Current global health priorities, such as the targets of the United Nations (UN) Sustainable Development Goals (SDGs), are ambitious. Setting an agenda for the next 15 years, targets have been established to drastically reduce maternal mortality and premature mortality from noncommunicable diseases; end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases; achieve universal health coverage; and ensure universal access to sexual and reproductive health care services, among others. While vast improvements have been made in global health in the past decades, the health challenges that weigh disproportionately on low- and middle-income countries (LMICs) continue to stand as a barrier to achieving poverty reduction and economic prosperity. Meeting these ambitious targets calls for innovative approaches. In this regard the global health community has recognized the value of digital technology as a transformational tool to accelerate progress in improving global health outcomes.
Digital solutions can increase progress toward better health outcomes in LMICs through speed and reach, while increasing access to goods and services in a more people-centric, affordable, and sustainable way, said
1 The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
Ann Aerts of the Novartis Foundation in her introductory remarks. She noted that digital technologies can also increase the quality of care in LMICs by centralizing expertise and coaching less-skilled health workers by phone, for example. Additionally, digital technologies can reduce inefficiencies by reducing unnecessary referrals to hospitals. As an example of the latter, she explained how a physician or trained nurse could coach a community health worker on how to assist a mother in labor instead of sending her on a 9-hour journey over bumpy roads to the hospital to deliver her child. “I am passionate about digital health not only because it is expanding access,” said Aerts, “but you can put power in the hands of patients themselves. You can empower patients to take more responsibility in the management of their own health.” She added that digital health can empower providers too by supporting them with clinical decision support and remote learning for continuous education.
Digital solutions that contribute to the social, economic, and environmental dimensions of sustainable development can provide attractive business opportunities. Companies in the health and technology sector have core competencies that can be leveraged and the prospect of the value creation for investing in digital health may create incentives for multisectoral involvement. Additionally, both the public and private sectors can find value in developing partnerships with a digital health focus. Public–private partnerships (PPPs) have the potential to promote a multidisciplinary approach to developing solutions, which is ultimately beneficial to all partners and the countries in which they operate. However, as several workshop speakers emphasized, understanding the incentives, priorities, expectations, and core competencies of each stakeholder is essential for identifying effective solutions.
Digital health, Aerts explained, encompasses all concepts and activities at the intersection of health and information and communication technology (ICT), including mobile health (mHealth), health information technology (IT), health information systems, wearable devices, telehealth, and telemedicine. The three main areas of digital health include the delivery of health information to health professionals and health consumers through the Internet and telecommunications; using ICTs to improve public health services, such as through education and training of health workers; and using health information systems to capture, store, manage, or transmit information on patient health or health facility activities.
Applications of digital health are being used to reduce inefficiencies, improve access, reduce costs, increase quality, and personalize care (FDA, 2017). However, despite the growth of the digital health sector, communi-
ties in LMICs often miss out on the benefits of digital health’s potential (Lancet, 2012). LMICs continue to face a fragmented digital health landscape in which multiple public and private actors and agencies with varied technologies and interests are working separately and with overlap (Broadband Commission for Sustainable Development, 2017). Other factors that may lead to this fragmentation include a lack of common standards for digital health technologies and limited human resources in many LMICs to manage the technology infrastructure and use the data this infrastructure can generate (WHO, 2010a).
In this fragmented landscape, scaling of promising digital health solutions is often impeded by a lack of coordinated funding aligned with government priorities; limited regional leadership and peer support; and a lack of low-cost, easily reused, and adapted technologies such as those built with open source software. As several speakers emphasized throughout the workshop, developing digital health-focused PPPs based on government- and community-identified priorities can help connect the dots among the many stakeholders within the digital health landscape, foster coordination and integration, engage both public and private sector stakeholders in tackling existing challenges, and increase the potential for impact.
To explore how the use of technology can facilitate progress toward globally recognized health priorities, including the SDGs, the Forum on Public–Private Partnerships for Global Health and Safety (PPP Forum) created an ad hoc committee to plan a workshop with the following objectives (see Box 1-1)2:
- Identify and explore the major challenges and opportunities for developing and implementing digital health strategies within the global, country, and local context.
- Frame the case for cross-sector and cross-industry collaboration, engagement, and investment in digital health strategies.
- Discuss how health and the health sector can drive other sectors to adopt digital technologies as a common platform.
- Identify the ecosystem of actors necessary for successful digital health strategies, and country- and local-level solutions for moving forward.
2 The PPP Forum was launched in late 2013 with the objective to foster a collaborative community of multisectoral health and safety leaders to leverage the strengths of multiple sectors and disciplines to yield benefits for global health and safety. PPP Forum workshops are an opportunity to share lessons learned and promising approaches, and to discuss how to improve future efforts in areas of global health and safety promotion that have been prioritized by forum members.
To provide some additional context for the workshop, Aerts briefly described the findings of a study conducted by the Broadband Commission for Sustainable Development’s digital health working group. The subsequent report (Broadband Commission for Sustainable Development, 2017), developed from case studies of eight countries at different stages of development or implementation of their digital health strategies, outlined three key success factors. The first is the need for visionary and
committed government leadership to formulate a strategy and secure sustainable funding for implementation. The second factor is to have effective governance mechanisms that engage stakeholders with clearly defined roles and help ensure efficient decision making on a national digital health strategy. The third key to success is a national ICT framework that facilitates alignment between the health and ICT sectors. Such alignment can promote connectivity and interoperability, help establish common standards, and enable appropriate policies and regulations for digital health. The study also found that the eight countries applied one of three different governance mechanisms for digital health: a health ministry mechanism, a government-wide digital agency mechanism, or a dedicated digital health agency mechanism.
Concluding her remarks, Aerts posed four questions for the workshop participants to consider over the course of the day:
- How can we make digital health into a transformative tool, one that improves health and increases equity and economic development?
- How can we encourage innovation across the spectrum, with regard to systems, services, and partnerships?
- How can digital technology be leveraged to address the most pressing global health challenges in a multidisciplinary manner?
- What is needed to ensure we can proceed to scale?
An independent planning committee organized this workshop in accordance with the procedures of the National Academies of Sciences, Engineering, and Medicine. (See Appendix B for the agenda.) This publication summarizes the workshop’s presentations and discussions, and it highlights important lessons, practical strategies, and opportunities for using digital technologies and developing partnerships to advance global health. The content of the proceedings is limited to what was presented and discussed at the workshop and does not constitute a full or exhaustive overview of the field.
In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations, focusing instead on issues identified by the speakers and workshop participants. The workshop proceedings was prepared by designated rapporteurs as a factual summary of what occurred at the workshop.