At the 75th World Health Assembly, digital health took center stage. The attention was unsurprising given the massive acceleration and acceptance of digital tools over the past few years. I was surprised, though, at how little the conversation had evolved. Over and over, I heard the same refrain that I’ve been hearing for years: “We need to address the fragmentation problem in digital health!”
I agree that the duplication of digital health tools in low- and middle-income countries is a waste of scarce resources. My concern with the “fragmentation” refrain is that it implies that it’s time for consolidation around a narrow set of solutions and that, by extension, new technologies are unwelcome.
Instead of lamenting fragmentation, we should talk about actionable strategies that might solve the duplication problem — insofar as it is a problem — while also focusing on building a robust digital health ecosystem. Strategies like improving transparency and modernizing digital health infrastructure will reduce duplication while simultaneously allowing differentiated solutions to co-exist.
At the same time, we should ensure that we have future-ready digital health solutions by supporting public-private partnerships and transformative technologies. Ultimately, we need to remember that we aren’t creating technology for the sake of it, but to drive toward the better health outcomes outlined in the Sustainable Development Goals.
Improve transparency
Organizations rarely set out to duplicate already existing solutions. When it does happen, it's usually a result of imperfect information in the digital health marketplace. We need a standard clearing house for digital innovations that are open to all. Some initiatives are already heading in the right direction. For instance, Digital Square has a clearing house for certified digital global goods, and PATH has created a tool for digital tools focused on noncommunicable diseases in certain African countries.
Yet, both are limited in scope and exclusive rather than an open marketplace. There are also burgeoning groups like The Digital Connected Care Coalition, chaired by Philips, PharmAccess Foundation, and Medtronic LABS — a consortium of digital health innovators actively implementing solutions and building programs in global health. The goal of the group is not only to reduce duplication but also spur collaboration, and to problem-solve around shared challenges.
Modernize infrastructure
Flourishing digital health ecosystems with an integrated set of technologies require modern digital infrastructure. Recognizing the foundational need, large donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank have started early investments in broadband connectivity, modern data centers, and cloud services. Advocacy groups are also pushing for better standards and increased funding.
Transform Health, for instance, is an advocacy organization that comprises private, public, and social sector organizations focused on better equitable digital health transformation through improved coordination and data governance.
Interoperability standards are also key. While interoperability, or the ability for two or more systems to work together, isn’t always the best solution, integrations across different types of platforms allow technologies with different capabilities to co-exist, reducing the burden of fragmentation on the health system.
Rather than exacerbating the digital divide by discouraging innovation, let’s focus on strategies and investments that will allow digital health to reach its full potential.
—Build public-private partnerships
Moving beyond issues of fragmentation, we need to focus on building a strong pipeline of technologies that meet country needs. Private-sector innovators, both local and global, can help country governments execute their digital health priorities through public-private partnerships, or PPPs. While the private sector has often been left out of traditional donor-funded programs, private companies can bring talent, investment, and fresh thinking to spaces that have been stagnant since the first set of digital survey tools launched in the early 2000s.
Even without the support of major donors, successful PPPs demonstrate the power of this approach. Zipline, a logistics innovator best known for drone delivery with cutting-edge technology that is transforming the supply chain and bringing life-saving supplies and medicines to patients, has several PPPs from Rwanda to Ghana. Babyl is another private sector organization transforming care delivery with its technology platform that provides telemedicine services across Rwanda.
As the nonprofit, global health arm of Medtronic, Medtronic LABS has established PPPs and partnerships with health systems in over 10 countries, focused on transforming community care delivery through smarter use of data and clinical algorithms.
Invest in transformative technologies
Due to the consolidation of donor funding, the pathway for new innovators in global health isn’t easy. Many large donors funnel money into a few preferred open source platforms or a few digital global goods, suggesting that alignment avoids fragmentation. Yet, many of the common digital tools used in global health programs haven’t kept up with the global pace of innovation. There are exceptions and signs that this thinking may be shifting, however.
The Rockefeller Foundation, often an early trendsetter, is driving thought-leadership and early investments in “precision public health,” funding initiatives that leverage big data for better population health outcomes. Others such as the Novartis Foundation and Patrick J. McGovern Foundation are supporting entrepreneurs and innovators who work on groundbreaking health care technology in LMICs, including new applications of artificial intelligence, machine learning, and data solutions.
We’ve only scratched the surface of how digital technology might transform health care. A decade ago, the digital health programs currently running wouldn’t have been possible. A decade into the future, the rate of change will accelerate even further. Rather than exacerbating the digital divide by discouraging innovation, let’s focus on strategies and investments that will allow digital health to reach its full potential. Next year at WHA, I hope we’re not lamenting fragmentation, but embracing digital transformation with the potential to drive improved health and well-being for all.
Medtronic LABS is a health systems innovator that develops community-based, tech-enabled solutions for underserved patients, families, and communities across the world. By bridging hyperlocal services with cutting-edge technology, Medtronic LABS provides sustainable and localized health care solutions that produce measurable patient outcomes for all.
Learn more at www.medtroniclabs.org
About the author
Anne Stake
Anne Stake is co-president at Medtronic LABS, where she leads the organization's strategic vision and develops open-source technology and AI to transform health systems. With over a decade of experience at the intersection of technology, design, and public policy, Anne has worked with the Clinton Health Access Initiative, Rwanda’s Ministry of Health, and IDEO. She has designed health technologies alongside communities in Rwanda, Kenya, Ghana, Sierra Leone, Tanzania, India, and the United States. Anne holds degrees from Stanford University, Parsons School of Design, and Oxford University, and is passionate about scaling well-designed technology to improve global health outcomes.
