2.2 The global digital health context: relative focus on decentralized structures

2.2 The global digital health context: relative focus on decentralized structures

There has been considerable work carried out in the past two decades in particular to expand and embed the use of digital data systems in the global South. Yet such work frequently lacks attention to decentralized health structures (whether through discussing their potential/actual inputs, possible pitfalls, any evidence for or against such focus, etc), while calling for greater equity of data collection and use, which would presumably require engagement at all levels of a health system, horizontally as well as vertically.

Recent initiatives include the May 2018 71st World Health Assembly Resolution on Digital Health, which demonstrated global recognition of the value of digital technologies to contribute to advancing universal health coverage (UHC) and other health aims of the Sustainable Development Goals (SDGs).

The Resolution urged Ministries of Health to assess their use of digital technologies for health […] and to prioritize, as appropriate, the development, evaluation, implementation, scale-up and greater use of digital technologies, as a means of promoting equitable, affordable and universal access to health for all, including the special needs of groups that are vulnerable in the context of digital health...to consider, as appropriate, how digital technologies could be integrated into existing health systems infrastructures and regulation, to reinforce national and global health priorities by optimizing existing platforms and services (p. 2).

However, the 2018 Resolution did not discuss decentralized aspects of digital health data systems.

Moreover, with respect to the SDGs: none of SDG 3 (Good Health and Wellbeing) targets or indicators makes reference to digital data, indeed to any data, aggregate or disaggregated. SDG 9 and its 9a, 9b and 9c targets tangentially refer to ICT access, more sustainable infrastructure, research capabilities and the like: all relevant to digital health data collection and use, which is nowhere specified.

The 2019 WHO guideline: recommendations on digital interventions for health system strengthening emphasizes the pivotal necessity of digital data for supporting improved health service delivery, while highlighting the challenges ahead.

Thus the Guideline states: Amid the heightened interest, digital health has also been characterized by implementation rolled out in the absence of careful examination of the evidence base on benefits and harms. The enthusiasm for digital health has also driven a proliferation of short-lived implementations and an overwhelming diversity of digital tools. (p. i)

Despite the wide-reaching nature of the Guideline, it does not address space for decentralized digital health engagement; the adapted Tanahashi framework model set out in the Guideline fails to include such wider governance and management levels in its overview of opportunities for digital health specific to achieving UHC.

The widely endorsed (including by BMGF) nine Principles for Digital Development, first developed in 2012 3, address issues such as:

Designing with the user: this supports the building of better, more transparent, jointly shared and robust digital data systems designed with the context and user in mind.

Understanding the existing ecosystem: this requires the involvement of 'community members, donors, local and national governments' in an iterative process throughout a project/initiative lifecycle.

3 Principles of Digital Development. Retrieved from: https://digitalprinciples.org/ The Principles are an attempt to unify digital principles and create a community of practice for those who work in digital development. The Digital Principles were first created in consultation with organizations such as BMGF, SIDA, UNICEF, UNDP, the World Bank, USAID and WHO.