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 kirsten.mathieson@transformhealthcoalition.org 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. 

Reflections by Mathilde Forslund & Kirsten Mathieson at Transform Health in preparation for UNGA78

The 78th session of the UN General Assembly (UNGA78) is set to commence on Tuesday, 5th September 2023, with the high-level week kicking off on the 18th. This year’s UNGA will focus on global solidarity to accelerate action on the 2030 agenda and the Sustainable Development Goals towards peace, prosperity, progress, and sustainability for all. Concurrently, a High-Level Meeting on Universal Health Coverage (UHC) will take place on the sidelines of UNGA78 on 21st September with the theme ‘Expanding our ambition for health and well-being in a post-COVID world. 

The outbreak of COVID-19 acted as a catalyst, compelling governments across the world to intensify their usage of digital health tools, technologies, and solutions to tackle public health issues. During the pandemic, and increasingly in the post-pandemic world, we saw the immense potential offered by digital health and data-led solutions to enhance delivery of primary healthcare and accelerate progress towards UHC by 2030. 

This year’s UHC High-Level Meeting will be a pivotal moment and platform to ensure digital health is prioritised as a key driver to achieve UHC by 2030. Building political consensus and an enabling environment for digital health transformation are critical. And as we undertake this transformation, we must ensure that equity and human-rights are at the forefront of the digitisation of health systems, ensuring that we are reducing disparities and leaving no one behind, particularly the most marginalised and neglected communities.  

Transform Health – a global coalition of 150+ organisations – participated in the multi-stakeholder hearing on UHC convened by the President of the United Nations General Assembly in May. The hearing provided a platform for a diverse set of stakeholders to express their aspirations for the Political Declaration, which is set to be endorsed by world leaders at the 2023 UHC HLM. Transform Health underscored the vital role of equitable, inclusive, and sustainable digital transformation of health systems to achieve health for all. 

While the zero draft of the Political Declaration that came out following the multi-stakeholder hearing included reference to digital health, it was framed more as a vertical health intervention. The Declaration didn’t go far enough in recognising the transformative potential of digital health as an integral part of all health systems and an accelerator of UHC progress. Transform Health issued recommendations on the zero draft, stressing the need for greater prioritisation of digital health, stronger health data governance, and increased and better-coordinated funding for digital health transformation. 

We welcome the zero draft of the Political Declaration on UHC that was published in July, following negotiation by Member States. The latest draft emphasises ‘Innovation & Digital Health’, however, we feel that greater prioritisation of digital health as a key accelerator to achieve UHC by 2030 can still be strengthened, while highlighting concrete actions for Member States and other stakeholders to take this agenda forward.

As governments meet at this year’s UNGA, including the High-level meeting on UHC, we urge them to make bold commitments to deliver health for all. In the digital age, this means going beyond the status quo, recognising the transformative potential that digital and data-drive solutions offer. Transform Health is calling on governments and other stakeholder to: 

1. Prioritise digital health transformation as a cross-functional enabler and accelerator to achieving UHC by 2030, rather than a siloed vertical health issue.
2. Champion health data governance and call for the development of a global framework to establish a set of common regulatory standards (for subsequent endorsement by governments at the World Health Assembly in May 2023), to strengthen national legislation and regulation and govern health data sharing across countries.
3. Ensure a global health data governance framework is developed through a transparent and inclusive multistakeholder process (with the meaningful engagement of civil society) and underpinned by equity and rights-based Health Data Governance Principles. We call on governments to endorse the Principles, which provide a foundation for the development of a global framework and should inform national legislation, regulation and policies.
4. Increase and better target funding for digital health, to support the equitable, inclusive, sustainable digital transformation of health systems, as part of wider health system investment to deliver UHC. Ensure funding is coordinated and aligned with national priorities.
5. Develop national costed digital health strategies as an integral component of UHC and health system strengthening agendas. Strategies should be developed, implemented and monitored in an inclusive and participatory manner, with the involvement of all relevant stakeholders.
6. Establish a strong national regulatory and policy environment to guide the digital transformation of the health system so that it is inclusive, equitable and sustainable. This is important to establish what kind of digitalised health system a country needs to achieve UHC.
7. Strengthen mechanisms for meaningful multi-stakeholder engagement at all levels of planning, strategy, execution and monitoring to ensure the digital transformation is effective in improving health outcomes and accelerating UHC progress. This must include the meaningful engagement of civil society, youth, women and marginalised and hard-to-reach communities.
8. Close the divide in digital access, prioritising strategic, targeted and coordinated actions to ensure this happens. This is a prerequisite for equitable access to technology-enabled health services. This means confronting coverage gaps, affordability and digital literacy.

Join us in New York by participating in our side event: Transform Health and partners are convening a high-level discussion on the Global Initiative on Digital Health and country resource portal, and how we can better optimise investment and alignment to accelerate UHC progress. Visit the event page for more details and to register your attendance by the 13th of September. Get in touch to schedule a meeting and learn more about Transform Health.

In its report Closing the digital divide: More and better funding for the digital transformation of health, Transform Health highlighted the lack of publicly available information on current funding levels and gaps in domestic and external funding for digital health, particularly for low and lower-middle income countries. 

As part of a new Global Initiative on Digital Health (GIDH), the development of a digital health resource portal is currently under consideration with the aim of optimising investment and alignment with country priorities. Working with WHO and the G20, Transform Health is facilitating a multi-stakeholder consultation to inform the development of the resource portal, including carrying out an online survey and key informant interviews to gather initial insights ahead of the final G20 Health Working Group and Health Ministers’ meeting in August 2023.

