Public consultation on a draft model law (7-30th April)

To fully harness the potential of health data for public benefit and improved health outcomes, while also managing risks, protecting individual rights, and ensuring people’s data is protected from misuse, it is important for governments to strengthen the governance of health data through more robust and equitable legislation and regulation. A model law on health data governance can support this by building consensus around what is needed.

A PUBLIC CONSULTATION ON A DRAFT MODEL LAW ON HEALTH DATA GOVERNANCE (7-30 APRIL 2024)

On the 7th of April, World Health Day, Transform Health and partners are launching a period of public consultation on a draft model law on health data governance, which contains core elements, guidance and reference legal text to support more effective and equitable health data governance. The model law aims to build consensus across countries and stakeholders around essential areas that should be addressed through national legislation, while also helping to establish a level of harmonisation in national approaches to foster greater legal coherence across jurisdictions. This, we believe, would strengthen trust and collaboration across countries and facilitate cross-border data sharing, with the needed protections in place. Importantly, the model law serves as a resource for governments by offering guidance and sample text to support them to integrate the principles and standards into their existing national legislation and frameworks, or develop new laws where and if needed.

The public consultation period will run from the 7th until the 30th of April. Through this process we aim to gather stakeholder and expert feedback to strengthen and validate the draft, while building consensus, alignment and broad support around the core elements of the model law. The consultation page contains the model law and survey to provide feedback, in five languages (English, French, Spanish, Portuguese, Arabic). You can also find more information about the model law and the consultation period, resources to support governments and partners wishing to convene consultations and a social media toolkit. 

WHY IS A MODEL LAW NEEDED AND HOW CAN IT MOVE US TOWARDS MORE EFFECTIVE AND EQUITABLE HEALTH DATA GOVERNANCE?

While several countries and regions are taking steps to strengthen their health data governance legislation and regulation, approaches vary and there is no overarching consensus around core areas that should be addressed through national legislation and regulations for the effective and equitable governance of health data.

We believe that there is value in countries and other stakeholders coming together to learn from different approaches and experiences, identify good practices, understand where there are gaps, and build a level of consensus and alignment around what is needed. This would be strengthened by governments taking the model law through the process to endorse a World Health Assembly resolution, and subsequently through national implementation. 

HOW HAS THE MODEL LAW BEEN DEVELOPED?

Transform Health and partners have been supporting the development of the draft model law on health data governance. The drafting has been led by a team of legal experts, with guidance from an expert advisory group and feedback from the Africa CDC Flagship Initiative on Health Data Governance working group and the governance circles of Transform Health, a coalition of more than 150 organisations. The draft has been informed by equity and rights-based principles, among other national, regional and international instruments, commitments and best practice; inputs from multi-stakeholder regional consultations convened by the Asia eHealth Information Network (AeHIN), the Pan African Health Informatics Association (HELINA) and RECAINSA, which consulted nearly 500 stakeholders from across 65 countries to learn from experiences and gather insights and perspectives; and national legislative and regulatory landscape reviews of more than 30 countries. 

During the public consultation period (7-30 April), we will gather feedback to further strengthen the draft. This will include a widely disseminated public survey; a community forum on the 29th of April that is open to all stakeholders to learn about the Model Law and provide feedback (Register here); national and regional consultations; stakeholder-specific consultations and outreach with youth and parliamentarians; and interviews with national, regional and global experts.

The process of developing the model law has been designed to be inclusive and collaborative, to bring in a diversity of perspectives and expertise to inform its development and to ensure its legitimacy and ownership. 

WHAT’S NEXT

Following the consultation period, the draft model law will be updated to reflect the feedback received. It will be presented at a World Health Assembly (#WHA77) side event, ‘Stronger Health Data Governance through Country Leadership and Consensus’, taking place on the 28th of May 2024 in Geneva. The event will bring together experts in this field, together with country leadership, to build the consensus needed to drive this agenda forward.

Government leadership on this agenda is critical. The model law provides a starting point for governments to discuss, negotiate and build consensus around what is needed to strengthen health data governance. We encourage governments to take the model law forward, through  Member State consultations, towards its eventual endorsement through a World Health Assembly resolution and regional processes. As we look towards the 77th World Health Assembly in May 2024, we encourage governments to take action to move this process forward.

The model law on health data governance is an important step and opportunity to move us towards more effective and equitable Health Data Governance, laying the foundation for improved public trust in health data systems! 

