Digital health spells the future of effective pandemic response and UHC attainment in the Global South: Perspectives from Kenya

If we have learned anything since COVID-19 struck, it’s that when it comes to pandemics, timing is critical. COVID-19 exposed the vulnerabilities of health care systems the world over and made it abundantly clear that coordinated approaches for early detection and response require quick action on readily available information. The availability and quality of actionable data has meant the difference between an incident and a catastrophe. Learning from continents where advanced technology solutions have been employed to significantly contain transmission of the virus, one thing has become undeniably apparent for many nations in the global south: to effectively fight COVID-19 and manage other health system crises, we must get our data right. Having real time data during a pandemic aids rapid response by helping to speedily identify at-risk populations and geographies. This informs planning and resource distribution in terms of expanding health facility capacity, contract tracing, identifying mass testing zones, restricting movement in delineated hotspots and mapping households for service delivery.

 

Kenya’s journey to having sophisticated and expansive data technologies is admittedly a steady work in progress. With a national vision for attaining universal health coverage (UHC) by 2030, there’s been increased urgency to comprehensively address data availability from household to national level, both for service delivery and as an important building block for delivering health for all. Although community health is an integral part of Kenya’s primary health care system, health data collection and reporting at the community level is heavily reliant on paper-based data systems that are often slow, labour-intensive, and error-prone. While community health workers serving households across Kenya routinely collect health data – and have been deployed in recent times as a vital resource in community surveillance and home-based care protocols for pandemic management – the use of manual systems hampers timely decision making.

 

To effectively fight COVID-19 and manage other health system crises, we must get our data right.

 

Commendably, the government with support from development partners is already spearheading efforts to digitize the health system as part of far-reaching health sector reforms to achieve UHC. Initially focusing on facility levels of care, these plans now critically also include building a robust electronic community health information system that leverages digital mHealth data collected by community health workforces. With existing capacity challenges in public health facilities being further compounded by COVID-19, community-level health data is now more important than ever in helping governments to fight COVID-19 and reduce preventable deaths especially among at risk populations like pregnant women and neonates who often fall through the cracks during pandemics. Digital tools have also played a huge role in driving COVID vaccination in Kenya by helping in mapping and tracking coverage to better target low uptake areas or at-risk populations, and in following up individuals to ensure full vaccination.

 

Secondly, available community-level health data must correlate with different systems within the health sector for holistic insights that enable informed action. In the health sector in many parts of Africa, data is often siloed within and across different levels of care and is usually not interoperable with other health care ecosystems like insurance and medical commodity supply systems. At the community level, even where digital mHealth tools are already in use, the current landscape in Kenya is fragmented with various implementors employing over 140 digital tools across the country often with piecemeal, program-specific approaches. While advanced tools for diseases like HIV, malaria and TB exist, they are often standalone solutions that don’t relate to other contextual factors to guide wider system-strengthening initiatives.

 

This has called for adoption of standardized and modular community health digital tools that are cost-effective, scalable and interoperable by design, especially as Kenya looks to roll out its national UHC programs that will heavily leverage the eCHIS platform. Led by Kenya’s Ministry of Health these harmonization efforts have led to the development of an interoperability framework as well as system standards that all community health digital tools must adhere to. Based on these standards, MOHK and partners have developed, tested and are undertaking a pilot of a digital health solution for community health to inform eventual national scaleup that will potentially revolutionize access, sharing and use of health information. The government has also invested in the setting up of data centers that will ensure the safe storage and integrity of all data collected as it eventually flows into the Kenya Health Information System (KHIS).

 

At the community level, even where digital mHealth tools are already in use, the current landscape in Kenya is fragmented with various implementors employing over 140 digital tools across the country often with piecemeal, program-specific approaches.

 

Third, for digital transformation to happen, we must also recognize that the health system does not operate in isolation. Data correlation and use should go beyond healthcare to integrate multi-source data from other public sector services and the wider private sector economy. The Kenyan government has plans in place to develop an e-economy across sectors, and while it promises to transform data utility it will not happen overnight. While investing in these interoperable systems to advance the public health sector, countries like Kenya would do well to borrow a leaf from ethical practices of governments that have worked in partnership with telcos, financial institutions and tech companies to, for example, use geospatial data and technologies to enhance disease prevention and control strategies.