Further consultations will take place over the coming months to allow for in-depth discussions to help shape the portal, ensuring it responds to the needs of users and to build wide stakeholder buy-in. 

Key perspectives from the consultation so far:

So far, 34 organisations have shared their views on the potential uses, audience, scope and functionality of the portal. They represent civil society; implementing / technical partners; intergovernmental organisations; multilateral donor agencies; academia; and private foundations. Here is what they told us:

1. A portal to track investments in digital health will help to address several challenges

Stakeholders support the creation of a portal to track financial investments in digital health as part of the GIDH. Survey respondents and key informants felt that a portal— which must build on and align with existing tools and health investment tracking efforts—could help to address a range of challenges currently facing governments and other actors in the digital health ecosystem, including:

• Lack of transparency about current and projected levels of digital health financing.
• Missed opportunities to match available resources to funding needs and country priorities.
• Lack of knowledge about funding gaps for different areas of digital health transformation. 
• Fragmentation and duplication in donor financing.
• Inconsistencies in tracking and reporting on digital health investments.
• Weak understanding of donor priorities, grant cycles and funding processes.
• Insufficient timely information to support future strategies, budgets and assessments (e.g. on unit costs, cost effectiveness, return on investment, impact of interventions, etc).

By making information about digital health financing more accessible, stakeholders believe that a portal will assist governments, donors and the private sector to make more impactful investment decisions, fill funding gaps and increase accountability. 

2. A range of users and uses must be considered for the portal and involved in its development 

Consulted stakeholders agreed that a portal will be of particular use to governments from low and middle-income countries (LMIC) who are facing significant financial barriers to implementation of their digital health strategies. Representatives from LMIC governments and their partners should therefore play a major role in the design and testing of the portal. 

In addition to governments, other potential users of the portal identified were civil society and communities; donors (bilateral, multilateral and philanthropic); the private sector; implementing partners; and research and academic institutions. Each stakeholder group is likely to have slightly different information needs and expectations from the portal. A fully inclusive process involving each of these groups in developing the portal—and other aspects of the GIDH—will help to ensure that these are met as far as possible. Involving as many stakeholders as possible will also enable lessons to be learned from previous efforts to track investments in other areas of health. 

3. A portal should bring together information on different sources of investment in digital health transformation 

When asked what kinds of information should be included in the portal, survey respondents indicated that they would be keen to see different types of information collected and presented, including:

• Government (domestic) funding commitments and allocations for digital health transformation 
• Donor pledges / funding commitments and allocations for digital health transformation 
• Detailed information about digital health transformation investments (e.g. programme descriptions, areas of investment) 
• Compilation and summaries of costed national digital health strategies 
• Details of available resources versus total funding needs to implement national digital health strategies (funding gaps) 

Many respondents expressed a desire to have a single online portal that brings together information on financial investments with information on countries’ needs and country-enabling resources. It was suggested that a ‘one-stop shop’ would be helpful for both countries and development partners to better understand the environment and context for future investments and to learn from past investments. 

4. Tracking investments in the foundational pillars of digital health transformation must be a priority

Many stakeholders expressed their desire for the portal to support countries in moving away from a project-based approach to digital health, towards implementing a more holistic and sustainable approach to digital health transformation. In addition to tracking investments in different types of digital health interventions, the portal should support better prioritisation, reporting and analysis of investments in the foundational building blocks for digital health transformation. This will help countries and donors identify opportunities to increase investment in these critical but often underfunded areas. 

5. The portal should be designed to help to inform decision making

Respondents broadly agreed that a portal should be more than just a monitoring tool and include components to help with benchmarking, analysis and learning to inform future decision making and resource allocations. 

In addition to tracking funding flows at national and sub-national levels, potential portal users wanted to be able to see how funds were used and what impact investments had. This kind of information would help stakeholders to better understand what works and what should be scaled up. Users should be able to put a country’s financing information into context by cross referencing it with information about, for example, digital maturity and the broader health, economic and political landscape. 

6. Data collection and verification challenges will need to be addressed

Whilst stakeholders were enthusiastic about a portal, many believed that it could be challenging to populate and maintain it. The majority of organisations surveyed do not currently have a system in place to track digital health investments. Digital health transformations are often invisible within programmes and there is currently no system for governments or donors to report on investments in digital health transformation (i.e. through National Health Accounts or the OECD-DAC). 

Respondents agreed that it will be important for governments, donors and other stakeholders to agree on a set of categories for investments in digital health transformation. The WHO/ITU eHealth building blocks and WHO classifications of digital health interventions were both considered as the ideal starting point for this exercise.  

To ensure the portal is both effective and widely used, different stakeholders will need to be incentivised to share accurate and relevant information on a regular basis. Its value proposition will need to be clearly communicated and the data within it will need to be trusted and objectively verified. Respondents agreed that contributing data to the portal should not place unnecessary burden on countries or donors. 

Recommendations for the way forward

Transform Health recommends that G20 leaders, WHO and other partners incorporate the findings from this consultation into the next phase of the GIDH’s development. Further perspectives on the resource portal and other pillars of the GIDH should be sought as soon as possible, particularly from constituencies and key partners, such as LMIC governments, bilateral donors and other multilateral partners, including development banks.

Looking to the longer term, governments and development partners should explore more routine and sustainable mechanisms for reporting on both domestic and external investments in digital health transformation. For example, expenditure categories for digital health transformation could be included in the National Health Accounts and OECD-DAC reporting systems. Information from these sources could then be presented together in the digital health resource portal along with other relevant data.

READ THE FULL CONSULTATION REPORT

Read the recommendations from our earlier consultation on the GIDH