Digital health: Pathway to health for all

The pandemic has, in a way, changed our worldview of healthcare. While it has forced global, national and sub-national cooperation, it has also exposed the systemic gaps in health governance, human resources, and infrastructure. Our progress in achieving the health-related Sustainable Development Goals, especially the universal health coverage (UHC) aspiration, which was off-track even before the start of the pandemic, has been further disrupted due to the pandemic. In order to achieve our goals, we need to redefine our strategies and the instruments we choose. We recognize the expediency of building agility and resilience into our health systems. To this end, one of the most powerful instruments we can leverage is digital health. Digital health can significantly improve the quality, accessibility, affordability and sustainability of person-centric health services. The inherent power of technology enables doing more with less—and faster and on scale.

Safe and secure digital technologies promise to transform the health sector. It provides immense opportunities to solve some of our most pressing health problems. For example, tele-medicine, teleradiology and tele-dispensing can connect and provide specialized services from health professionals to patients in remote or hard-to-reach areas; digital technologies have the means to better collect, analyze and disseminate data at all levels, so changes in population health can be identified and acted on; safe and secure digital technology supported personal health records (PHR) empower the citizens to access health services more conveniently and enable consent-based access to patient’s history to healthcare providers to enable quality personalized care.

Digital health can accelerate the transition from curative services to a primary health care centric ecosystem, which focuses on preventive and promotive care, especially for high-risk groups and individuals. It also has a potential to produce efficient and cost-effective methods for disease surveillance and program management. Digital health is a stepping stone to leverage the immense potential of emerging advanced technologies like artificial intelligence, machine learning, augmented reality, internet of things, big data and biotech. Most of all, digital technologies give us the hope of leapfrogging toward UHC and other health-related SDGs. What is needed is ’raising the bar’—from systems to ecosystems. Achieving UHC, as our region has sought to do since 2014, is dependent on taking full advantage of the opportunities digital health holds out. In our march toward UHC, there have been significant advancements in the region, however, much more is still needed, and it is needed quickly. The WHO South-East Asia Region has witnessed an increase in the service coverage index—from 47 in 2010 to 61 in 2019—the pace of improvement is inadequate to achieve the minimum essential service coverage index of 80 by 2030. In the context of financial protection, while there has been considerable reduction in the impoverishment on account of out of pocket spending on health from 12.4 percent in 2015 to about 6 percent in 2017, the catastrophic health spending has remained at the same level or increased in a majority of the countries of the region. Poor health infrastructure, shortage of qualified human resources, problems related to access, availability and affordability of health services and host of issues relating to health administration and governance continues to challenge poor progress toward UHC and push us behind the curve in achieving most of the health-related SDGs by 2030. Use of digital technology is one quick way to address these challenges to a certain extent. Several developing countries have already demonstrated the transformative power of digital health to make a huge difference at a population scale. In India, Ayushman Bharat Digital Mission has created over 350m digital health identification and enabled the citizens to create over 200 million electronic personal health records during the last one year alone. The Co-WIN platform has enabled and smoothened the humongous task of vaccinating over 1 billion population for protection from Covid-19. The national telemedicine platform of India, eSanjeevani, has provided teleconsultation services to more than 100 million beneficiaries during the Covid-19 pandemic. Estonia has been an early adopter of digital health activities of all kinds. Every individual, who has been to an Estonian doctor, has access to an online personal e-Health record, allowing both patients and doctors to have easy access to past medical records, including e-prescription and x-ray images. Brazil has made significant strides toward a digital transformation of PHC, building on more than a decade of policies to digitalise health care and make better use of health data, and with key investments in networks, data, interoperability and digital capacities. The quality and pace of adoption of digital health can be greatly enhanced by the concept of Digital Public Goods (DPGs), which are ‘open-source software, open data, open AI models, open standards, and open content that adhere to privacy and other applicable laws and best practices, do no harm by design, and help attain the Sustainable Development Goals’. As has been illustrated in several countries, digital public goods have played a game-changing role in sectors like financial inclusion and self-help. DPGs can similarly make a huge difference to the health sector.  These could include platforms, devices and apps designed to transform areas like telemedicine, immunization, mother and child health, non-communicable diseases, IEC and digital health literacy. While public funding could focus on creating core DPGs like digital health IDs and registries, governments can formulate appropriate policies and frameworks for incentivizing the development of DPGs in the rest of the ecosystem by the private sector. The time for action is NOW. We owe it to our people that they indeed reap the full benefits of all the tools at our command to achieve ‘Health for all’. And it is our moral imperative and also in our collective self-interest that the digital health technologies and innovations are targeted to those countries and populations that are furthest behind. The author is WHO South-East Asia Regional Director