If you have any questions or would like to get involved, email us at [email protected].

Digital transformation of health is an important accelerator of progress towards Universal Health Coverage (UHC) and improved health equity. It also offers an important entry point to address gender inequalities in health access and outcomes and improve women’s and girls’ health and wellbeing. However, this requires an intentional focus to prioritise gender within plans, strategies and financing for the digital transformation of health systems.

Transform Health is a coalition of more than 150 organisations committed to harnessing the potential of digital tools and data to achieve UHC by 2030. With our focus on the individuals and communities who are most affected by the lack of access to affordable and high-quality healthcare, particularly young people, women and marginalised communities, we have been identifying priority areas for action around gender and digital health, with the aim of working with partners across the health, digital health and gender landscape to drive action.  

Our early research has revealed that women and girls face particular challenges in accessing digital solutions and benefiting from the digital transformation of health to improve their health and well-being. As part of this work, we conducted a survey to gather the inputs of communities, organisations, health workers and other experts on the key barriers, challenges and opportunities for women and girls to fully benefit from the digital transformation of health systems. These important perspectives will help inform a new policy brief that we will launch later this year. This blog highlights key issues that have emerged from the survey. 

Challenges preventing women and girls from accessing and benefiting from digital health solutions 

Many of the challenges and barriers are applicable across diverse contexts and geographies. A key access barrier is limited internet connectivity and gender-skewed smartphone ownership, particularly in low-resource settings and rural areas, which hinder the ability of women and girls to fully utilise digital health solutions, restricting their access to health information and care. Digital health solutions also often overlook the specific needs and preferences of women and girls, resulting in them inadequately addressing their specific healthcare concerns.

Cultural and social factors also play a significant role in hampering women’s access to digital health solutions. Gender norms and societal expectations often discourage women from independently engaging with digital health platforms, due to fear of social stigma or familial repercussions. Policy and governance issues also play a role. The absence of gender-sensitive legislation and policies can expose women to privacy breaches and misuse of their health data, eroding trust in digital health platforms. Without adequate safeguards and regulations, women may remain hesitant to utilise these services, further widening the gap in healthcare access and outcomes.

Opportunities to improve access to digital solutions for women and girls 

A key opportunity that can help improve access to and the use of digital solutions is increasing investment in education and awareness, through digital skills programs targeted at women and girls. Such programs can support  basic digital literacy, along with specific skills related to navigating digital health platforms. Additionally, allocating funding specifically towards research, innovation, and implementation of digital health solutions tailored to women’s unique healthcare needs and preferences  is important. 

Another area is fostering a more equitable healthcare landscape by ensuring that digital health solutions are unbiased, accessible, effective and respond to the needs of all individuals, regardless of gender. Similarly, gender considerations should be considered in the design and implementation of digital health governance systems, including the handling of health data, thus facilitating greater trust, participation and engagement in digital health platforms.

What next?

Transform Health will convene a workshop at the Geneva Digital Health Forum, around key issues, opportunities and priorities within gender and digital health, with the aim of building consensus, forging a joint vision, and strengthening collaboration around needed action. During the session we will launch a new policy brief outlining positions on the intersection of gender and digital health, while setting out key areas and opportunities where Transform Health and our partners aim to play a strategic role to drive progress in this area. 

We are committed towards advocating for equitable, sustainable and inclusive digital transformation of health systems to deliver UHC. Narrowing the digital gender divide and fostering more inclusive and equitable healthcare systems that meet the diverse needs of women and girls worldwide is a pivotal point of action in this direction.

Transform Health’s recommendations for the G20 2024

This statement is issued by Transform Health, the Partnership for Maternal, Newborn and Child Health (PMNCH), HealthAI – The Global Agency for Responsible AI in Health, RECAINSA, AeHIN, FIND and PATH.

Transform Health and partners (a coalition of 150+ organisations) welcome the Brazilian presidency of the G20 Health Working Group’s focus on Building Resilient Health Systems worldwide and working collectively to make progress in achieving universal health coverage (UHC). Digital technologies in health and the digitisation of healthcare are rightly prioritised as critical opportunities to drive progress towards the achievement of UHC and to ensure quality health services to those most in need, with a focus on sustainable and equitable digital transformation.

