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The COVID-19 pandemic facilitated short-term digital transformation across all critical sectors, including health. In many countries, especially in low- and middle-income countries (LMICs), COVID-19 catalyzed the scaling of a variety of digital health interventions, including telemedicine, disease surveillance and reporting systems, health hotlines, mass communication through mobile phones, optimized digital supply chain systems, and cross-border data sharing for global vaccination certificates and passports.

However, many of these catalytic investments have not translated into the sustained digital transformation of health globally.

Today, less than 50% of countries systematically include health in their national digital transformation policies. After 25 years working on various aspects of mobile health and digital health in low and middle-income countries, I am convinced that without larger digital transformation it will be impossible for the health systems in most LMICs to digitally transform, as they lack IT capacity and relevant foundational enablers. Many of the developing countries that have digitally transformed their health systems have done so by leveraging a thriving broader digital ecosystem. A good example of this transformation approach is Estonia, which invested heavily in digital infrastructure, IT workforce development, relevant policies and regulation, and cross-cutting architecture for financial and social services, then leveraged this development to support the digital transformation of health.

With the broader technological advancements happening around the world — including higher bandwidth connectivity, eGovernment services, growth in digital literacy and the adoption of emerging technologies like artificial intelligence (AI) — the enabling environment for digital health transformation is stronger than ever before. But greater strategic alignment, smarter investments and more forward-looking policies are needed to unlock this potential and enable LMICs to leverage digital tools to move us toward universal health coverage globally.

A New Resource to Advance the Development of Digital Health

To support these efforts, HealthEnabled worked with our partners to launch the Global Digital Health Monitor (GDHM) at the World Health Assembly in May 2023. Hosted by the Global Development Incubator, the GDHM is an interactive digital resource designed to help countries strategically advance their digital health transformation. To that end, it aims to:

• Monitor and improve the quality of digital health at the country level;
• Track countries’ progress towards comprehensive, integrated digital health systems;
• Identify funding and technical assistance needs within and across countries;
• Foster better alignment among policymakers, donors and implementers in digital health; and
• Highlight potential areas of risk for country-level investment

Facilitated through a multi-stakeholder initiative that includes representatives from ministries of health across regions, regional digital health networks, UN agencies and policymaking representatives, the GDHM uses the World Health Organization (WHO)/International Telecommunication Union (ITU) National eHealth Strategy Toolkit as its underlying framework — a toolkit that’s used by many countries to develop their national digital health strategies. The GDHM also provides a set of core indicators that align with the WHO’s Global Strategy on Digital Health 2020-2025. This accounts for its alignment with UN goals like universal health coverage, broader digital transformation, private sector engagement and the use of emerging technologies such as AI, as well as diversity, equity and inclusion — including an indicator to help countries address the widening gender digital divide.

The GDHM is designed to be used by ministries of health, private health and technology sector stakeholders, and international agencies. Its breadth of services enables countries and regions to benchmark and track their progress over time, advocate for resources, identify countries that are performing well to facilitate cross-country learning, and support the private sector’s efforts to strategically prioritize new market entry and strategies. In the lead-up to its launch, it was adopted by 62 countries representing more than 2.5 billion people globally. Over half of these early adopters are in Africa (33 countries), due to a push by Global Fund to use the GDHM to set a baseline and monitor its digital health investments in its 55 high-impact and core countries. Gavi, the Vaccine Alliance is also using the platform in a similar fashion. The tool has also been adopted by countries in the Americas, and the Eastern Mediterranean, European, Southeast Asian and Western Pacific regions.

Initial Insights from the Global Digital Health Monitor

The Global Digital Health Monitor analyzed early adopter countries on a five-phase scale, with Phase 5 being the highest state of maturity. This analysis involved 23 indicators, mapped to the seven digital health enabler components highlighted by the WHO/ITU National eHealth Strategy Toolkit — namely Leadership and Governance; Strategy and Investment; Legislation, Policy and Compliance; Workforce; Architecture, Standards and Interoperability; Infrastructure; and Services and Application. Through our initial analysis of 62 countries, we found that just 5% are in Phase 5 maturity (Portugal, Saudi Arabia and the United Arab Emirates), while 95% are in Phase 4 digital health maturity or lower. There is no country in Phase 1. Globally, the area with the highest maturity is Leadership and Governance and the lowest is Workforce. This is not surprising, as many countries struggle to translate their strategic digital health ambitions into scaled digital health interventions — and then ultimately into strengthened health systems and improved health outcomes.

A closer look at the Workforce area highlights one way the GDHM can encourage progress toward better digital health systems: We found that 48% of countries have no digital health curriculum for health professionals as part of their pre-service training requirements, with only 13% teaching digital health in relevant institutions. In addition, 38% of countries reported having no training for their digital health workforce available in the country, with 74% having no workforce strategy, policy or guide that recognizes digital health. These findings can help guide the efforts of government and other stakeholders: According to Innocent Chiboma, Principal ICT Officer, Ministry of Health in Zambia — a country that has used the GDHM to inform the development of its National Digital Health Strategy — “We knew that we had issues with our workforce, but we didn’t know to what extent. The insights from the Monitor show us that we really need to concentrate on our workforce and do something about it.”

GDHM data has also revealed a need for greater strategic clarity, with clearer roles for public and private sector players. For instance, we found that while less than half of participating countries include health in their national digital transformation strategies, digital health is included in the national health strategies of 84% of these countries. However, only a small percentage periodically evaluate and optimize digital health as part of these strategies. And though 61% of the GDHM’s participating countries have formal governance structures in place for digital health, only 42% are fully functional and government-led. Additionally, only 10% of countries reported having a structured and systematic budget line for digital health that is sufficient to meet the country’s digital health needs. And for 75% of participating countries, private sector participation is either non-existent or ad-hoc and limited. According to Dr. Gloria Nenita V. Velasco, OIC-Director IV of the Department of Health – Knowledge Management and Information Technology Service in the Philippines, “When we started, government was leading the development of information systems, but now we’ve seen that the private sector has actually overtaken the government in terms of capacity. We need to pivot.” In response to these insights, several countries are now shifting to clearer roles for the public sector, while working to create a supportive environment to de-risk investment and activity by the private sector, in order to increase the reach and impact of digital health interventions.

Our team’s early analyses highlight progress worth celebrating, while also offering more targeted visibility into areas that require further growth and improvement. And our ability to measure and monitor digital transformation will only increase as more countries participate.

As our reach continues to grow, the GDHM is raising the bar on the digital transformation of health by supporting countries’ efforts to prioritize and monitor their investments, and facilitating cross-country learning between higher-maturity and lower-maturity countries. Together we can improve health and well-being for all and achieve universal health coverage by creating a more effective, equitable and efficient global and national health system through digital transformation.

To explore the platform visit: www.digitalhealthmonitor.org.

If you’re a government health official interested in joining the GDHM by completing a country profile, please contact info@digitalhealthmonitor.org.

Patricia Mechael, Ph.D. is co-founder and policy lead at HealthEnabled. She leads the Global Digital Health Monitor and is a Senior Associate Professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

Photo courtesy of Jernej Furman.