 

Also read: Making The Case For Stronger Health Data Governance

 

Finally, as African governments sets up systems to drive data availability and integration that will catalyse the continent’s transition to a data-centric culture, they must also pave the way in create enabling environments. While Kenya’s high political commitment for UHC bolstered by existence of several key policy frameworks for community based PHC is certainly worth applauding, governments at national and subnational levels must continue to develop and operationalize facilitative policies that enable that vision. This also means actively increasing community health investments from domestic and external resources to durably fund well equipped, supervised and compensated community health workforces. Sustainably implementing an end-to-end digital health system will require significant human capital, financial and ICT infrastructure investments. But governments cannot do it alone. The public must remain engaged and multisector stakeholders should continue partnering with governments to strengthen sustainably financed and government-led primary health systems. In Kenya’s experience, increasing government ownership means that funding and implementing partners must by design think through transition and how to build government’s long-term operational capacity to manage digitized systems. On the regulatory front, matters to do with data privacy, protection and security must not be taken lightly. For Kenya this means that by building on existing frameworks such as the e-health policy and data protection law, all state and not state actors must collectively do more to institute sound data governance frameworks as the country goes digital across health and other sectors.

 

Data correlation and use should go beyond healthcare to integrate multi-source data from other public sector services and the wider private sector economy. The Kenyan government has plans in place to develop an e-economy across sectors, and while it promises to transform data utility it will not happen overnight.

 

As the world continues to grapple with COVID-19 almost two years on, digitized data is becoming essential currency as part of the new norm. We in the global south must leverage health and related data better to save lives now and guarantee a more effective response to future pandemics.

The Case For Digital Health: Report Launch By Transform Health

Transform Health launches the report ‘The Case For Digital Health: Accelerating Progress to Achieve UHC’ at the AI For Good Summit during Digital Health Week.

All countries have committed to extend universal health coverage (UHC) to everyone by 2030. Whilst most countries have expanded access to essential health services, the goal of UHC remains elusive for around half of the world’s population, particularly those living in low and middle income countries.

Innovative approaches are urgently needed to put all countries on track to achieve UHC. There is much excitement and hype about the potential of digital technologies to strengthen health systems and expand coverage of essential health services.

Digitalisation and the use of digital technologies is already an important and growing part of most health systems. However, national governments and international health partners are not yet fully unlocking the potential of digital health to scale up access to primary health care services as a pathway to achieve UHC.

The positive benefits of digital technologies and data for health are not yet being made available to everyone, which risks widening health inequalities. Furthermore, the application of digital technologies, without due consideration of key principles such as equity and human rights, can undermine efforts towards UHC.

ACTIONS TO ACCELERATE PROGRESS TOWARDS UHC

Transform Health has launched a new report that makes the case for digital health and how it can help us to accelerate progress towards UHC. In the report, we explain how digital technologies can support the achievement of UHC but also the barriers that need to be overcome in order for the digital technologies and data to improve—and not undermine—health equity.

View The Report
View Executive Summary

Unleashing the potential of digital health for everyone will require coordinated, multi-sectoral action to close the digital divide and implement UHC-driven approaches to digital health. The report outlines six steps that policymakers and other digital health actors need to take to enable us to achieve health for all in the digital age.

See how countries and health partners are harnessing digital health technologies to advance UHC in our collection of case studies.

View Case Studies

In this digital age, it is unacceptable that half the world’s population are being deprived of essential health care. As we countdown to the year 2030, digitalisation and the appropriate application of digital technologies should be a central part of countries’ approaches as they redouble their efforts to achieve UHC by 2030.

By taking the actions proposed by Transform Health, governments and technology companies can maximise the potential of digital health and allow everyone to realise their right to health.

Investing in the digital transformation of health services is the most effective way to build back after COVID19

Transform Health welcomes the G20 leaders’ recognition that “Well-functioning, value-based, inclusive, and resilient health systems are critical to moving towards achieving Universal Health Coverage (UHC)” and G20 leaders’ reconfirmation of “the importance of UHC financing in developing countries”.

 

The commitments to UHC set out in the Sustainable Development Goals (SDGs) are critical to ensuring the world is able to effectively prepare, prevent, protect and respond to outbreaks of infectious diseases such as COVID-19 and realise people’s right to health.

 

However, this commitment will not be realised unless the G20 and leaders from across the world invest in the equitable digital transformation of health systems and the effective and responsible use of health data to ensure all populations are able to access decent health services.

 

G20 leaders have recognised that “connectivity, digital technologies, and policies have played a key role in strengthening our response to the pandemic”. We now need to expand the digitalisation that has taken place in response to COVID-19 in many countries to cover other dimensions of health system strengthening, particularly health systems in low and middle-income countries, to ensure everyone is able to benefit from this transformation.