This offers an important opportunity to build on the work and commitments of previous G20s, including last year’s launch of the Global Initiative on Digital Health (GIDH) and a commitment from Health Ministers to support its implementation. We therefore commend the Brazilian Presidency’s proposition of setting clear goals for the implementation of the GIDH and facilitating coordination with other existing frameworks.

Towards these goals, Transform Health and partners urge G20 leaders to prioritise the following action areas to ensure the equitable, inclusive and sustainable digital transformation of health systems to deliver UHC:

1. Prioritise action to strengthen health data governance, to facilitate responsible data sharing for public benefit, while safeguarding individual rights. We encourage G20 governments to support the development and endorsement (through a World Health Assembly Resolution) of a global health data governance regulatory framework that contains a draft model law and regulation, setting out core components for health data governance regulations (a regulatory playbook), as a resource and benchmark for governments to strengthen their national approaches. We further encourage governments to endorse the equity and rights-based health data governance principles which provide a foundation for stronger regulation and a global framework. Discussions through the G20, alongside the World Health Assembly, would help establish consensus, alignment and agreement across countries around what is needed, while also establishing a level of harmonisation across countries, which is important to facilitate responsible cross-border data sharing. 
2. Ensure more effective and accountable digital health investment, as part of wider health system investment to deliver UHC. This is an important catalytic investment to build stronger and more resilient health systems that leave no one behind. Funding must prioritise areas that support the equitable, inclusive, sustainable digital transformation of health systems, and it must be coordinated and aligned with national priorities. G20 governments should also prioritise action to address the lack of available, or systematically collected, information on digital health investment, which is requisite to identify and close funding gaps and for better coordination. This includes building consensus around how both domestic and donor investments in digital health transformation should be classified, for example within existing mechanisms such as National Health Accounts and the OECD-DAC donor reporting system, alongside efforts to strengthen routine and sustainable mechanisms for reporting and tracking of investments. Operationalising the GIDH serves as an important opportunity to support this.
3. Operationalise the Global Initiative on Digital Health (GIDH) to drive more coordinated and impactful digital health action. G20 governments, through catalytic investments in GIDH lighthouse countries identified in 2024, should align with country-led priorities and needs towards their digital health transformation. G20 governments should ensure that the GIDH prioritises improving the availability and transparency of digital health funding information and better tracking of investment. The meaningful engagement of civil society must also be prioritised as goals are set for the GIDH and as it is operationalised so that it responds to population needs, including vulnerable communities, women, children and adolescents.
4. Make a G20 commitment on responsible Artificial Intelligence (AI) governance for health, including to work across governments and other sectors to prioritise equity and rights-based approaches in strengthening policies and regulation for AI in health in order to cultivate trust and catalyse innovation. Prioritise the collaborative implementation of  global guidelines and principles into country-led regulatory systems and workflows, to support the responsible development, adoption and deployment of responsible AI solutions in health. Ensure responsible AI development and deployment that prioritises health equity, transparency and accountability, while addressing potential biases and ethical concerns, which is essential for building trust and ensuring positive outcome for all. We also encourage G20 governments to recognise and prioritise the need for robust data governance as the bedrock for more effective and equitable digital health and AI governance.

These action areas should be prioritised by G20 countries, both through G20 processes, as well as other important processes and meetings throughout the year, including the World Health Assembly, UN General Assembly, UN Summit of the Future, World Bank meetings, among others. These offer continued opportunities for deliberation, consultation and to take forward action. 

Transform Health and its partners stand ready to support the G20 in achieving these goals and making important progress towards delivering health for all in the digital age.

Universal health coverage (UHC) is aimed at ensuring all people have access to essential health services without financial hardship – a goal that all countries have committed to through the Sustainable Development Goals. However, progress remains slow across many countries. Digital health transformation and digital tools offer immense potential to accelerate UHC and equitably improve health outcomes. But realising this potential will require focused investment and  action.

Transform Health has long recognised the catalytic power of digital health in building stronger, more resilient health systems that can deliver health for all. Our flagship report, “The case for digital health: Accelerating progress to achieve UHC”, outlines the critical role of digital health and needed action to strengthen digitally-enabled health systems. Building on this, last year we launched a new report, “Closing the Digital Divide,” which makes the investment case and calls for increased, better coordinated and better targeted funding in the equitable digital transformation of health systems, as an integral part of overall health system financing. 

