NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Digital health, which is the use of information and communication technology (ICT) to provide health services, has long been touted as an innovation agent and a tool for international development. If well used, we’ve seen that it can advance the goal of providing universal health coverage and improve the quality and efficiency of health care services worldwide – including for the poorest of the poor. Over the years, the field has transitioned from “pilotitis” toward a focus on large-scale implementations that increase efficiency and effectiveness. However, sustainable systems-based solutions are still hard to attain. It is no surprise that in many ways, the ecosystem of digital health solutions and programs remains disjointed. Countries continue to face a proliferation of uncoordinated digital health projects resulting in a fragmented ecosystem, inhibiting scaling and long-term sustainability.

Currently, many countries are moving toward the complex task of implementing national digital health strategies to coordinate this fragmentation. In fact, the World Health Organization reports that 73 of its member states (or 63 percent) have defined national digital health strategies and corresponding implementation plans. But many challenges to implementation remain, including the complexity of coordinating the diverse set of players required. In a report commissioned by the Broadband Commission for Sustainable Development Working Group on Digital Health, co-chaired by the Novartis Foundation and Nokia, Vital Wave highlights eight countries that have used leadership and governance effectively to develop and implement national digital health strategies. Through these case studies and interviews with experts in the field, three critical success factors emerged:

1. Sustained senior government leadership and committed financing for digital health are prerequisites for a successful national digital health strategy. 

As one can imagine, initiating and operationalizing a national digital health strategy can take several years, making it a long-term commitment. Therefore, a strong vision supported by senior government leadership is essential. This vision should articulate the value and potential impact of digital health and ensure the buy-in and alignment of stakeholders. Endorsement and leadership across sectors is also needed, both from health leaders who recognize the transformative potential of ICTs in health care and from ICT leaders who understand the potential of digital technology to address health challenges. 

2. Effective governance mechanisms that engage stakeholders, all of whom have clearly defined roles, are needed to ensure efficient decision-making. 

Governance mechanisms have the ability to formalize decision-making and provide a forum for discussion, bringing together leaders and stakeholders from different domains. They can provide clarity to external stakeholders, from the private sector or the development community, as to when and how they can provide input. In developing the strategy, clarifying and codifying organizational roles can be used as a basis for governance structures and domain ownership. Whether it be a dedicated program management team, a digital health ICT steering committee or technical working groups, these structures can help to ensure strategic direction and execution of a strategy. 

3. A national ICT framework that facilitates alignment between health and ICT sectors can promote connectivity and system interoperability, establish common standards and enable appropriate policies and regulations in digital health.

A strong ICT framework will enable shared capital investments, rationalized resource allocations and leveraged workforce capabilities between government entities. At the same time, it will help avoid the duplication of solutions. Combining digital health efforts with national ICT frameworks, such as national broadband plans or national digital plans, can enhance cooperation even more. This is important as dual expertise is needed to ensure success. For example, for digital regulation to be effective, health experts familiar with patients’ rights should work with ICT regulation experts who are experienced in data protection and security.

Governments do not have to develop and manage every digital health system. However, they do need to play a leading role in creating a vision and digital architecture that NGOs, private-sector companies and public-sector agencies can plug into. Private companies will be more likely to get involved in an open, productive and helpful way if the health system is built around a transparent, officially promoted architecture. For instance, this will enable a ministry of health to engage resources, skills and knowledge from the private sector, and others such as civil society, academia, expert bodies or other government entities, to execute the national digital health strategy and solutions.

Progress is happening in digital health, and with that progress comes a call for action to truly realize the potential of ICTs to achieve global health goals. Ultimately, the active engagement of partners across the private, public and development sectors will lead to a complementary set of skills and resources, resulting in more successful and scalable digital health implementation.

Cat Meurn is the manager of client services at Vital Wave. 

Photo courtesy of Vital Wave