 

Digitalising health systems and services will require governments to develop effective regulation that governs the collection and use of health data as a public good while protecting the rights and integrity of the individual. The trust deficit that exists between governments and other institutions, and citizens in relation to the collection, storage and use of data, even in situations of emergency, needs to be addressed through stronger regulation. A global governance framework on the use of health data would go a long way in addressing this trust deficit. Governments also need to ensure that their citizens are provided with enough information and have sufficient knowledge about data and digital technology to be able to meaningfully engage in government priority setting and to be able to use digital tools and technology to access information and services that would enable them to manage their own health and wellbeing more effectively.

 

Over recent years the digitalisation of health systems in low and middle-income countries has often suffered from underinvestment and a lack of effective coordination among donors. The result has been a multiplicity of pilot projects that have failed to make it to scale. Donors need to learn from successful initiatives such as the Global Fund to Fight AIDS, TB and Malaria and the Global Financing Facility which collaborate to ensure sufficient levels of funding is provided and channeled through one mechanism aimed at supporting national health plans. These, in turn, need to be developed with multiple stakeholders, particularly representatives of front line staff and of youth, women and marginalized communities who are often excluded from planning and implementation of new approaches to health systems that impact on their lives.

 

COVID-19 presents world leaders and citizens everywhere with a set of challenges and opportunities to work together to ensure the digital transformation of health systems and the effective use of health data serve all segments of the population. Only by working together will we reduce the potential impact of future threats.

Creating healthier futures after COVID-19: Let young people lead!

Author(s): Danielle Mullings, Young Experts: Tech4Health and co-chair of Transform Health’s Resource and Investment Circle. @damullingstweet

 

Although I haven’t had COVID-19 directly, this disease has had a significant impact on me, my family, and my friends. Our lives have moved from being very busy, rushing to classes, hugging each other in the hallways to being home most of the week, conducting all learning sessions virtually and greeting each other with socially distanced ‘elbow handshakes’. The impact of COVID-19 on the lives of young people needs to be evaluated further.

 

YOUNG PEOPLE’S LIVES GREATLY AFFECTED

 

I know I am not alone. COVID-19 has impacted young people across the world in so many different ways. Whilst we are at lower risk of becoming ill from COVID-19 compared to older generations, it doesn’t mean that young people’s lives haven’t been greatly affected by the pandemic.

 

The secondary effects of COVID-19 – created by responses to the pandemic, rather than the virus itself – have disrupted our homes, our communities, our education, and our social lives. Lockdowns and other restrictions have limited young people’s autonomy, freedom, and ability to access a range of services that are important for our wellbeing. All of this has taken a huge toll on our mental health.

 

For almost one year, young people’s access to healthcare and other services has also been limited. Whereas before, young people often relied on schools and universities to get essential health information and services, these options have largely been unavailable to us during lockdowns. Many specialist adolescents and youth health services have remained closed and our access to a wide range of health professionals, from guidance counsellors to dentists has been taken away. Added to this, our economic prospects have been set back years and we will be landed with national debts that may take us a generation to repay.

 

WE NEED TO REMEMBER OUR POWER

 

The response to COVID-19 has demonstrated what is possible when there is sufficient political will to address a health challenge. We’ve seen immense political willpower and economic investment to create a new vaccine in under a year. This is truly incredible but I wonder if it would have happened if the virus didn’t disproportionately affect the health and wallets of older populations that hold the reigns of power, globally?

 

Where is this same willpower to cure the diseases and other causes of poor health that have been with us for years, and that disproportionately affect the youth, women and marginalised groups? Young people have been largely overlooked in the response to COVID-19 and the consequences will be devastating for us and our communities. Governments must act now to mitigate the direct and indirect impacts of the pandemic on young people’s lives.

 

I encourage the global health community to reassess what it’s priorities are. Are we doing the best we can to accommodate and include young people, women and other underrepresented groups in the COVID-19 response? Can we invest the same energy and resources into tackling the health challenges that most directly concern young people?

 

HARNESSING THE DIGITAL TRANSFORMATION FOR YOUNG PEOPLE’S HEALTH AND WELLBEING

 

Digital technology has helped overcome some challenges presented by the pandemic and we are seeing faster adoption of digital technologies for health as a result of COVID-19. Young people have used the internet, social media and apps to get health information, manage their health and wellbeing, keep up with their studies, and stay connected to friends. Several have been able to take advantage of digital health services such as telemedicine, virtual therapy sessions, and online support groups. Some of my peers are even creating digital health content and solutions to respond to the needs of other young people, and help fill gaps created by the COVID-19 response.

 

This has not been the case for all young people, however. The pandemic has highlighted a huge digital divide between young people with access to the internet, devices and affordable connectivity, and those without. As we move to increase the use of technology in health and other domains, we must not let young people without ready and affordable access to the internet get left behind. We also need to ensure we are not allowing digital technologies and data to automate inherent biases and reinforce imbalances in power.

