A global digital health framework is only at a nascent stage. Understandably, policymakers in all countries are first dealing with the considerable challenge of adapting technology to their own domestic health frameworks. And international organizations are only just starting to develop the common principles, best practices, and tools to help late adaptors and developing countries catch up with leading countries. The risk is domestic frameworks will fragment away from international standards, thereby preventing health companies and research organizations from leveraging health data and digital technologies in order to provide new and better services across different countries. COVID-19 has underlined the importance of international cooperation and collaboration to global health.
LMIC policymakers and their international health and development partners must focus on foundational issues—namely, a national digital health strategy, digital skills, ICT infrastructure, and data governance—to build effective domestic and global digital health frameworks. This report aims to support these policymakers in doing this. The first section outlines the promise of digital health (the appendix includes case studies from several regions that illustrate how this is working in practice). The paper then gives an overview of core enablers for digital health, including an analysis of the importance of ICT infrastructure and digital skills, and domestic and international data governance. The paper then reviews the growing focus on digital health by multilateral organizations and other nongovernmental organizations (NGOs).
The paper concludes with general findings and recommendations, summarized below:
Countries should develop holistic national digital health strategies. There is wide disparity in progress in this area among LMICs, with several important countries having no formal national plans. Digital technologies will not achieve anywhere near their full potential absent a plan that provides the necessary resources, coordination, cooperation, and leadership. These plans need to be holistic, in part, as each country’s situation will be somewhat different, including the considerable complexity that comes from integrating digital technologies with legacy health systems.
Several multilateral organizations and private-sector initiatives have elevated the focus on digital health at the international level, such as the WHO-backed global digital health strategy. LMICs should work with WHO and other actors to mobilize the resources and expertise to help develop and implement—or improve—their own digital health strategies.1
Training and education to use digital technologies is critical, but few LMICs have integrated digital skills into their health-workforce training. Regional and multilateral health organizations, donors, and other stakeholders should prioritize efforts to help LMICs address the most pressing skills gaps.
There are particularly acute gaps in ICT infrastructure in LMICs, which are home to most of the people that remain disconnected from the Internet. Poor ICT infrastructure severely limits the potential of digital health. Regional and multilateral development agencies, and other donors, should fill these gaps to cover private-sector shortfalls—for example, with regard to wireless mobile coverage in rural areas.
LMICs need to enact a data governance framework that balances data privacy and protection with innovation. The generation, protection, use, sharing, and international transfer of high-quality data is fundamental to an effective and innovative digital health program. An overly restrictive data governance framework will limit the potential of digital health technologies.
Policymakers need to build interoperability into their frameworks from the start, as many of the benefits of digital health technologies require cross-border transfers of data. This is critical, as many firms and research organizations involved in digital health rely on the Internet, the free flow of data, and centralized IT facilities to easily, cheaply, and reliably access data, patients, and health-care providers around the world. The emergence of a meaningful, integrated global digital health framework will depend on national governments enabling cross-border flows of data.
THE PROMISE OF DIGITAL HEALTH
Simply put, “digital health” refers to the use of digital technologies for health. It is an umbrella term that includes electronic health (eHealth), mobile health (mHealth) and emerging areas such as the use of artificial intelligence (AI), big data, and genomics.2 As populations age and noncommunicable disease burdens rise, there will be even greater pressure on health-care systems, underscoring the need to deploy current and new technological solutions.3 WHO has stated that “universal health coverage cannot be achieved without the support of eHealth.”4
Digital health holds considerable promise.5 It can make health information, care, and diagnosis more accessible, such as through telemedicine.6 This is especially true for people in hard-to-reach places, given the proliferation of low-cost smart phones and medical devices. Digital health can enable health-care providers and services to become more efficient and of higher quality. In particular, the enhanced use of health data offers the prospect of more personalized and coordinated care, and better, faster treatment at a lower cost.7 AI has advanced to the stage where it can mitigate shortages of specialists, providing reliable diagnosis and lower-cost services in fields ranging from tuberculosis to diabetic retinopathy. Similarly, AI can use the greater availability of health data to identify and prevent emerging health issues, such as epidemics. When combined with software, better, richer datasets allow health system managers to identify, plan, and allocate resources more efficiently. Digital health can also accelerate the drug development process.8 For example, AI can integrate and analyze a broader range of “real-world” data from mobile and wearable technologies and social media, and combine it with traditional lab and clinical data.9
Many of these benefits are already evident, and hold particular promise for LMICs given they can be deployed at significantly lower cost than traditional brick-and-mortar health services. Indicative of this, digital health technologies are currently undergoing a surge in uptake. Globally, 44 percent of mobile users have seen a medical professional for diagnosis or treatment via their mobile device.10 According to IQVIA (a U.S. health technology firm), the number of mHealth products and services has doubled in the past 5 years in LMICs, and there are now over 165,000 mobile applications for health services.11 In fact, mobile health services are more popular in LMICs, with 59 percent of patients in LMICs using mHealth applications and services, compared with 35 percent in high-income countries.12
As populations age and noncommunicable disease burdens rise, there will be even greater pressure on health-care systems, underscoring the need to deploy current and new technological solutions.
There is potential for digital health to benefit the wider economy, not only through significant cost savings but also via increases in productivity as patients receive faster, more accurate diagnoses and treatment.13 For example, Canada measured the cost savings generated by its digital health investments and reported an aggregate saving of US$11.2 billion since 2007.14 Many studies anticipate considerable cost savings from digital health, such as a 2013 GSMA study that estimated mHealth technology could result in $400 billion worth of cost savings over a 5-year period in high-income countries.15 A review of 14 evaluations of digital health interventions across a range of high-income countries found them all to be cost effective and an improvement over existing interventions.16
THE BUILDING BLOCKS FOR DIGITAL HEALTH
Despite the potential benefits of digital health, few nations have put in place the policies, programs, or strategies needed to take full advantage of it. The 2019 Global Digital Health Index assesses the state of preparedness and adoption of digital health in 22 countries of varying stages of economic development (see figure 1).17 It also measures the readiness of the wider health system to successfully adopt and deploy digital health interventions. The Index is benchmarked according to components of the WHO and International Telecommunications Union (ITU) eHealth Strategy Framework, which uses 19 indicators in 7 policy areas: leadership and governance; strategy and investment; services and applications; standards and interoperability; infrastructure; legislation, policy and compliance; and workforce.