Photo: Gary McNutt/Community to Community Productions
Digital Health Policy: Frontiers and Fault Lines
icia Gerber, MHS/HP, Technical Officer, Policy Impact and Strategy, Health Metrics Network, WHO
T
International Telecommunication Union, September 17, 2010
The Backstory
The views expressed are solely the presenter’s and may not reflect those of her institution.

Photos (l to r): KjetilLenes, Heidi Sheppard/iStockphoto

Global Digital Health Emergence

uInternational public health evolution framework
u(1800–1950) Tropical medicine—Colonialism and imperialism

u(1950–1990) International health—Cold War

u(1990–Current) Global health—Rapid advance of the global economy
(Elizabeth Fee, Ph.D, Examining a Framework: The Three Phases of International Health, November 2003)
vDigital health intertwined with growing “global health” movement
wKey in efforts to obtain better health with the same or less
resources, further fueled by world financial crisis which is
exacerbated in developing world.
uNational health budgets threatened by falling foreign direct investment in
emerging markets, which is predicted to decrease by 82%.
uInternational health financing will be constrained by reduced remittances, reduced
aid and reduced multilateral funding. Overall, a global decline of remittances
of between 1% and 6% is expected, though some countries will see
decreases of upwards of 20%.
Photo: Perry Kroll/iStockphoto

Digital Health in Rural Areas

uDigital health solutions help address critical health care issues in
rural areas such as:
uAccess to care


uHealth care provider shortages
uOrganization of services for vulnerable populations
uHigher incidence of chronic disease, traumatic injuries and substance abuse




Photo: Perry Kroll/iStockphoto

Digital Health in Rural Areas

“In most developing countries, 85% or more of the populations live in rural
areas. They are in need of health services. The medical systems in these
countries have limited resources and gaps of various shapes and sizes. It is
generally rural peoples who are neglected.”
(Proceedings of the third Annual Scientific Meeting of the Rural Clinical School of Western Australia, 2009 )
“One in 3 adults living in rural areas is in poor health”
(Improving Health for Rural Populations: Research in Action)
“Rural practice is a particular field which requires representation in national
and international policy making bodies if the continuing serious
disadvantage in rural health and rural health services are to be
overcome. It is essential that the voice of rural health be included directly
in policy.”
(A Framework for Rural Healthcare: WONCA)


Photo: Perry Kroll/iStockphoto

Ecosystem of Policy Players

uGovernments (Agencies, Legislators, Regulators)

uCommunity leaders
uDonors

uInternational health organizations
uHealthcare administrators and professionals
uPatients

uDevelopers and implementers

uPrivate sector
uOther influencers in civil society
Photo: Perry Kroll/iStockphoto

The Health Reform Waters

Photo/NASA/nasa.gov

Global Dialogue and Action

WHO
World Health Assembly reviewed and adopted resolution WHA58.28, in
May 2005 urging Member States to:
u

Consider developing long term strategic plans for developing and implementing
eHealth services
uRequested WHO provide technical support to Member States, and facilitate

integration of eHealth in health systems and services, including in training.
Other notable examples

EU
G20
ITU
NEPAD
PEC
A
HMN
mHEALTH ALLIANCE
Photo: Perry Kroll/iStockphoto

Global Dialogue and Action

HMN (Health Metrics Network)
u

Hosted and administered by the World Health organization (WHO)
uDeveloped a Framework and Standards for Country Health Information

Systems and supported nations in deploying it

u
Efforts of HMN and its partners have produced HIS advancement in 83
nations since 2005, including 70% of low-and middle- income countries
(LMICs)
Photo: Perry Kroll/iStockphoto

Momentum: Policy and Templates


u
Clear, available policy options critical now when countries are addressing
HSS, eHealth, HIS and CRVS reform
u

Many nations express an urgent need for resources in the area of policy
development and planning
u

Key global voices emphasizing more robust data and CRVS strengthening to
improve health and achieve MDGs (MOVE-IT, H8, PMAC, PARIS 21,
Global Fund)
u