The Global Digital Health Strategy and the new Global Initiative on Digital Health (GIDH) recognise the role of digital health as “a proven accelerator to advance health outcomes and achieve UHC”, offering opportunities to align convene stakeholders towards this goal.  The World Bank’s “Digital-in-Health:Unlocking the value for everyone” report reinforces the concept of blending digital and health investments into one integrated approach. 

Digital health must be a core part of delivering UHC

We are seeing an important shift – digital can no longer be seen as an add-on, as a vertical health issue or as an issue merely for the private sector. Digital tools and the digital transformation of health systems must be embedded across health systems and central to UHC strategies. 

While the UHC Political Declaration – endorsed by Governments at the UHC High-level meeting in September 2023 – recognised the important role of digital health, it didn’t go far enough to recognise the game-changing potential of digital health transformation as a health system enabler and critical component in achieving Health for all.

We must also go further to bring the digital health and UHC communities together, which still operate far too much as separate groups of stakeholders, despite working towards similar aims. We must merge these conversations and work to deliver faster and more impactful change.

Excited optimism as we look ahead

We are optimistic as we look ahead and to the increased recognition and prioritisation of digital health transformation as a driver of UHC progress.

Transform Health is already a strong supporter and partner of UHC2030, as well as the civil society engagement mechanism (CSEM), as a driving force for UHC to be achieved by 2030. We are excited to now join the UHC2030 Task Force and look forward to supporting the work of the movement, including efforts around the role of digital health and health data governance as key catalysts towards achieving UHC goals.

We also look forward to working with partners as we take forward key priorities to harness the transformative potential of digital health, including through: 

• Increased and better targeted funding 
• Ensuring a digitally-enabled health workforce
• More robust and equitable governance of health data
• Putting communities are at the centre of digital health, and
• Closing the digital divide

Through digitalisation we can move faster towards our UHC goals. The time for action is now!

In our rapidly evolving technological landscape, the increased generation of health data from more digitalised health systems offers a huge opportunity to advance healthcare and wellbeing. However, it also raises important issues around data rights, privacy, security, sharing and access. This situation brings to the fore the need for adequate regulations and legislation to be in place to ensure the effective and equitable governance of our health data, which facilitates responsible data sharing for public benefit with the needed protections in place. Robust data governance will contribute to stronger health systems, better patient care and improved emergency response – ultimately enhancing health outcomes. At the same time, it is needed to ensure the protection of individual rights and to mitigate risks of data misuse. 

What is needed? Agreeing on minimum standards (considerations) for health data governance regulation

To realise this vision, it is important for governments to strengthen their national regulations and legislation governing the collection, ownership and use of health data. However, given the complex and diverse landscape of regulations and legislations in places across countries, as well as gaps within this landscape, we believe that there is value in countries and other stakeholders coming together build consensus around the key elements of necessary and optimal regulations to govern health data – essentially a set of minimum standards (considerations) for health data governance regulations. We believe that minimum standards should be framed around core guiding principles, such as the equity and rights-based Health Data Governance Principles that have already been endorsed by 150+ organisations and governments. And they should form part of a wider health data governance framework.

To build high-level political commitment, alignment and consensus across countries on what is needed, these minimum standards must garner endorsement through a World Health Assembly resolution. They would serve as a guiding resource and benchmark for governments to enhance their national legislation and regulations, whilst also improving harmonisation across countries, which is important to support cross-border data flows, with the needed protections in place.  

Through national implementation, this would establish the binding instruments to hold all actors in the country involved in the collection and use of that data accountable; provide various actors in the country with avenues for redress in case people’s rights are being violated or data is being misused; and establish a predictable environment for the private, not for profit and public sectors operating in the country.

A multi-stakeholder process to support the development of a set of minimum standards

While we believe that governments should be in the driver’s seat, an inclusive and consultative multi-stakeholder process is important. To support such a process and feed into and catalyse the development of a set of minimum standards, Transform Health proposes two key phases, including: 1) Regional and national multi-stakeholder consultations and landscape assessments to inform the development of an initial draft; and 2) consultations on a draft set of minimum standards. 

