> Key partner: United States
> Last updated: 20 December 2021Download PDF
Digital connectivity, as a channel for the delivery of data, information, and services, is a critical health commodity. Indeed, a recent Lancet and Financial Times Commission report posits that digital transformation is a new determinant of health.
During the COVID-19 pandemic, as with the Ebola epidemic of 2013-2016, efforts to meet the urgent need for accurate information in a rapidly changing environment are hampered by fragmented digital systems (i.e. not interoperable). Digital health systems that are siloed by disease or health promotion area are common and they impede data exchange and use. By making it harder to access, analyse and triangulate health data, the silos obscure health trends and nuance, undermining scope for more targeted health information sharing and service delivery.
This issue is particularly critical in low-income and lower middle-income countries where health system digitalisation often depends on assistance from international partners who have a history of investing in digital systems that are siloed, reflecting their own institutional structures, expertise and technological capacity. COVID-19 (and Ebola before it) revealed that the lack of co-ordination (rather than a lack of digital technology and systems) is one of the greatest problems in the digital transformation of health systems. International development agencies and organisations urgently need a new strategic approach oriented toward strengthening the digital transformation of partner country health systems, promoting more interoperable and co-ordinated digital systems.
The United States Agency for International Development (USAID) recently published a Digital Strategy and a sector-specific Digital Health Vision that describe the importance of assessing and strengthening the country ecosystems in which digital systems are used. Moreover, other countries, India and United Republic of Tanzania being interesting examples, have begun publishing national strategies for health sector digital transformation, creating a powerful opportunity for funder co-ordination. Several multilateral organisations and development co-operation partners have recommended adopting a similar, systems-level approach to planning for, and investing in, digitalisation. In the health sector, organisations call for strengthening national digital health governance, strategy, policies, and architecture through, for example, the 2018 World Health Assembly Digital Health Resolution, the 2020 WHO Global Strategy on Digital Health, and related materials issued by UNICEF, the Pan American Health Organisation, and the Asian Development Bank.
To strengthen co-ordination, USAID is undertaking a variety of co-investment and co-ordination activities described below. USAID also supports the periodic assessment of country health system digitalisation, enabling funders to align around existing tools and address identified gaps. In the context of fast-moving disease outbreaks like COVID-19, investing in the reuse and strengthening of existing digital systems - already a core part of a country’s health system - is an efficient way to meet urgent needs prior to investing in something completely new or parallel.
In line with its Digital Strategy and in collaboration with other bilateral development agencies and multilateral organisations, USAID is supporting initiatives that facilitate co-ordinated investments in interoperable and scalable digital health systems. These include, for example:
A community of practice made up of endorsers of the Digital Investment Principles. The community meets regularly to identify and address opportunities to maximise co-ordinated investments.
The UNICEF-WHO Digital Health Center of Excellence (DICE), a new, multilateral technical assistance facility on digital health. It is designed to respond to COVID-19 needs using a co-ordinated, systems-strengthening approach.
New centralised and WHO-administered platforms addressing barriers to information. These include the Digital Health Atlas, which captures information about the deployment of country-level digital systems, and the Digital Clearinghouse which connects ministries of health and their partners to vetted digital solutions.
The digitalisation of health systems presents a critical opportunity for countries to become more nimble and agile in detecting, responding to, managing, and recovering from health threats. These benefits will only accrue, however, if the global community fully implements and learns from well-documented lessons.
Despite the clear benefits of moving to interoperable health systems, there are many barriers to finding alignment between country priorities and international development funding. These include a lack of commonly accessible basic information about existing country digital systems and capacity, the complex delivery architectures of funding institutions, the high transaction costs involved in co-ordinating or harmonising projects between multiple funding partners, and the current lack of visibility about past, ongoing, and planned digital health investments by funding organisations.
Open, secure, inclusive, rights-respecting and standards-based digital health systems are critical to the delivery of public services. Many international development co-operation partners are calling for increased consideration of digital public goods that can work across disparate geographical regions and health sectors, building on country assets.
Investments in digital health systems require parallel investment in “analogue” components, such as strengthening the human and institutional environments in which digital systems and data are used, to advance progress towards outcomes of equity, quality, and resource optimisation (see USAID vision for health system strengthening 2030, p.38).
To understand how best to direct funding, it is essential to conduct periodic assessments of country digital systems and digital capacity readiness. With the advent of the Digital Health Atlas, there is now a home for information about country digital systems. A similar hub is needed for information about country digital capacity readiness, including data sets such as those published on the Global Digital Health Index.
Funders should track and publish investments related to the digitalisation of country health systems. A simple lack of access to information about funding flows is currently a major obstacle to improved co-ordination.