More Than Cables & Devices: Digital Health Event Points to Human Factors Digital Health 28/05/2021 • Svĕt Lustig Vijay Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) In two decades of work on World Bank digital health initiatives, global health policy specialist Akiko Maeda found many fell short of their promises. She suggested these underperforming digital health initiatives focused too much on delivering hardware — but they failed to provide means to ensure stable electricity supplies, and similarly failed to provide adequate human resources to manage data, or to design initiatives that the most vulnerable groups could benefit from. Akiko Maeda, health economist with over 30 years of experience in international development in over 40 countries “It’s not just the infrastructure and the hardware, but how we design the software that goes with it,” Maeda said Thursday. She spoke at a World Health Assembly side event co-hosted by the Geneva Graduate Institute’s Global Health Centre, the Lancet & Financial Times Commission, and Digital Square, which is supported by USAID and the Bill and Melinda Gates Foundation. “Digital infrastructure is more than just a bunch of cables and devices,” said data literacy consultant Gulsen Guler, who is also co-chair of My Data Global, a civil advocacy group promoting equitable digital societies – adding that the stakes are high: “Digital technologies can determine what the future of a child will look like…or even more, they can determine between life and death.” Digital Health Saves Resources to Reach Universal Health Coverage Roger Kamba, Special Advisor to the Democratic Republic of the Congo (DRC), called digital technologies crucial in low-income countries. He said these tools can help countries reach universal health coverage and that digital health can help to meet Sustainable Development Goals. “Digital health is not an option, but rather a necessary step towards universal health coverage,” Kamba said. “I remain personally convinced that there can be no universal health coverage without a substantial contribution from digital health.” However, he said that for that to happen, governments must prioritize digital transformation through a multi-sectoral approach that goes beyond the health ministry. In 2019, the DRC adopted its digital technology strategic plan, Kamba said. Implemented by a newly-created ministry, the plan engages all sectors, including health. “All governments need to take a systems approach to digital transformation. It’s not just the health ministry that needs to be working on health care anymore.” An Epidemiological Nerve Centre – The Emergency Operations Centre Kamba said existing digital health initiatives, notably the nation’s Emergency Operations Centre (EOC), have proven useful in quickly containing infectious disease outbreaks like Ebola. Set up two years ago by PATH, USAID, and the Bill and Melinda Gates Foundation in collaboration with the DRC Centers for Disease Control, the EOC acts as the country’s epidemiological nerve centre to coordinate efforts to prevent, detect, and rapidly respond to public health emergencies. “The center uses tools such as digital mapping, Geographic Information System (GIS) mapping, and mobile health technologies to produce layers of information that help reveal patterns that enabled more effective interventions during the Ebola epidemic,” he said. “Actionable surveillance data and digital epidemic maps made the response faster and more focused, and was the first time that response data was digitized and centralized”. Recently the EOC expanded its scope to investigate regional and local malaria trends; it also facilitates disease control strategies using advanced data analyses. Kamba warned that digital health initiatives depend on reliable and affordable electricity, which can be a challenge in low-income countries: “We’re talking here about the potential of digital solutions to help us overcome long standing infrastructure challenges in sub-Saharan Africa … Investments in digital health in DRC must be coupled with energy solutions at the national level.” “These [digital] infrastructures are also faced with a fundamental financing gap,” said Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. “To really have sustainable financing that’s also reflected in the budgets of countries is a truly, truly big challenge.” Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. Digital Health in Burkina Faso Improves Care Quality Meanwhile in Burkina Faso, Swiss NGO Terre des Hommes (Tdh) has worked for over a decade with the Ministry of Health to develop Ieda – a digital job aid tool that enhances the clinical diagnosis of childhood diseases and improves health workers’ performance using artificial intelligence (AI) algorithms. Ieda already is available in 80% of health-care facilities in the country and has helped with a whopping 10 million digital consultations. This generates savings of US$1.6 million every year, Tdh health programmes research head Riccardo Lampariello said. “Digital health solutions at scale bring financial savings for the authorities, of course after the initial national investment, of $1.6 million every year. Hence the importance of investing in digital health.” Lampariello stressed that the bulk of digital health expenditure is not on infrastructure but on human resources required to build necessary technical and regulatory capacity. He noted that governments need to run local data centers, extract and analyze data, update software and fix data platforms when they crash. Riccardo Lampariello, head of Tdh’s health programmes “Digital health is human resource-intensive, and we should equally invest in infrastructure — which is not only tablets and solar power panels, it is also data centers, for example — and in human resources, including local authorities, including the government, the MOH, in technical skills … and also look to teach them the governance skills to regulate labor use.” Thanks to this already-existing digital health infrastructure, when the coronavirus hit it took only a few weeks for Burkina Faso’s Ministry of Health to deploy digital tools to support training, awareness-raising and triage, and to reach vulnerable groups in remote and unsafe areas, Lampariello said. But he warned that the digital health landscape is still fragmented in low-income countries, challenged by duplication, a lack of interoperability and waste of precious devices and electricity. “Even before COVID, it wasn’t rare to pay a visit to a health-care facility in a very poor country, open a cupboard and find two or three tablets or smartphones [for] dealing with different platforms and databases. In a context of limited resources, this represents a lot of wasted tools,” Lampariello said. “And not to mention, for example, the additional unnecessary e-waste and energy consumption related to that.” Speakers Ask For Well-Designed & Equitable Digital Health Initiatives Digital health initiatives are likely to be more impactful if they designed to be equitable, added panelists on Thursday. In Japan, for example, vaccine uptake in older age groups was hampered by the country’s response plan failing to consider that booking vaccine appointments online can be a struggle for older people. “It’s a design issue, and it’s not a complex issue, but it was not adequately designed for the elderly, so there’s a huge problem going on right now in Japan,” said Maeda. Ann Aerts, Head, Novartis Foundation “Every solution, digital- or AI-driven, has to be human-centered,” said Novartis Foundation head Ann Aerts. “And that’s quite obvious, although it’s not always the case. The best way is to use a human-centered design with input from the people who will have to use a solution, and by thinking up-front how the solution will be integrated in the processes of the health workforce, or the workflow.” According to a World Bank study, successful digital health initiatives tend to share characteristics like strong leadership and regulatory systems, substantial financial commitments to digitize health systems, and national frameworks to facilitate data flows between systems, added Aerts. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. 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