As part of this first phase, Transform Health and partners are convening a series of regional and national multi-stakeholder consultations, including in:

• Africa at the Africa HealthTech Summit in Kigali on 19 October and at the HELINA conference in Cape Town on 2 November
• Asia at the AeHIN General Meeting in Jakarta on 6 November
• Latin America at the RECAINSA Digital Health Forum in Panama City on 21 November
• Virtually through an online survey to facilitate wide participation and inputs
• Nationally across various countries

Guided by the Health Data Governance Principles, the consultations aim to learn from and gather insights from stakeholders and experts to identify good practices and approaches currently employed by countries; understand where there are gaps;  identify existing international and regional norms and standards that would complement the minimum standards; and hear perspectives on what is needed. We believe that these different components would serve as the building blocks for the development of a draft set of minimum standards. Further consultations will be convened on the draft, to garner input, validation and consensus-building. These consultations present a valuable opportunity for stakeholders to contribute to shaping the future of health data governance. 

These phases also aim to actively engage governments, to build buy-in, consensus and ownership and we hope will be followed by Member State-led consultations and negotiations in preparation of a resolution at the World Health Assembly (and other regional decision-making bodies), and subsequently national implementation.

Charting the path towards more effective and equitable health data governance

The need for more effective and equitable governance of health data is undeniable and the development, endorsement, and implementation of a set of minimum standards for health data governance regulations charts a clear path towards that goal. Transform Health believes that an inclusive and consultative process will build the needed alignment and consensus around what is needed. We look to governments to show their leadership in championing this process and endorsing and implementing minimum standards, thereby laying the foundation for a future where health data is a force for public benefit, rooted in trust and accountability.

To get involved, please reach out to [email protected] and  share your views through the online survey.

~ Digital Health Week 2023 Task Group

Digital Health Week (DHW) 2023 is nearly here!

The global week of action, taking place from 6th to 12th November – across the world and online, aims to highlight the fundamental role that digital technology can  play to achieve Universal Health Coverage (UHC). 

Over the last twenty years health systems have undergone a significant shift towards digitalisation. However, this digital transformation has tended to be uneven and there is a risk that a digital divide adds onto a health divide and increases existing inequalities. To address this risk we need to work together and across all levels to ensure the digital transformation of health systems benefits everyone and leverages the expertise of all sectors. 

#DigitalHealthWeek2023 is a global moment where civil society, governments, private sector, health institutions and community members can come together to: 

• • Expand and enrich national and regional dialogues on the digital transformation of healthcare to achieve UHC.
  • Increase the number of actions or initiatives aimed at promoting digital transformation as a means of achieving UHC.
  • Promote collaboration and knowledge sharing on digital health within and across countries and contexts.
  • Build consensus, increase support and attention for the role of digital technology and the effective use of data as a means of getting the world back on track to meet set SDG commitment on UHC.

This week of action will provide a space for all stakeholders to champion digital transformation to achieve health for all!

ENGAGE DURING DIGITAL HEALTH WEEK 2023

Participating organisations and individuals in Digital Health Week 2023, can register their ‘action’ on the DHW website. These ‘actions’ could range from organising an event, engaging on social media, sharing stories, launching campaigns, making a public commitment, or anything else!

Organisations interested in taking ‘action’ can share details through the participation form. In the form, organisations can inform us of their events, activities, or other initiatives – highlighting the theme(s) that they will be engaging with. We will host the ‘actions’ in the ‘DHW Action Tracker’ and amplify them on the Digital Health Week website. 

Each participating organisation will be responsible for planning and implementing their own activities and events, including registering them on the DHW platform and promoting them on their networks.  

Learn more on how to engage through the participation guide.

Access resources: digital assets, social media messaging, presentation templates, zoom backgrounds, and more; These resources will help enhance your organisations’ engagement during this global week of action. 

TELL US YOUR DIGITAL HEALTH STORY – CONTRIBUTE TO THE DIGITAL HEALTH WEEK COMMUNITY

Digital Health Week is a key moment to create and amplify multimedia content around digital health. 

To speak to this, the DHW website will host a community page. This will be a space comprising a library of insights, articles, blogs, case studies, videos, or any other materials, submitted by participants from across the world, who are championing the potential of digital health. 

These materials will serve to broaden the conversation on digital health and foster collaboration and collective learning amongst organisations and individuals alike. 

Contribute to the community page; share your submission here. 

THEMATIC PRIORITIES FOR THE WEEK OF ACTION IN 2023

For Digital Health Week 2023, six themes have been identified to help focus the conversation and ensure the key elements are discussed. Participants are encouraged to  organise their actions and events on the day corresponding to their theme. The week will will flow in the following manner: 

Breakthroughs in digital health, the rise of artificial intelligence (AI), and the increased reliance on machine learning (ML) and deep learning (DL), offer significant potential to enhance healthcare systems and patient outcomes. However, without proper regulation they also present risks.