WHO drafting common framework for national health policy and strategy
with special focus on the health of women and children

Photo: Perry Kroll/iStockphoto

Silos to Systems

What policies encourage person centered, user
driven, integrated, collaborative, sustainable,
scalable, reusable, demand-driven solutions
in-country and on a global level?
Themes
uBe
daring in health technology visions for the Global South—much has been done
with limited resources and a lot of ingenuity
uUltimate
goals should be to strengthen health systems and improve people’s health
uCollaboration
and innovation across resource constrained countries and south to
south learning are occurring—Equator is NOT the dividing line for innovation—
playing out in policy arena
Photos (l to r): Perry Kroll/iStockphoto, Joel Selanikio/DataDyne.org/ © Rockefeller Foundation

Digital Health: Promise and Policy

hibabava, Mozambique
C
Frontline SMS, new health computing infrastructure
Philippines
Rural eHRs—Open-source, multi-lingual
Mongolia
Telemedicine in 13 provinces
Belize
Comprehensive national health information system
Photo (top left): iStockphoto

Digital Health: Promise and Policy

Addressing and resolving policy questions is a complex process,
particularly at the convergence of healthcare, technology and information
systems where:
uMany
policy development efforts are in nascent stages;
uPolicy
at the district, regional, national and global level must align or at a
minimum, be complimentary;
uThe
issues at play and stakeholders involved participating in the policy
process are significant, with competing interests; and
uPolicy
can be many different things such directives, regulations, laws, and
judicial interpretations.
Photo: iStockphoto
Digital Health: Promise and Policy

LMIC eHealth projects share funding, sustainability, interoperability, adoption
and patient/stakeholder engagement challenges with their developed world
counterparts BUT different policy issues may predominate:
uPolicy
Teeth?—“Policy” can have very different meaning in LMIC context
uLegislative
Specialist Shortages—LMICs may have a limited capacity of
specialists to draft needed legislation and review outdated laws, many
times dating from time of country independence
uBasic
Needs—Capacity-building/infrastructure vs. data privacy and
confidentiality
uGovernance
Challenges—Political instability can be more frequent and
acutely felt—policy shelved for decades
uOverlay
of Global Goals and Institutions—Policymakers look to MDGs,
WHO and regional bodies for guidance and policy alignment
uDonor Alignment—Multiple
donors mean multiple policy alignment,
evaluation and reporting issues
uDistrict
and Local Solutions—More locally-driven and customizable
strategies: e.g. open source tools and community health workers
Photo:iStockphoto
HMN Policy Toolkit

uStarting points for dialogue are emerging and a set of overarching policy

issues with which to grapple, including:
uData
u
Stewardship and Policies for Information-Sharing/Use;
Governance;
uWorkforce
Training and Capacity-Building;
uInter-jurisdictional
uFinancing,
and Global Issues;
Business Models and Incentives; and
uArchitecture
and Interoperability.
vCoordination between efforts, nations, institutions and movements
(eHealth, mHealth, HIS and health systems reform) is critical to share new
and quickly emerging intelligence.
wLessons learned can be applied globally and will feed insight and
information into larger international policy discussions on health systems,
health coverage and health technology use, for example.
Photo: iStockphoto
HMN Policy Toolkit

Photo: iStockphoto
Digital Health: Promise and Policy


“If you want to go fast, go alone;
if you want to go far, go together”
—Ancient Proverb
Photo (top left):iStockphoto
TICIA GERBER, MHS/HP

World Health Organization
Health Metrics Network
www.healthmetricsnetwork.org
Avenue Appia 20, CH-1211
Geneva, Switzerland
202.486.5236
gerbert@who.int
Photos (l to r): Perry Kroll/iStockphoto, Heidi Sheppard/iStockphoto, Carolina K. Smith, M.D./iStockphoto/iStockphoto (2), NASA, Gary McNutt