In the past five years, we have witnessed remarkable advancements in technological innovations — including mobile phones, tablets, remote patient monitoring devices, and sensors — that drive so-called “digital health” around the world. Increasingly, these innovations are also equipped with GPS and metrics that generate promising evidence of their cost-saving and, more importantly, life-saving capabilities.
The technologies alone are not enough, however. To truly harness the power of these trends, we need a Global Digital Health Index that will drive the expanded use of life-saving digital health technologies by making health systems more transparent, resilient, responsive, and better able to meet the needs of the population.
Alongside technological breakthroughs and advancements, we are also encountering cross-border, global, and ecological scourges the like of which the world has never seen. The 2014 Ebola crisis in West Africa is one example — the United Nations Development Program reports it was the longest, largest, deadliest, and most complex health crisis in recent history, marking the first time that the virus had been transmitted to other countries through air travel. The new global threat of the Zika virus is another one.
Both Ebola and Zika highlight the need for high-impact investments in digital health within and across countries — not just as a “nice to have,” but rather as an integral part of how you deliver and improve coverage of critical health interventions. For many years the field of digital health has had to defend itself against economic skeptics, answering questions such as, “Do I pay for SMSes to track immunization coverage … or vaccines?”
But this is no longer a valid paradigm. Digital health is part and parcel of the full health intervention package, and needs to be thoroughly integrated into health systems.
Let’s look at the Ebola virus. While it was shameful that the global health community was unable to put strong systems in place before the Ebola epidemic took its toll — even with unprecedented technological capabilities to track epidemics — the virus did demonstrate that with enough urgency, technology could be used to identify and track every single Ebola case from Texas to Liberia and Sierra Leone, and ensure no new cases. Countries are now moving to national and multinational scale disease surveillance, thanks largely to linked data systems.
The case for a Global Digital Health Index
The recent adoption of the Sustainable Development Goals marks an important moment in time to build strong systems before the crises happen. We need to use this opportunity to set a baseline, measure and monitor investments in digital health, and correlate those investments with progress against SDG 3, which includes ensuring healthy lives and well-being for all at all ages.
The Global Digital Health Index — an interactive digital resource to track, monitor, evaluate, and score the effective use of digital technology for health among World Health Organization member states — will support these efforts. Similar to how the Human Development Index has driven global development progress and the eGovernment Index has shaped investments in technology infrastructure, the Global Digital Health Index will harness data to improve the health of people around the world, help government officials better serve their countries, drive informed investment from funders, and guide smart private sector engagement. HealthEnabled and the WHO are currently developing the Index and plan to release the first edition within the next year.
Importantly, the index will provide data on the uptake and use of information and communication technologies over time by countries, regions, and globally. These data will be invaluable for trend analysis and planning. Users of the Index will be able to create searches based on their specific information needs and retrieve their search results in graphic or tabular forms.
Information guidance to drive progress
Why do we need an index?
While over half the countries that reported into the WHO’s 2013Global eHealth Survey (from which the Index evolved) reported having national eHealth strategies and policies, it has been difficult for countries to bring coherence to tens of hundreds of systems and applications, mitigate the risks of large-scale investment, and bridge the “know-do gap” from policy to implementation. Thus far, investments in digital health have been piecemeal — almost like building parts of the house without the frame in place first — and the use of technology to improve health in most countries and at a global level is fragmented, unsynchronized, and duplicative.
The index will help government officials drive health progress in their countries. With national frameworks in place to monitor the effects of digital health investments and provide informed guidance as to where those investments are most needed, those investments will go further and link more effectively with global frameworks.
The Index will also drive progress by shining a light on positive examples — decision-makers in ministries and departments overseeing public health will be able to borrow best practices from other countries and engage the corporate sector and funding agencies effectively. Currently without guidelines to facilitate a rational approach to using and adopting technology within national health systems, the situation is a bit like the “Wild West” — some leaders are getting it right, making sense of technology, and ensuring it is part of the bigger health picture; while others are circling the wagons with limited impact.
The index will help private sector leaders as well. The private sector has so far largely engaged in digital health either strictly as for-profit business or corporate social responsibility. Companies should explore a third dimension to leverage the best of their expertise in commercial grade enterprise systems the produce social returns on investment, making it possible to transition from national to global health real-time monitoring and disease surveillance. The index is poised to identify and promote public and private sector financing’s advancement of social and economic returns on investment.
The rising tide
Most of all, people around the world will benefit from the index. There is growing evidence that digital health is having a multiplier effect in improving access, increasing efficiency, measuring progress, and providing transparency and accountability. Individuals will be equipped with information to prevent disease and receive better care if healthcare providers and governments have better data.
The potential of digital health is there, but it must be unlocked. In many countries, a unique combination of political will, technological breakthroughs, private sector engagement, and getting people to take charge of their own health will do this. As postulated in Amara’s Law, “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.” The Global Digital Health Index aims to help all boats float to the top, and it is our collective responsibility to see that it happens.
Wired for Impact is an online conversation with Novartis Foundation and Devex to explore how to integrate digital health into global development in a way that is scalable and sustainable, and improves the overall quality of health care delivery to build essential connections between patients, health facilities, health providers and policymakers. Tag #Wired4Impact and @Devex to join the conversation.
Dr. Patricia Mechael is principal and policy lead at HealthEnabled, an Africa-based not-for-profit that helps governments integrate lifesaving digital health solutions into their health systems. She also is the executive vice president for the Personal Connected Health Alliance and a visiting professor at Princeton University. @PattyMechael @HealthEnabled
Misha Kay is the head of the Global Observatory for eHealth, launched by the World Health Organization in 2005 to monitor, analyze and report trends in the adoption of information and communication technologies for health. Over the past 10 years the GOe has conducted three global surveys and published numerous thematic and global reports. Prior to WHO, Misha was the director of electronic publishing at the Open Society Institute, Budapest, where he introduced a special program to support NGOs using the internet to promote open society in countries in transition.
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