 

ALLOW YOUNG PEOPLE TO LEAD THE RESPONSE TO COVID-19

 

The next stage of the pandemic response must ultimately serve all people, not just the powers at hand. The best way to achieve this is to include young people in the elaboration and implementation of policies that directly impact them. Policymakers need to give young people a seat at the table and listen to us. Allow us to be part of a response to COVID-19 that addresses the damage done to our mental and physical health over the past year. Make space for us to be part of a response that allows us to harness the potential of digital technologies and create healthier futures for everyone.

 

I am calling on leaders around the world to commit to addressing other health issues with the same dynamism and political will as they have demonstrated with COVID-19. Investing in the equitable digital health transformation of health systems and extending universal health coverage to everyone so that we meet the Sustainable Development Goals target by 2030 would be good first steps. In all that we do, we must ensure that we keep this year’s UHC Day theme in mind: ‘Health for all: protect everyone’.

 

For all young leaders who may be reading, I encourage you too to remember your power. In mobilizing and empowering our communities to put young people at the heart of the COVID-19 response, and wider digital transformation of health, we are mobilizing and empowering the world.

 

Author(s) Bio:

 

Danielle Mullings is the co-chair of Transform Health’s Resource and Investment Circle. You can follow her on Twitter.

Digital Health and Data Hold the Key to UHC: Reflections on UHC Day 2020

Health has been front and center of most people’s thoughts and actions over the last year. The joint effort and solidarity requested of populations and communities across the world to slow the spread and address the pandemic is a testament to what can be achieved when public understanding and political will converge to confront a common threat. That same convergence is now needed to ensure we achieve universal health coverage (UHC) by 2030.

 

The vast amount of resources mobilised to address COVID-19 was made possible because most people and politicians agreed with the science that this particular pathogen needed to be addressed. Science has been making the same pleas for action for maternal, newborn and child health, malaria, HIV and AIDS, antibiotic resistance and a host of other threats. However these have tended not to be prioritised, largely because the health impact of these conditions have tended to disproportionately affect marginalised and underserved populations. It is time we address this by redoubling efforts to ensure health for all by extending UHC.

The vast amount of resources mobilised to address COVID-19 was made possible because most people and politicians agreed with the science that this particular pathogen needed to be addressed.

UHC aims to ensure “all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.” Leaders across the world committed to achieving UHC by 2030 as part of the Sustainable Development Goals (SDGs). On current trends at most 63% of the global population will be covered by 2030 according to the WHO. Countries across sub-saharan Africa are projected to lag furthest behind, most will struggle to achieve 50% coverage by 2030.

 

On 10 October 2019, world leaders reaffirmed their commitment to UHC, shortly afterwards the first cases of COVID-19 started to emerge. COVID-19 has brought into sharp relief the interconnected relationship between people’s health and therefore the need to protect everyone in order to protect each one of us. The notion that other people’s health is their business has, for the moment at least, been dispelled. When it comes to infectious diseases, we are all in it together and we all have a role to play.

 

There is a danger that this salutary lesson gets forgotten now that we have discovered a vaccine for COVID-19, and that this latest pandemic is considered another specific disease needing a specific response, rather than a broader health challenge. It would be easy for politicians and the public to think that now we have a vaccine, we can return to a business as usual approach and hunker down in our national and disease or health specific silos. This would be a mistake.

 

Now more than ever we need to build on what we have learnt from the COVID pandemic – the health of others matters to us all – be they other people, groups or nations. We need to ensure UHC as much to secure the health of our own communities as that of others. The best way to achieve this is to leverage the potential offered by digital technology to accelerate primary healthcare coverage for all.

It would be easy for politicians and the public to think that now we have a vaccine, we can return to a business as usual approach and hunker down in our national and disease or health specific silos.

We also need to rebuild the trust between politicians, technical experts and the general public. One way of achieving this would be through the development of a global framework that governs the use of health data for public good. This would provide clarity on the use of data and ensure digital technology is able to leverage the vast amounts of data in an equitable, transparent and non-discriminatory manner to serve public health interests. This requires a new social contract between politicians, technical health experts and the public. This can only be done if all sectors are at the table – youth, women and representatives of marginal communities in particular, many of whom have been excluded from decision making on health issues that impact on their lives.

 

As we look back over the last year, 2020 will strike many as an annus horribilis; however this year will also be remembered for the accelerated adoption of digital technology in health. World leaders now need to seize the initiative and work together to digitally transform the health sector to ensure it is maximising the full potential of health for all in the digital age.