From Promise to Impact: Can the Digital Revolution Transform Global Health?
This piece is part of our month-long focus on health in the lead up to the 2018 World Health Assembly.
In 2010, Apple trademarked the slogan, “There’s an app for that”, a caption from its advertising campaign that went viral. The resonance of that term in popular culture highlighted the ubiquity of not just smart devices, but also the interactions that they facilitated. Devices and apps together opened up a metaphoric wormhole into the previously unseen universe of relationships, movements and personal preferences; providing a treasure trove of data in digital form that serves as the foundation of the digital economy. It’s no wonder that the Economist recently proclaimed, “Data is the new oil”, referring to the giants of the digital economy – Alphabet, Facebook, Apple, and Amazon.
The opportunity to capture the potential of the digital revolution within the social sector is very real. The advances made in technology – devices, infrastructure, bandwidth that are faster, better and cheaper – has opened the space for countries and communities to leapfrog into a world that is not constrained by the traditional limitations of labor, land, and capital. The transformation heralded by digital payment platforms is a prime example of how digital systems can change the paradigm of social impact and deliver real financial inclusion for millions—potentially billions. What will it take to similarly transform healthcare in the developing world?
The hare and the tortoise
As leading decision makers in global health gather in Geneva this month for the 71st World Health Assembly, there is a general consensus around universal access to basic healthcare—something The Rockefeller Foundation has championed for a decade. Yet the realities around delivery of appropriate, affordable and quality healthcare to the household remain mired in complexities around human resource constraints, fractured or absent supply chains for essential medicines, and fragmented primary and community health structures. The promise of digital tools and systems to transcend these barriers has captured the attention and imagination of the sector. Getting from promise to action is rife with debate, with transformative technologies and health infomatics squaring off in an Aesopian race.
Perhaps the most exciting opportunity—the hare in this race—is the combination of big data and machine learning. Global health experts can now detect, respond in real time and even predict outbreaks and epidemics. These new approaches for leveraging big data can identify cold spots or the absence of service provision, transform disease surveillance and enable a more timely response to natural and humanitarian emergencies as well as to disease outbreaks.
The solution is not just building digital systems, but ensuring interoperability, aligning with existing national health systems and ensuring national ownership, governance and capacity.
The current opportunities within data analytics in health are bounded by the lack of rich sources of customer-centric information that can drive targeted and personalized health services. These sources include patient registries, electronic medical records, and health information management systems. Health management information systems are the tortoise to the big data’s hare. They aren’t as flashy, but they form the nervous system of public health delivery. The digitization of these systems can unlock gains in delivery efficiency, resource allocations and effectiveness of interventions, amplifying impact on key population health indicators.
The good news is that there have been significant investments in digitizing these systems. For example, the District Health Information System (DHIS2) is the management system used in more than 60 countries, and the Open Medical Records System (OpenMRS) is operating in over 20 countries. These two are part of an emerging set of digital health global goods that are poised for scale. However, while the movement towards national digitized health systems has been unprecedented, it has also been deeply fragmented, often driven by disease-focused interests and financing, and exacerbated by lack of overarching national strategy and governance. Unfortunately, despite the best intentions and investments in digital health platforms, the current state consists of duplicative structures that are single disease or demographic focused, creating significant inefficiencies. The solution is not just building digital systems, but ensuring interoperability, aligning with existing national health systems and ensuring national ownership, governance and capacity.
It’s easy to lose perspective when either being mesmerized by the promise of fast-paced advanced analytics or being caught in the plodding labyrinth of country health digital platforms and interests. Kentaro Toyoma said it best: “Technology amplifies human intent and capacity.” The reality is that we need both the robust ground truth data that give us insight into customers of health services—which when linked to big data analytics have the potential to transform public health systems, opening new opportunities in precision public health—and direct to patient personalized health services.
At The Rockefeller Foundation, we are seeking to leverage digital technology and build systems that provide insights into the health needs and behaviors of communities, especially mothers and children. By focusing on community health – the interface between the frontline health provider and households –we hope that digital systems will enable health providers to deliver appropriate and targeted services that save lives and improve health outcomes for all members of the community. Moreover, national data platforms linked to community data will allow national decision makers to effectively plan resources, motivate their workforce and build efficient infrastructure and supply chains, taking us closer to achieving universal health coverage.
It’s worth reminding ourselves that before they were Alphabet, Facebook, Amazon, and Apple, they were first a search engine, a social network, an online bookseller and a hardware manufacturer. We believe that community health can provide an analogous platform to transform global health.