Last year, the Alliance kicked off a multiyear research project to understand better the impact and role of digital innovations for primary health care managers. With support from the Bill and Melinda Gates Foundation and in collaboration with the Digital Health and Innovation (DHI) Department at WHO, ten teams across eight countries (Bhutan, Ethiopia, Georgia, Ghana, India, Indonesia, Pakistan and Zimbabwe) have been hard at work studying a range of digital solutions and how they have strengthened health systems at the primary level. The digital solutions being studied include: electronic medical records, decision support systems, health management information systems, identification registries and directories and immunization information systems. These tools were shown to improve decision-making by health workers, enhance data management and facilitate better care delivery at the primary health care level.
From 12–14 June, over 30 participants gathered in Addis Ababa, Ethiopia, to reflect on progress and share their key findings. The attendees included members of the Alliance Secretariat and others from WHO headquarters, researchers and policy-makers from the study teams, and representatives from the WHO Country Office for Ethiopia and the Ministry of Health of Ethiopia.
Over the three days of discussion, participants stressed the need to review their research findings in the context of the broader government approach to digital health transformation. They recognized the need for minimum interoperability standards for successful data exchange across digital systems, health programmes, workforce and facility levels. Dr Garrett Mehl of the WHO DHI Department noted that these are cross-cutting issues serving as core requirements for a sustainable and effective digital health ecosystem that supports continuity and quality of care, which resonated with the findings of many teams. Teams also highlighted the importance of ensuring digital systems are developed with the needs of users in mind, for example, allowing those entering data at the facility level to access data (with appropriate safeguards in place) for management and provider monitoring, as this would increase the acceptance and use of digital solutions. Additionally, participants underscored that capacity strengthening to support digital transformation needs to be more inclusive and responsive to the needs of health workers.
Examples from different countries noted the positive and negative unintended consequences of digital solutions. On the plus side, they could support job creation, digital literacy among users and even create a shared platform for community health workers to come together. In another instance, the introduction of new technologies helped make inequities more visible. On the negative, teams highlighted the added burden that some of these technologies placed on already-stressed health workers.
Participants were enthusiastic both about the projects but also the opportunity to share lessons across contexts. Mr Mongal Singh Gurung, from the Ministry of Health of Bhutan, said that when he was first approached by the research team he was too busy, “I am a bureaucrat, and usually bureaucrats are very busy”. He was later convinced to be involved and now notes, “in retrospect, I am very happy that I could be there. And trust me, this project has made a substantial contribution to the digital health innovation of the country.” Although the study in Bhutan focused on the vaccine system, they aim to share lessons with the electronic patient innovation team and build out further work.
Dr Tinatin Manjavidze, Principal Investigator of the Georgian Birth Registry Project at the Department of Medical Statistics of the National Centre for Disease Control and Public Health in Georgia emphasized how valuable it was to share and gain insights with other country teams. She noted: “The synthesis workshop was an excellent example of how important it is to share the knowledge, experience and challenges for researchers and stakeholders with different backgrounds and interests – we all learnt from each other." Dr Anant Bhan, a health systems researcher from Sangath Bhopal Hub in India, was also enthusiastic about the learning community established by the project. “This meeting and the larger initiative have underscored the importance of more work led by the Global South”, emphasizing the pertinent results coming from this initiative. He added, “we need more South-to-South initiatives, and this is a prime example of how supportive platforms to enable this can be implemented.”
Teams showed a strong commitment to stakeholder engagement – including with government agencies, health care providers, academia and community members. As they finalize their studies, they plan to share findings more widely through meetings and workshops spanning the district to national levels, peer-reviewed journal publications and detailed reports. Teams are also planning for more in-depth community engagement through social media, webinars and multimedia tools.