Reflections by Mathilde Forslund & Christoph Benn, Transform Health

Almost a year ago, Transform Health published a report, Closing the digital divide: More and better funding for the digital transformation of health, to guide investment and action to support the digital transformation of health systems. The report highlighted issues with the current digital health financing landscape, which are standing in the way of countries fully harnessing the potential of digital health to transform their health systems to deliver health for all. 

One of these issues is the lack of publicly available information about past and current expenditure on digital health transformation. Without knowing how much money is being spent, by who, and for what, it is difficult for countries and donors to know which investments are most impactful and where the most urgent funding gaps are. Another challenge is poorly coordinated digital health investment and a lack of alignment of external funding from donors and the private sector with national priorities. This leads to fragmentation, duplication of resources and missed opportunities to sustain and better scale up effective solutions.

Consequently, one of the key recommendations from Closing the digital divide was that governments and other donors should increase and better coordinate investments in digital health transformation, particularly in low and middle income countries. 


Under the Indian G20 presidency and WHO’s leadership, reducing fragmentation in the digital health ecosystem becomes a priority

At the end of 2022, the Indian government announced that digital health innovation and solutions to aid Universal Health Coverage would be one of the priorities under its G20 presidency. Transform Health welcomed this, and has been working closely with the Indian government, WHO and coalition partners, to translate its recommendations for better digital health investment, and for meaningful multi-stakeholder engagement within digital health transformation, into action. 

Ahead of a G20 Health Working Group in April, Transform Health was invited to convene a multi-stakeholder consultation on the G20-supported Global Initiative on Digital Health (GIDH), aimed at reducing fragmentation and aligning digital health initiatives and funding. Feedback from more than 80 individuals representing over 50 organisations was gathered and shared directly with G20 leaders, offering a platform for stakeholders to have a say in the development of the initiative.

As plans for the GIDH developed, under the leadership of WHO, Transform Health was invited again to collate inputs from diverse stakeholders. This time, the focus of the consultation was on the second component of the GIDH: a country resource portal to optimise investment and alignment with country priorities.

Pillars of the GIDH. Source: WHO

To help inform the creation of the portal, and strengthen its alignment with other pillars of the GIDH, stakeholders from a range of sectors shared their views on the portal’s potential uses, audience, scope and functionality. 

We shared the results from both consultations  with G20 leaders during the Health Working Group Meeting in April and at the final Health Ministers’ meeting in August. Following the meeting, G20 Health Ministers officially announced and committed to support implementation of the GIDH in their outcome document.


Addressing gaps in financing information must be addressed as part of the Global Initiative on Digital Health

Whilst stakeholders consulted by Transform Health are enthusiastic about the potential benefits of a resource portal, many believe that it will be challenging to populate and maintain it. The lack of available, or systematically collected, information on digital health investments was highlighted yet again as a major barrier. 

The majority of governments, donors and organisations surveyed, do not comprehensively track digital health investments. As the World Bank highlighted in its new Digital-in-Health report, there is currently no agreed system to classify investments in digital health transformation and neither governments nor donors are required to report on such investments within existing mechanisms such as National Health Accounts or the OECD-DAC donor reporting system. Data that is reported is often assumed to be an underestimate since digital investments are difficult to separate from investments in other areas of health system strengthening. 

Until these barriers are overcome, our understanding of the quantity and quality of digital health investments will be incomplete and it will remain difficult for countries to identify and close funding gaps. The development of the GIDH will help to draw further attention to these challenges and hopefully bring about the needed coordinated actions to increase the availability and transparency of funding information. 


What is next? Moving towards an improved digital health funding ecosystem

Through our recently established Investing Smarter in Digital Health Transformation working group, Transform Health stands ready to support WHO, the World Bank, OECD and other partners in exploring more routine and sustainable mechanisms for reporting and tracking of both domestic and external investments as part of the GIDH. Powered with more complete funding data, governments, donors and civil society alike will then be in a stronger position to mobilise and better coordinate and align additional resources for equitable and sustainable digital health transformation in LMICs. 

Transform Health will also continue efforts to strengthen the case for funding and digital transformation of health as a strategic investment. This will be alongside work to improve guidance and accountability to ensure digital health funding drives improved health outcomes for all. 

We look forward to working with our partners to deliver health for all in the digital age.