Well-chosen, widely available, affordable digital technology with connected, well-governed health data systems – integrated into health systems – can support countries’ delivery of the right services to more people with less financial stress. Connected electronic health records and virtual interactions such as telemedicine can bring up to 15% in efficiency gains and free resources for addressing patients’ other needs. Early digital efforts have been piecemeal, fragmented and siloed. The World Bank’s recently published Digital-in-Health: Unlocking the Value for Everyone suggests that countries need a new mindset about digital health investments. Digital-in-health can make health personal, contain costs, reduce health differences, help accelerate public health actions and improve conditions for health workers. As in banking and communications, it can also improve efficiency and reduce inequity, provided it is intentionally designed. To move to the next level of impact, countries need to do three strategic things: 1. Prioritise the digital solutions that respond to people’s health needs, are evidence based and are equitable. 2. Connect to deliver new, more, better, seamless health services through leadership and partnership, data governance, and to fill digital infrastructure and health information gaps. 3. Scale to ensure equitable access to all, improve digital skills and literacy, create MARELIZE GÖRGENS Marelize Görgens is the lead of the Digital Health Flagship Program at the World Bank. Armed with expertise in engineering, mathematical modelling, public health, data science and integrative medicine, she first rose to the ranks of director at a global management consulting firm. She then worked for a government ministry in a low-income country to strengthen information systems. She then embraced entrepreneurship in health analytics, collaborated with non- governmental organisations on strategy, and excelled in academia. She has a prolific publications record and serves on the editorial boards of two journals. www.worldbank.org/en/topic/health/ publication/digital-in-health- unlocking-the-value-for-everyone
neurodegenerative diseases, cardiometabolic diseases, vitamin absorption, arthritis, colorectal cancer, glucose metabolism, frailty, osteoporosis, functional gut disorders and more. Advanced big data analytics enable much of these findings. Yet inequity exists here too: this research has been done mainly in the United States and Europe, with minimal done in Africa. There is a need for more local government leadership and research financing, and more focus on diseases of highest public health importance in Africa. THE NEED FOR PERSONALISATION Other areas have also emerged where more integrated thinking and interventions are needed – such as new evidence for reducing tuberculosis incidence and mortality. Tuberculosis has resurfaced as the largest cause of disease burden worldwide. A recent study in India showed that providing a basic food rations package and multivitamins to tuberculosis patients and their immediate families reduced mortality by a whopping 60% and also infections to family members by almost 50%. Populations need different services from in the past, and each person may not respond the same to the exact same intervention, suggesting that personalisation is needed. Fifth, artificial intelligence holds the promise to accelerate health and drug discoveries, provide personalised disease treatments, deliver new types of diagnostics and health services, make health system administration and financing easier, ease the administrative burden of health workers, and provide new ways to access accurate health information that will help people make decisions for better health. Health systems face the impossible task of metamorphosising faster, with fewer staff and less resources, at a time of accelerated and expanded scientific discovery and declining trust. Health systems need to quickly assimilate the accelerated pace with which new evidence is generated and, simultaneously, deliver new, more, better, seamless services that reach everyone. Digital technology and data hold the key to fast-tracking simple and seamless solutions that deliver value exponentially. Digital can help countries address universal health coverage gaps, manage health systems better and deliver care that accommodates the new evidence.
synergy with wider digital transformation efforts, nimble partnerships, and support with financing, monitoring and implementation. There are pragmatic, low-cost aspects of digitalisation to focus on, no matter the maturity of a country’s systems, digital infrastructure or financing situation. Setting up health data governance, regulations and standards for interoperability of digital solutions are not costly but will reduce siloed digital solutions and help manage fragmentation. All countries should pursue them. Over the past decade, the World Bank has invested almost $4 billion in digital health, including in health information systems, digital governance, identification systems and infrastructure. There is significant and growing demand from countries in their journey to bring digital and data into health systems in ways that protect, expand and innovate, acknowledging that each dollar allocated to fortify health systems is also an investment in digitalisation and data utilisation to enhance the effectiveness of health systems for the benefit of all. Digital works. Covid-19 has shown that countries with higher levels of digital adoption prior to the pandemic had fewer Covid-related deaths and cases per million population. The choices that governments make to invest in digitalisation and data today will move us to Health For All for generations to come, regardless of the health emergencies to come. ▪
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Health: A Political Choice – From Fragmentation to Integration
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