The discussion was chaired by Dr Christoph Benn, President of Transform Health and Director of Global Health Diplomacy at the Joep Lange Institute. He said digital transformation of health systems could potentially result in unprecedented improvements in health access and help to meet the goal of Universal Health Coverage (UHC) for all by 2030. Huge challenges remain, however, to close the digital divide and ensure the process is inclusive, equitable and sustainable. 

The Conceptual Frameworkcalls attention to the urgent need for increased and coordinated funding for digital health and sets out priority areas for investment and the level of funding needed. Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) co-financed the development of the framework and Dr Tania Rödiger-Vorwerk, BMZ’s Deputy Director Global Health, took part in the panel discussion.

A conceptual framework for digital transformation

Mathilde Forslund, Executive Director of Transform Health presented the key recommendations of the report. The analysis showed that the adoption of digital technology and data for health has been fragmented and uncoordinated, with uneven benefits of different population groups, particularly in low- and lower middle-income countries. That was why, she said, Transform Health, with input from more than 350 stakeholders, had developed a Conceptual Framework to guide investment and action towards health in the digital age. She summarised the report’s six key recommendations for national governments, international donors and the private sector to increase and improve investments towards building digitally-enabled health systems. 

The report’s six key recommendation areas:

• More investment from domestic and international sources
• Better coordinated investments, aligned with national priorities
• Costed national digital health strategies and investment road maps to guide transformation
• Robust regulatory frameworks and policy environments in countries
• Mechanisms for meaningful multi-stakeholder engagement in the digital transformation process, including civil society and marginalised communities
• Improved digital connectivity, including coverage gaps, affordability and digital literacy

Ms Forslund said that the costed priority investment areas outlined in the Conceptual Framework for 75 low- and middle-income countries over the next five years would require a baseline budget of USD 12.5 billion (or 2.5 billion per year). Closing the divide in digital access is a prerequisite for equitable access to technology-enabled health services she said.  

Without the political will to address these digital gaps, the equity gap in health care access will increase.

Mathilde Forslund

Indonesia’s great strides towards digitalising its health sector

Maria Endang Sumiwi, Indonesia’s Director General of Public Health, described how the COVID-19 pandemic had resulted in an ‘unprecedented acceleration’ of digital transformation in health in Indonesia. She said that, working with 20 start-up companies, 7,000 daily telemedicine consultations had taken place with self-isolating patients. PeduliLindungi, a mobile app designed for contact tracing purposes and vaccine certificate registration has also been downloaded by 100 million people. 

However, she said the pandemic had also exposed a highly fragmented health data information system and had prompted Indonesia to launch a new digital health blueprint and data exchange platform that will standardise the data of 270 million Indonesians, with aggregate or routine data health data collected from 10,000 primary health care centres, 17,000 private clinics, 33,000 hospitals, 1,000 laboratories and 30,000 pharmacies. This platform will be particularly useful, she said, for collecting data from rural areas and tackling health problems at village level through further development of telemedicine. 

Better coordination is a prerequisite for digital transformation

Dr Rödiger-Vorwerk said that the pandemic had created a global momentum for digital transformation. However, it had also resulted in uncoordinated multiplication of stand-alone solutions in the health sector and highlighted the need for better coordination between international development partners. The call for better alignment of efforts was not a new one, she said, reminding participants that at the 2018 World Health Summit in Berlin, more than 30 partners – including BMZ and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) – had signed the Principles of Donor Alignment for Digital Health. However, in a note of self-criticism she added, ‘to be honest Germany [has not been] the best performer in that call for better alignment.’ It is now necessary to renew the principles of donor alignment and review how they can best be put into practice.  

The objectives of donor alignment are to overcome fragmentation and inefficiency of investment…. we need to renew our commitment and modes of cooperation.

Dr Rödiger-Vorwerk

Digital solutions can help deliver health as a human right

Tzipi Livni, former Foreign Minister of Israel and Member of Nizami Ganjavi International Centre, said human rights and equity should be at the heart of digital transformation. COVID-19 had highlighted existing health inequalities: 

As an Israeli I was so happy to get the first [vaccination] shot. But frankly when I got the third shot, there were many people in different countries that still hadn’t received the first one.

Tzipi Livni

The pandemic had also, she said, resulted in new digital innovation about how health can be delivered. In Israel, for example, a combination of different government and competing private health providers had responded well to the pandemic. All citizens are entitled to a minimum ‘basket’ of services that are legally and financially guaranteed by the state, but a competitive free market in healthcare had resulted in digital innovations to improve access to and provide better health care through, for example, telemedicine and video appointments with doctors. The government encourages private start-ups to invest in such digital solutions and provides an enabling environment for innovative ideas. 