The COVID-19 pandemic has accelerated global digital transformation, illustrating the effectiveness of partnerships in healthcare delivery. Sustainable collaborations between governments, the private sector, healthcare providers, patients, legislators, and academia are crucial to unlock the potential of digital technologies, manage risks, and achieve health for all.

Digital health plays a vital role in modern healthcare systems. However, for UHC to be achieved, it’s essential to develop and implement digital health solutions in a fair and inclusive manner. Failing to do so could lead to a digital divide that worsens existing healthcare disparities, especially affecting women, youth, and marginalised communities. In rural and marginalised communities, where traditional healthcare services might be limited, digital health tools bridge the gap by providing remote consultations, health monitoring apps, and access to vital health information. 

As digital health continues to reshape the healthcare landscape, it’s crucial to ensure that these innovations address the healthcare needs of all, with a strong emphasis on promoting gender equality and inclusivity. By striving for equality and accessibility in healthcare technologies and services, we can ensure that individuals of all genders, backgrounds, and identities have equitable access to and can benefit from digital health solutions.

Digital health technologies are increasingly becoming an integral part of healthcare systems across the world. Increasing digitisation brings with it its own risks, in relation to the development, deployment, application and use of digital tools – such as the unchecked use of personal data that risks marginalising individuals and entire groups.   

These risks need to be mitigated through legislation, regulation and policies that effectively govern the digital health space, drawing out the benefits for the individual and the population at large while curbing its potential harms,  abuses and misuses. A global health data governance framework, underpinned by equity and rights-based principles, is one measure by which we can ensure common regulatory standards, enabling health data to offer public good benefits and improve health outcomes for individuals. However, many such efforts and initiatives can be taken to bridge the governance and technology gap.

We have now reached a stage in the digital health journey where we need to think beyond enhancing health systems through the introduction of individual digital technologies and to instead consider the digital transformation of health systems in its broader sense. 

We need to remove the underlying obstacles and challenges to sustainability and scale. We need to focus on the actions and the investments that are necessary to drive a more equitable, inclusive and sustainable transformation of health systems in low-and lower-middle-income countries, in an otherwise fragmented funding system. There is a need to ensure that investments towards digital transformation are better coordinated and aligned across diverse stakeholders. 

Healthcare has swiftly evolved over the years due to digital technologies, enabled by data-driven innovation and AI centred healthcare solutions. Such advancements offer potential to advance diagnostics, treatment, and healthcare delivery. Climate change and pandemics have further spurred the advancement of digital healthcare solutions. 

However, as we stand in the midst of this digital health revolution, it is imperative to carefully consider not only the potential benefits, but also the potential associated risks that need to be mitigated. 

Moreover,  bridging the gap in digital literacy and access to technology is crucial to prevent marginalised communities from being left behind in this digital health revolution. The future of digital health holds tremendous potential to enhance healthcare accessibility, efficiency, and quality. To fully harness these benefits, it is vital for healthcare organisations, policymakers, and technology developers to work collaboratively in addressing the associated risks and ensuring that digital health solutions are inclusive, ethical, and secure for all.

The intersection of digital health innovation and climate change represents a dynamic and increasingly integrated area of focus for our future well-being. 

Digital health technologies not only enhance our ability to deliver healthcare efficiently but also can play a role in mitigating the impact of the global climate crisis. From telemedicine reducing the need for carbon-intensive travel to data-driven solutions optimising resource use in healthcare, this synergy is where innovation meets sustainability. 

As we broaden our conception of health and health systems in a climate stressed context, we need to confront the social determinants of health and how these are intricately linked with climate change. Digital technology, the production, management and use of increasing amounts of data, allows us access to greater analysis and information on the intersection between environmental and human health, and opens the possibility of more coherent and coordinated approaches to both for the benefit of people and the planet.  By harnessing the power of digital health, we can not only improve individual health outcomes but also contribute to a healthier planet for generations to come.

The digital transformation of health systems has the potential to improve access, quality and efficiency of health care on an unprecedented scale, and accelerate progress towards Universal Health Coverage (UHC). It can help scale up access to primary health care services, strengthen health system resilience, and close equity gaps to help deliver health for all. However, for this to be achieved, it is critical for national governments to allocate necessary funding to digitally enable their health systems (complemented by donor investment) as part of wider health system strengthening investment, and to ensure that this is part of their national plans and priorities. 

