Does it go far enough on digital health and health data governance?
Co-authors
Allan Maleche (Executive Director, KELIN/Transform Health Kenya coordinating partner), Caroline Mbindyo (CEO, Amref Health Innovations), Christoph Benn (Director for Global Health Diplomacy, Joep Lange Institute), Dedi Supratman (President, IAKMI – Indonesian Public Health Association/Transform Health Indonesia coordinating partner), Dykki Settle (Chief DIgital Officer, PATH), Eléonor Silva (Executive Director, UNITE), Frances Baaba da-Costa Vroom (President, HELINA), Iveth J. González (Head of Health Programme, Terre des hommes foundation – Tdh), Jai Ganesh Udayasankaran (Executive Director, AeHIN), Jeroen Maas (Director, Digital Connected Care Coalition – DCCC), Joseline Carias (Chief Operating Officer, RECAINSA), Juan Pablo Carvallo Vega (CEO, CEDIA/Transform Health Ecuador coordinating partner), Krishna Jafa (CEO, Medic), Marta Fernandez Suarez (Chief Technology Officer, FIND), Mathilde Forslund (Executive Director, Transform Health), Neira Budiono (Youth Coordinator, YET4H – Young Experts: Tech for Health), Nicole Spieker (CEO, PharmAccess), Nirmala Nair (Founder/Director, Kaboom Social Impact), Pape Gaye (Founder-President, Baobab Institute for Health and Development), Ricardo Baptista Leite (CEO, I-DAIR), Riccardo Lampariello (CEO, D-tree), Stefan Germann (CEO, Fondation Botnar)
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Governments will meet on 21 September at the High-level meeting on Universal Health Coverage (UHC HLM) – taking place during the 78th session of the UN General Assembly – to identify gaps and solutions to accelerate progress towards the achievement of universal health coverage by 2030. Ahead of the meeting, the latest draft of the Political Declaration has now been submitted to the President of the General Assembly.
Similar to the zero draft of the Political Declaration that came out in May, the latest draft includes important commitments related to digital health, including around the promotion of policies, laws and regulations to build and strengthen an interoperable digital health ecosystem; addressing the digital divide; investing in and encouraging the use of evidence-based and user-friendly technologies; and recognising the need to protect data and privacy.
It also includes additional language around ensuring that digital health interventions complement and enhance health system functions, including the need to address challenges that developing countries face in accessing and developing digital technologies. However, it notes that digital health can’t replace core health system functions (e.g. the health workforce, financing, leadership and governance, and access to essential medicines) and that these areas require continued attention.
We welcome these important commitments. However, we think that the Political Declaration could still go further to fully recognise the transformative potential of digital health to accelerate UHC progress. While digital health can’t replace core health system functions, it can complement and enhance them. Digital health is already an important and growing part of most health systems and can help scale up access to primary health care services (including community healthcare), strengthen resilient health systems, and close equity gaps by expanding the reach of health services (such as screening and diagnosis) to remote and neglected areas to deliver health for all.
The new Global Initiative on Digital Health (GIDH), launched by the WHO and the G20 India presidency during last month’s G20 Health Ministers Meeting, recognises the critical importance of digital health as a “proven accelerator to advance health outcomes towards achieving Universal Health Coverage”. It provides an important opportunity to bring countries and partners together to move towards this goal and deliver on commitments in the Political Declaration.
In recognising the importance of digital health, governments must increase and better target funding for the equitable, inclusive, rights-based and sustainable digital transformation of health systems, as part of wider health system investment. This is an important catalytic investment, which has the potential to build stronger and more resilient health systems that leave no one behind. Transform Health’s Closing the Digital Divide report lays out key recommendations for what is needed, including around better coordinated and aligned investment, prioritising digital health strategies, strengthening the regulatory and policy environment, and meaningful multi-stakeholder engagement. The World Bank’s new report Digital-in-Health: Unlocking the Value for Everyone, presents a new way of thinking about digital health investments, integrating digital and health as one: Digital-in-health.
When it comes to data, the Political Declaration highlights the importance of data to monitor SDG3 progress and for evidence-based decision making, while also recognising the need to protect data and privacy. However, it doesn’t speak to the need for more effective and equitable governance of health data to maximise the potential of health data sharing within and across borders, while also managing risks, protecting individual rights, and ensuring people’s data is protected from misuse. People must also be empowered and enabled to understand and actively participate in managing their health data. These are important to lay the foundation for improved public trust in health data systems, stronger and more equitable health systems, improved health emergency response, and better health outcomes. This is also critical for creating an enabling environment for equitable impact of technological innovation, for example, in fields such as artificial intelligence powered diagnosis and surveillance.
For this to happen, governments must strengthen their national legislation and regulations that govern the collection, ownership and use of health data, underpinned by equity and rights-based principles, giving individual and collective rights of marginalised groups and populations particular consideration. By agreeing on what the optimal and necessary regulations are (articulated within a health data governance framework, for endorsement through a World Health Assembly resolution), this would provide an important benchmark and tool to support countries to do so.
As governments harness the opportunity for digital advancements to accelerate health and other SDG goals, this must be alongside concrete action to close the divide in digital access, which is imperative for equitable access to technology-enabled health services. As emphasised by the UN Special Rapporteur on the Right to Health in her report on Digital innovation, technologies and the right to health, there is a need to “promote digital inclusion, access to affordable and reliable connectivity, and the underlying need to address digital literacy and the gender digital divide”.
As we head into the High-level meeting, we urge governments to not miss this opportunity to make ambitious commitments around digital health and health data governance as key accelerators and components for UHC to be achieved by 2030. This will help ensure we are “scaling up the global effort to build a healthier world for all” – the ambition set for this year’s High-level meeting.