A ‘step-change’ in bringing digital health forward

Dianne Stewart, Deputy Director of the External Relations and Communications Division in the Global Fund to fight AIDS, TB and malaria, said the publication of the Conceptual Framework would bring a ‘real step change’ in moving digital health forward in really practical ways. The Fund, she said, sees digital transformation as a key strategy and investment for tackling AIDS, TB and malaria in the next six years. Human rights principles are central to this digital agenda, but people not only have a right to access care, but also a right to security and privacy of data.  

Although huge challenges and weaknesses remain in the digital space, Ms Stewart said she also wanted to recognise the huge progress made in supporting Health Management Information Systems in low- and middle- income countries. ‘COVID 19 has shown us that actually we can do a lot more, a lot faster and have a lot more data available,’ she concluded. 

A call to transformational action

Professor Dr Alain Labrique, the recently appointed Director of the Digital Health and Innovation Department at WHO, said that for over a decade there had been talk about the need for coordinated investments in digital health to avoid ‘reinventing the wheel’. He reminded participants about some discordant digital health initiatives of the past, such as in Uganda where in 2011 there were so many uncoordinated efforts to harness the potential of technology to solve public health problems the government issued a moratorium on new projects. Since then, he said, coordination had improved and partners such as the Global Fund and Gates Foundation had begun to implement the principles of global alignment. However, care must be taken, he joked, not simply to move from what he called ‘pilotitis’ to ‘appatitis’, or an over-reliance on apps. 

The Conceptual Framework should, he said, be viewed as a call to transformational action. To make this possible, countries need clearly costed digital strategies and roadmaps for future health systems that will fulfil the human rights of their citizens. The WHO’s role, he said, is to empower countries to build these costed digital health plans by providing guidance on norms and standards and helping to build the enabling digital architecture. Once that has been done, coordinating the required investments becomes a very different proposition: It’s no longer an abstract concept. ‘That’s the way we need to reframe this very, very important conversation.’ This represents a ‘foundational shift’ in thinking, said Prof Dr Labrique. 

We are at a unique intersection point where we can really see this change through. So, I hope we’re doing more than launching just a Framework – this should be an action plan.

Professor Dr Alain Labrique

Building political will

Pape Amadou Gaye, Founder and President, Baobab Institute for Health and Development in Senegal, expressed his belief that the Conceptual Framework would drive momentum towards digitalisation, and that he was excited about the progress being made to move from what he viewed as outdated global health models: ‘The last few years have seen incredible changes and questioning of the current models, as well as the entry of new players, new visions and ways of working.’  These changes had already resulted in real progress in, for example, improving life expectancy, better treatment for people living with HIV and AIDS and efforts to eliminate malaria. 

However, he warned that political will would be crucial for ensuring further digital progress and making sure that less developed countries have the standards of health care that everybody deserves.  He drew attention to the technical challenges of reaching the ‘last mile’ in many countries, addressing the growing needs of the urban poor, and the acute shortage of healthcare workers which – given the length of time it takes to train doctors and nurses – is likely to continue for the foreseeable future. 

This is why we are so excited about digital: We can empower a digitally-enabled community health worker to accelerate progress and provide health care for hard-to-reach populations.

Google as essential public health repository

Susan Thomas, Clinical Director at Google Health said that during the pandemic Google had become an essential public health repository for millions of people around the world as they sought information online: ‘Getting the right information to people is so critical.’ 

She said that the Google.org Foundation was keen to invest in research and development and bring new digital products to market.  Wherever possible, she said, those products should be open source, to ensure that digital tools and knowledge were widely available. Google is keen to develop powerful partnerships internationally – both with WHO and governments – but also to nurture local knowledge at country level and work with small and medium enterprises to build a vibrant network of entrepreneurs and people who really understand the healthcare needs of local populations. 

Young people call for equity in the digital transformation process

 In his closing remarks Chairman Dr Christopher Benn thanked participants and invited everyone to coalesce around the Conceptual Framework’s shared vision for successful digital transformation of health systems.  He reminded participants of the consultations that had taken place with governments, health experts, international development partners, youth organisations and marginalised groups, to make Conceptual Framework as inclusive as possible. Following a brief question and answer session with members of the panel, he invited Yacine Ndiaye, to give the closing remarks. Yacine is one of the 12 members of the Young Experts: Tech 4 Health (YE:T4H) which is a platform for young people to shape and guide the agenda towards achieving UHC by 2030 through data and digital technologies, which had, he said, played a critical role in drafting the Conceptual Framework. 

Yacine Ndiaye said that, as a young digital health activist, it had been an honour to be part of the process: ‘Many young people have been very vocal about being part of the solution and the design, so this has been an important opportunity for us.’ Building trust and ownership would be the key to digital transformation, she said, as digital infrastructures can only function well if communities trust them. It is also important for the process to be equitable – and entails redefining what is meant by equity in this context: ‘Ultimately what we want to do is leave no one behind.’ 

Ruth Evans,
October 2022