During the fifty-eight World Health Assembly in 2005, member states were urged to consider unlocking the potential benefits for integrating information and communication technology in the health sector; indicating the need for both low-and high-income countries to create health modules that could facilitate the development and implementation of digital health services. Recognizing that more than 120 member states, which included low-and middle-income countries, have created strategic plans to develop and implement digital health services that can stand the test of time; the sixty-six World Health Assembly in 2013, focussed on strengthening this foundation through the introduction of eHealth standardization and interoperability.
It is important to acknowledge that adopting information and communication technology to strengthen access to adequate healthcare is a laudable initiative that requires the cooperation of all countries around the globe, specifically low-and middle-income countries. Highlights of a joint report (2017) from the World Bank and the World Health Organization suggest that at least 50% of the world’s entire population cannot access essential health services. The report also reveals that more than 800 million people spend at least 10% of their household budgets on healthcare and 100 million people are pushed into extreme poverty due to their health expenses; these people are forced to survive on a maximum of $1.90 a day. If innovative and effective measures are not implemented to address this distressing condition, a third of the world’s population will still be underserved by 2030.
Although providing improved access to essential healthcare has not been a walk in the park for developed countries, the challenges associated with accessing healthcare are more pronounced in developing countries. With little or no infrastructure to facilitate health services, access to healthcare is largely limited in almost all developing countries. This condition makes it quite expensive to seek health services in developing countries, particularly for poor households who spend a sizable proportion of their income on healthcare. According to a World Bank report (2019), out-of-pocket health expenditure in developing countries amounts to half a trillion dollars every year; this means that every person in a developing country spends more than $80 on health annually. High expenditure for healthcare in developing countries pushes many people into extreme poverty every year; this leads to many deaths that could have been prevented.
A study published by the Lancet Global Health indicates that in low-and middle-income countries, more than 8 million people die every year from conditions that could have been treated; this outcome is largely attributed to poor-quality healthcare. In these countries, poor-quality healthcare is the major impediment to reducing mortality. Although insufficient access to healthcare also hampers efforts to reduce mortality, the impact of poor-quality healthcare is dominant; poor-quality healthcare accounts for 60% of deaths that could have been prevented by appropriate healthcare. The remaining percentage accounts for deaths attributed to non-utilization of the health system. Many lives could be saved if healthcare is improved in low-and middle-income countries. High-quality healthcare in developing countries could prevent 900,000 deaths from tuberculosis, 1 million newborn deaths, 2.5 million deaths from cardiovascular diseases and 50% of all maternal deaths every year. These deaths have a negative impact on human capital development and productivity. For instance in 2015 alone, economic loss amounting to $6 trillion was attributed to these preventable deaths in low-and middle income countries.
However, in recent times, access to healthcare is improving in some developing countries. The adoption of digital health technologies in developing countries is providing sustainable solutions to challenges that have obstructed the optimal delivery of equitable and high-quality healthcare. Highlights of study (2019) from the World Health Organization reveals how digital health is enhancing healthcare in Southeast Asia. In this region, Thailand has been phenomenal in implementing digital health innovations; the country is making headway in the use of medical robotics surgery, diagnosis, rehabilitation and other digital healthcare solutions which are improving access to quality healthcare in the country.
The story is not different in Timor-Leste, where the country has harnessed digital health interventions that have augmented access to healthcare. For a country that has underdeveloped infrastructure, limited human resource and a challenging terrain, leveraging technology for enhanced access to healthcare has been efficacious. In 2013, the Liga Inan, the first mobile health program was launched; this innovative approach allows pregnant women to connect with health providers via mobile phones. The widespread usage of mobile phones even by poor households is increasing the impact of the program as pregnant women living in deprived communities are now accessing the services of midwives and medical doctors. These pregnant women are able to access health information through facilitated voice communication and text messages. In South Asia, there is significant evidence that suggests that digital health technologies are facilitating access to adequate healthcare. For instance, in 2016, Sri Lanka, introduced the electronic reproductive health management information system; this digital health solution has ensured a complete, timely and high-quality data collection, analysis and the use of adequate data across all levels of the country’s health system. Sri Lanka’s electronic reproductive health management information system has been effective in reducing child and maternal mortality as it has improved healthcare across the length and breadth of the country.
In developing countries, many women die from preventable causes that are related to pregnancy and childbirth. According to the World Health Organization, 94% of all maternal deaths in 2017, occurred in low-and lower middle-income countries; South Asia and Sub-Saharan Africa accounted for 86% of these maternal deaths. Most of these deaths could have been prevented if information and communication technology is integrated into healthcare; this could have enhanced access to healthcare. There is considerable evidence to prove the positive impact of digital health technology on maternal mortality in South Asia and Sub-Saharan Africa; from 2000 to 2017, Sub-Saharan Africa recorded close to 40% reduction in maternal mortality. Within the same period, South Asia also experienced a reduction of about 60%, representing a decline from 384 deaths to 157 deaths. According to the World Health Organization, these five factors prevent pregnant women in developing countries from seeking healthcare: distance to health facilities, lack of information, cultural beliefs, poverty, inadequate and poor quality services. Although digital health is providing sustainable and innovative remedies to these challenges that are limiting access to healthcare, there is still potential for enhancement.
A report (2017) from the GSMA Intelligence suggests that to scale-up digital health to a level that could spur long-term benefits for developing countries, particularly countries in South Asia and Africa, where the largest proportion of the world’s population that do not have access to essential health services are located, policymakers and relevant organizations should focus on developing three key areas: expand coverage (access), enhance services (quality) and optimise resources (cost). This target could be achieved by upgrading information and communication systems in health facilities such as hospitals and clinics and implementing a digital health centre model that relies on a digitized supply-chain management; this development will be vital to expanding coverage, enhancing quality services and optimizing resources in developing countries.
This is necessary because the largest share of the population of people in South Asia and Africa live in rural areas where infrastructure is largely underdeveloped; this means that the surest means to improve access to quality healthcare is via a digital solution. The effective implementation of a digital health centre model in health facilities and the digitisation of supply-chain management will require that health professionals are also equipped with innovative digital health solutions that will ensure timely delivery of quality healthcare at a reduced cost in Africa and South Asia. This recommendation can be implemented effectively through public-private partnership, where the government, which in most cases is the largest fund provider for digital healthcare, collaborates with other relevant stakeholders such as telecommunications service providers and development organizations to scale-up digital health for universal healthcare.
About the Authors
Alexander Ayertey Odonkor is an economic consultant, chartered economist and a chartered financial analyst with a keen interest in the economic landscape of countries in Asia and Africa. Alexander is also an author and columnist for The Brussels Times, China Global Television Network (CGTN), The World Financial Review, China Daily, The Diplomat, The Business Standard, The People’s Daily and the Business and Financial Times. His articles have been published by NextBillion (University of Michigan), NTS Bulletin (Nanyang Technological University) and several other research institutions. Some of his research works include Stock Returns and Long-range Dependence, which was published by the Global Business Review (SAGE).