A panel of experts have called for cautious, strategic and realistic approaches in rolling digital tools out to ensure that patients remain a priority.

Speaking at the Geneva Health Forum on Tuesday, panellists noted that while the expectations for digital health are high, stakeholders need to be aware that digital health tools alone will not solve the world’s global health crisis, and that collaboration is needed to maximise potential.

David Stewart, associate director of the International Council of Nurses (ICN), argued that the differences in the outcomes of digital health implementation in various countries and settings “shine light on major gaps and deficiencies within health systems and digital health strategies”.

In the context of the COVID-19 pandemic, for instance, digital health applications can help track the disease better among patients and healthcare workers, but asked: “Do we have the mechanisms to resource these effectively, and the governance and regulations to support?”

“We are fully aware that we do not adequately capture the number of health professionals that are currently contracting COVID-19,” Stewart said, referring to the widespread assumption that the 20,000 health worker deaths from COVID that have been recorded is a huge under-estimate. “This is particularly relevant when you consider that hospitals and health services are meant to be safe places in which care can be delivered safely, so that people can enjoy quality outcomes.”

Kaspar Wyss, Deputy Director at the Swiss Tropical and Public Health Institute, took this sentiment further, saying that despite the growing number of digital health applications, real potential has often fallen short.

“We have seen a lot of interest, a lot of promises, a lot of new avenues related to digital health, in areas like asthma treatment, smoking cessation, or diagnostics of cancer,” he said. “But there are obviously downsides — ethical issues, legal issues. Sometimes promises were much higher than what was delivered in the end.”

The digital universe can also work against health workers, Stewart also said. Nurses, for instance, who comprise 60% of the overall health workforce have, new levels of censure and reprisal, when they complained on social media about abusive working conditions during the pandemic.

Digital Innovation is Key but Achieving UHC Requires More Work

Even so, the health sector is better positioned than ever to implement digital processes, said Maguette Thioro Ndong, Technical Advisor, Digital Health Solutions for the Digital Square of PATH, a Geneva-based global health non-profit that pioneers innovative health technologies.

“Ongoing digitalization and the introduction of new technology are already breaking down boundaries and creating patient-centered healthcare systems,” she said.

She cited telehealth and mobile health as services that allow healthcare professionals to communicate with, refer and potentially treat patients remotely – and more flexibly.

To achieve the ambitious goals for digital health, Ndong said it would require transformative thinkers to go beyond existing market structures to change the way digital health technologies and innovation are acquired and scaled.

“They will help us to better match the pace of digital health funding and implementation to the pace of technological evolution,” Ndong said.

But effectively innovating within the health sector would require more than just digital advancements and new technologies, argued Riccardo Lampariello, Terre des Hommes’ Head of Health Program.

He drew on experience from the deployment of the Integrated e-Diagnostic Approach (IeDA) in Burkina Faso, West Africa. The tool, which helps healthcare workers make a clinical diagnosis, has been deployed in 70% of primary health centers in Burkina Faso where it is being used for around 200,000 consultations every month.

The government of Burkina Faso is expected to take over the service by the end of 2020, and the system is now also being deployed in Niger and Mali.

“While digital health is necessary to reach universal health coverage (UHC), it is not sufficient to achieve UHC alone,” he said.

He emphasised several factors surrounding digital technologies which can limit – often severely – patient outcomes: namely sustainability and cost, along with health workers’ unwillingness or inability to use the technology applications.

These factors must play a part in designing implementation or response measures, he argued.

Keeping Patients at the Centre of Health Sector Innovation

Unlike in other global sectors, implementation of digital technology in health work must be more focused on patients than profit, argued Bernardo Mariano, Director of WHO’s Department of Digital Health and Innovation.

Referencing the Global Strategy on Digital Health, approved by WHO Member States during the 73rd World Health Assembly in November, he said the ambitious WHO strategy aims to lay the foundation for the future of digital health and achieve transformation of the health sector similarly to how it has revolutionised the finance and banking sector.

“These sectors are quite advanced in their transformation. Government, social media and media in general are also quite advanced in their digital transformation. We want to see the digital transformation of the health care sector to be much better than all these other sectors,” Mariano said.

But unlike the finance and media sectors, where efforts have been geared primarily towards achieving profitability, Mariano stressed that it is essential that all stakeholders are working to ensure that digitalization of the health sector does not result in the loss of the people-centric element of healthcare.

“People centric elements in the ecosystem will deliver those health benefits we want to see delivered at every level,” Mariano said.

Image Credits: Geneva Health Forum, Amnesty International.