Building a Global Digital Health Policy Framework in the Era of COVID-19

• Domestic technology standards and data protections risk fragmenting away from global interoperability, preventing health companies and researchers from leveraging health data and technologies to provide new and better services internationally.
• A global digital health framework requires low- and middle-income countries to work with international partners on key foundations: national strategies, skills, ICT infrastructure, and governance that balances innovation and data protection.

OVERVIEW – The case for coherent global digital health policy

Digital health—the use of information and communications technology (ICT) to provide and improve health services—holds transformational potential for health care around the world. Many digital health products are already proven, readily available, and adaptable to all kinds of countries. Digital health can help low and middle-income countries (LMICs), in particular, overcome traditional barriers to better health care, especially staffing and other physical resource constraints. Digital technologies are showing potential during the current coronavirus crisis by facilitating collaboration between health-care researchers and reducing the need for in-person care. While health data and digital technologies are not a silver bullet to COVID-19 and other health issues, they will be crucial to improving overall health outcomes in countries around the world. LMICs need to work with international partners, such as the World Health Organization (WHO) and development banks, to marshal the resources, expertise, and strategies to help them develop digital health policy frameworks necessary to realize technology’s potential..

COVID-19 underlines the importance of international cooperation and collaboration to global health.

A global digital health policy framework is only at a nascent stage. Understandably, policymakers in all countries are first dealing with the considerable challenge of adapting technology to their own domestic health frameworks. And international organizations are only just starting to develop the common principles, best practices, and tools to help late adaptors and developing countries catch up with leading countries. The risk is domestic frameworks will fragment away from international standards, thereby preventing health companies and research organizations from leveraging health data and digital technologies in order to provide new and better services across different countries. COVID-19 has underlined the importance of international cooperation and collaboration to global health.

LMIC policymakers and their international health and development partners must focus on foundational issues—namely, a national digital health strategy, digital skills, ICT infrastructure, and data governance—to build effective domestic and global digital health frameworks. This report aims to support these policymakers in doing this. The first section outlines the promise of digital health (the appendix includes case studies from several regions that illustrate how this is working in practice). The paper then gives an overview of core enablers for digital health, including an analysis of the importance of ICT infrastructure and digital skills, and domestic and international data governance. The paper then reviews the growing focus on digital health by multilateral organizations and other nongovernmental organizations (NGOs).

The paper concludes with general findings and recommendations, summarized below:

• Countries should develop holistic national digital health strategies. There is wide disparity in progress in this area among LMICs, with several important countries having no formal national plans. Digital technologies will not achieve anywhere near their full potential absent a plan that provides the necessary resources, coordination, cooperation, and leadership. These plans need to be holistic, in part, as each country’s situation will be somewhat different, including the considerable complexity that comes from integrating digital technologies with legacy health systems.
• Several multilateral organizations and private-sector initiatives have elevated the focus on digital health at the international level, such as the WHO-backed global digital health strategy. LMICs should work with WHO and other actors to mobilize the resources and expertise to help develop and implement—or improve—their own digital health strategies.
• Training and education to use digital technologies is critical, but few LMICs have integrated digital skills into their health-workforce training. Regional and multilateral health organizations, donors, and other stakeholders should prioritize efforts to help LMICs address the most pressing skills gaps.
• There are particularly acute gaps in ICT infrastructure in LMICs, which are home to most of the people that remain disconnected from the Internet. Poor ICT infrastructure severely limits the potential of digital health. Regional and multilateral development agencies, and other donors, should fill these gaps to cover private-sector shortfalls—for example, with regard to wireless mobile coverage in rural areas.
• LMICs need to enact a data governance framework that balances data privacy and protection with innovation. The generation, protection, use, sharing, and international transfer of high-quality data is fundamental to an effective and innovative digital health program. An overly restrictive data governance framework will limit the potential of digital health technologies.
• Policymakers need to build interoperability into their frameworks from the start, as many of the benefits of digital health technologies require cross-border transfers of data. This is critical, as many firms and research organizations involved in digital health rely on the Internet, the free flow of data, and centralized IT facilities to easily, cheaply, and reliably access data, patients, and health-care providers around the world. The emergence of a meaningful, integrated global digital health policy framework will depend on national governments enabling cross-border flows of data.