What’s needed to harness the potential of digital health?

When COVID-19 hit, the adoption of digital health technologies skyrocketed as many health services moved online. Global health institutions and leaders are now looking to harness this high-tech momentum to expand universal health coverage and bring services to underserved communities. Digital health was on the agenda at the Mobile World Congress — the world's largest mobile industry event, which took place in Barcelona, Spain — where attendees could see everything from remote surgery robots to digital health startups from every corner of the world and more than one big pharma logo. For the 11th consecutive year, the congress was also home to the Digital Health & Wellness Summit, a one-day event hosted by the European Connected Health Alliance. During the session “Africa is rising: Africa digital health networks,” Jean Philbert Nsengimana, the chief digital health adviser for the Africa Centres for Disease Control and Prevention, stressed that mobile technology could improve the access and affordability of health care across the continent. “​​Today, more than 50% of Africans live more than 5 kilometers from any health center, and in many of those places, there is no electricity, and other types of infrastructure are still lagging behind. The only type of infrastructure that reaches everywhere is mobile,” said Nsengimana, adding that “it’s a multibillion-dollar opportunity for investors, for innovators, for policymakers. But it’s also a great challenge that no one can solve on their own.” Over 40 African countries have developed national digital health strategies and the Africa CDC released its own last year to support its member countries. The biggest gap now is to ensure these strategies are being implemented, Nsengimana told Devex on the sidelines of the session. “After COVID, all [digital health] strategies became obsolete overnight. So now every country needs to review their strategy and try to align it to the context as much as possible. But be agile. Without agility, strategy is futile,” he said. Another session looked at unlocking digital health collaboration in India and how the sheer size of the country’s 1.4 billion population has allowed its digital health sector to thrive. “India is the digital health capital of the world,” said Rajendra Pratap Gupta, the founder of New Delhi-based research institute Health Parliament and a former adviser to the Indian Union health minister. During the COVID-19 pandemic, the country launched the world’s largest vaccination program through a homegrown app called Winning Over COVID — or Co-WIN — which delivered over 2 billion vaccine doses in just 18 months and provided citizens with a globally valid digital certificate while most countries were still using paper-based proofs of vaccination, Gupta explained. The app allowed the country to administer vaccines at a staggering pace, surpassing the combined vaccinations achieved by the United States, Brazil, Indonesia, and Japan, according to UNDP India. At one point, 14,000 people across the country were being vaccinated every minute. But reaching such a large and diverse population with digital health services doesn’t come without challenges. To ensure accessibility across India’s 28 states and its different local languages and dialects, the health ministry’s national telemedicine app eSanjeevani used large language processing models to enable patients and doctors who don’t speak the same language to communicate, explained Gupta during the panel. “If I speak in one of the languages from the southern states and I’m conversing with a doctor in north India who speaks a different language, the doctor hears a transcription in his native language and I as a patient hear everything in my language,” he said. Institutions and interoperability Gupta, who played a key role in drafting the National Health Policy for India, also pushed for the need to build strong institutions to help drive continuity in the implementation of digital health and to not only focus on policies and regulations. “If you create institutions, they work perpetually. Otherwise, you can have a digital health program, and the bureaucrat or minister who comes in and likes it will push it, but if someone doesn’t like it, they will just put it aside,” he said. The role of institution building was also highlighted in the context of digital health in Africa. “The difference between digital experimentation and digital transformation is that someone is actually in charge of transformation,” Dr. Alain Labrique, the director of the digital health and innovation department at the World Health Organization, told Devex on the sidelines of the event. He also stressed the importance of establishing institutions and a regulatory framework. “It’s making sure that … these solutions are developed with person-centeredness and interoperability in mind so that systems talk to each other even if the politicians don’t,” he said. Integrating the private sector However, there’s also a need to improve the integration of innovations from the private sector into the public health system. “There’s a lot of innovation happening with respect to AI and machine learning, so how do you integrate those in a seamless way into the domain of public health?” asked Pavan Ananth, founder and CEO of Pravesh, a consulting firm focused on scaling innovations in developing markets. Fragmented health systems — like the one in India — which count on both a public system as well as thousands of private sector providers in rural areas, also need to consider interoperability between systems, explained Ananth. For example, ensuring patient records can easily be transferred between providers and the systems used in different states. One area in the Indian digital health space with a lot of potential is point-of-care diagnostics, said Ananth. While there are over a million ASHA workers — accredited female health workers — working to reach millions of people across villages, they need to know what to address and what illnesses are out there, he explained. “A lot of innovation is going into point-of-care diagnostic devices that can be simple, handheld, and portable and in a couple of minutes give a result to the end user,” he said, adding that “it’s about empowering the frontline health care workers with the right technology tools to make their lives easier so that they can actually provide their services at the last mile.” Leveraging the lack of legacy The African continent offers other advantages for digital health, explained Ananth, who also works in several African countries. “Especially Kenya and Rwanda have been really open and fertile ecosystems for digital health, offering more political stability, which is an important factor,” he told Devex on the sidelines of the event. While India has seen a step-by-step implementation of digital health that’s been driven by the government, Africa has a chance to leapfrog and take advantage of the fact that the regulatory framework to a certain extent doesn’t exist yet, meaning the introduction of innovation is quicker and not stifled by legacy and complex regulations, he explained. “Some rural areas in Rwanda don’t even have road access, but they have drone delivery that now does some 40 to 60 deliveries a day,” said Ananth, who previously led global business development at drone-delivery company Zipline. In the case of Rwanda, regulation followed, meaning it could be adapted to quickly scale the innovation, he explained. In many Western countries, the problem of introducing new technology was made evident during the pandemic, when many countries had to pass exceptional legislation and remove restrictions to take advantage of telemedicine, explained WHO’s Labrique. “On the African continent, we have to examine where there are opportunities for innovation that are not stifled by legacy,” he said. There’s also potential for more demand-driven health care where clients can, for example, request a refill on their contraception and choose whether it’s delivered to them by drone or by a health care worker, said Labrique. “These are the paradigm shifts we need to be thinking about and Africa is absolutely the continent that will lead on this.”