The digital transformation of health is well underway in Africa. Whilst levels of digital maturity vary, most African countries are introducing an increasing range of digital solutions to both public and private health care and the majority of countries have a dedicated digital health strategy that is incorporated into health-sector strategic plans and aligned to broader national digital transformation agendas. However, very few African digital health strategies are accompanied by a costed implementation plan and implementation is uneven, with persistent barriers standing in the way of faster and more equitable digital transformation. 

The digital health funding landscape in the region

African health systems comprise a mix of government-funded public healthcare, private healthcare providers, donors, and non-governmental and faith-based organisations. According to the World Bank, sub-Saharan African countries spend an average of 4.97% of GDP on health, a lower rate than at the start of the century and far below the global average of 9.83%. Out of pocket expenditure accounts for around one-third of current health expenditure across the continent. 

To date, most funding for the digital transformation of health systems has come from donors, with Ministries of Health mainly providing funding for coordination of digital health divisions. Information about the amount that African countries are investing in digital health is not publically available as digital health is not typically highlighted within national health budgets and expenditure on digital health is not routinely reported. Health planners in Africa generally lack reliable information on the short and long term costs of digitally transforming their health systems. This lack of solid evidence on digital health investment issues also deters investors or donors from intervening in the region. 

Funding digital health transformation in Africa – what is needed?

During the Africa HealthTech Summit 2023, taking place in Kigali from 17-19 October, Transform Health is launching a new costing of the digital health funding gap for Africa. We estimate that an investment of approximately US$4.1 billion is needed over the next five years to support the digital transformation of health systems in low- and lower-middle-income countries in Africa, or approximately US$820 million per year on average. This is based on a medium cost scenario for nine priority investment areas. The primary driver of this cost is for digital connectivity infrastructure, which accounts for approximately 75% of the total projected investment.

US$4.1 billion is needed over the next five years to support the digital transformation of health systems in low-and lower-middle-income countries in Africa.

The true investment requirements will ultimately need to be determined country by country and based on costed digital health strategies and investment roadmaps. Investments in digital transformation of health systems will also need to be complemented by wider investment to increase digital connectivity and usage among the population, as well as investments to address the broader enabling environment. 

This costing builds on an estimate of resource needs for the digital transformation of health systems across all low- and lower-middle income countries, which was included in Transform Health’s report, Closing the digital divide: More and better funding for the digital transformation of health. 

A call to action to harness digital health to deliver health for all

We call on national governments, donors and development partners, and the private sector to increase and better coordinate investment in the equitable, inclusive and sustainable digital transformation of health systems to deliver health for all in the digital age. We call for:

1. Increased investment in digital transformation of health, ensuring investments are sustainable and support equity, inclusion and human rights.

2. Improved coordination and alignment of digital health investments with national priorities and strategies

3. Costed digital health strategies and investment roadmaps

4. Strengthened policy and regulatory environments to guide the  inclusive, equitable and sustainable digital transformation of health system

5. Mechanisms for meaningful multi stakeholder engagement to be established, involving stakeholders from multiple sectors and backgrounds in the development, implementation and monitoring of digital transformation strategies

6. Action to bridge the digital divide, which is a prerequisite for equitable access to digitally-enabled health services

Transform Health and its partners have been advocating for the digital transformation of health as a route to strengthening primary health care and accelerating UHC progress by 2023. To achieve this, we must prioritise investment in digital health. We will not achieve health for all, without prioritising digital health for all!

Transform Health was at #UNGA78! We organised a high-level discussion on ‘Optimising digital health investment to deliver Universal Health Coverage’ and participated in the high-level meetings on Pandemic, Prevention, Preparedness and Response and on Universal Health Coverage , alongside numerous other side events and meetings. Some highlights and reflections below!

A call for digital health to be prioritised as a driver of UHC progress

As we approached this year’s UN General Assembly, we had a clear ask for governments and other stakeholders to make bold commitments to prioritise #DigitalHealth to deliver UHC by 2030. As we got closer to the UHC high-level meeting (UHCHLM), and the final draft of the Political Declaration was released, we responded with a joint-statement co-authored by 22 global leaders, calling for a more ambitious commitment that fully recognises the transformative potential of digital health as a key driver to accelerate progress towards UHC. 

Throughout the entire UHCHLM, there was very little mention of the key role of digital health to accelerate UHC progress. This was despite continued efforts of Transform Health and other partners, including our participation during the multi-stakeholder hearing earlier this year, feedback on the Zero Draft of the Political Declaration shared in June, and our call to action earlier this month.. 

The Political Declaration was ultimately endorsed by leaders during the High-level meeting. While it included important commitments related to digital health, we believe it could have been much more ambitious in this regard, recognising the game-changing potential of digital health transformation in achieving Health for All.. 

A high-level discussion on optimising investment for digital health transformation to achieve UHC

On 18th September, Transform Health organised an event on the sidelines of UNGA78, which convened a discussion on what is needed to improve funding for the digital transformation of health systems, including key challenges and opportunities.  

Alain Labrique, Director for the Department of Digital Health and Innovation at WHO, kicked off the session by introducing the recently launched Global Initiative on Digital Health (GIDH), which is framed around four foundational pillars to support digital health transformation. He highlighted the important role that digital health plays in the pursuit of UHC, emphasising that there is no #HealthForAll without #DigitalHealth for all. Our Executive Director, Mathilde Forslund, then gave an overview of Transform Health’s report, “Closing the Digital Divide: More and better funding for the digital transformation of health”, which looks at the challenges within the current funding landscape for digital health; provides an estimate of the funding gap; and sets out key recommendations for increased and improved investment towards building digitally-enabled health systems that can help countries achieve UHC and improve health outcomes for all. She also shared insights from the two multi-stakeholder consultations convened by Transform Health to gather perspectives on the development of the GIDH and country resource portal respectively. 

We had a fantastic l panel discussion, moderated by Pape Gaye from Baobab Institute for Health and Development. The panellists – including Derrick Muneene from WHO; Jennifer Nelson from Inter-American Development Bank; Malar Veerappan from the World Bank; and Rebecca Distler from the Patrick J. McGovern Foundation – discussed key themes such as the importance of better tracking of digital health investments at global and national levels, facilitating improved coordination through the GIDH to avoid fragmentation and duplication, and funding non-profits and others on the frontlines to enhance the resourcing landscape; among others. Transform Health’s President, Christoph Benn, closed the session by underlining the key message that digitalisation can help us achieve UHC and other health goals. 

Transform Health is committed to advocating for improved and better-coordinated digital health investment and looks forward to continuing our work with existing and new partners to drive progres, including as part of the GIDH. We will also work with our recently set up Digital Health Investment working group as a space to facilitate collaboration and ensure digital health investment is high on political agendas.

High-level meetings on #UHC and #PPPR – meaningful civil society engagement or tokenistic participation?

Through our participation in the multi-stakeholder panels of the high-level meetings on Universal Health Coverage and on Pandemic, Prevention, Preparedness and Response,we hoped to share our key asks with Member States and other key stakeholders on the important role of digital health in advancing both agendas.  However, our side-event was dwarfed by the frustration we felt at the lack of space for meaningful civil society engagement during the high-level meetings. Only six civil society organisations were given an opportunity to make an intervention from the floor during the HLM on PPPR – that’s a total of 12 minutes out of the two-hour session, ie. a mere 10% of the session. The UHCHLM was even worse, with only four civil society organisations given an opportunity to speak. The session also started late and ended early, taking away precious time that could have been used for CSOs to share their views. Moreover, conducting multi-stakeholder discussions after the Political Declarations had already been adopted, and after some of the government plenaries had already taken place, felt a little tokenistic. 

On the positive side, the civil society organisations that were given an opportunity to speak were brilliant and were able to highlight critical perspectives and issues to round the discussions well, although none of the civil society organisatonshighlighted the importance of digital health transformation as an accelerator towards UHC, along with very few governments . 

Looking ahead

Such high-level meetings are pivotal moments for member states and other stakeholders to make ambitious commitments towards achieving our goals and priorities for universal health coverage. These could have been key opportunities to recognise and prioritise the fundamental role of digital health to achieve UHC; champion health data governance and support the development of a global health data governance; and set clear actions to close the digital divide. 

Transform Health is driven by our key agendas and we will continue to work with partners to advocate for digital health transformation to achieve health for all! We now look towards the implementation of the Political Declaration, hoping for much bolder actions from governments than the words they approved in New York.

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.