February 2, 2021

Utilizing Digital Health as a Health System Strengthening Tool for Developing Countries

"The coronavirus (COVID-19) pandemic has magnified existing weaknesses and gaps in health systems. Developing countries have been severely affected," according to a report published by the GSMA, a UK-based organization representing the interests of mobile operators worldwide. "From under resourced health facilities to poor data and information coordination, weak health systems pose serious challenges for developing country leaders and development partners working to mitigate the impact of COVID-19 and other health issues."

Titled Digital Health: A health system strengthening tool for developing countries, the report further says that "there is a pressing need to strengthen health systems in developing countries. Reducing and mitigating the impact of these challenges will require a holistic approach that recognizes health systems as complex and adaptive, functioning at multiple, interconnected levels with a range of stakeholders."

In outlining its objectives and scope, the report explains: "Our research aimed to reveal the transformative impact digital health can have in developing countries. This report unpacks the challenges facing health systems in developing countries and how they have been exacerbated by the COVID-19 pandemic. It examines digital health as a strengthening tool for health systems, featuring different private sector business models, and highlights the role of digital health in managing COVID-19. Finally, we share strategies for reaching those at the bottom of the pyramid (BOP) and conclude with strategic recommendations for digital health stakeholders during and beyond the COVID-19 pandemic."

Shaped by interviews with health and digital experts across seven developing countries (Benin, Nigeria, Rwanda, Somalia, Bangladesh, Myanmar, and Pakistan), below are the report's strategic recommendations for key digital health stakeholders including development partners and nongovernmental organizations (NGOs), start-ups, mobile operators, investors, and governments and health ministries.

Development partners and NGOs

Align efforts and support the government to build capacity to deliver policy and strategy
  • Consider committing and adhering to collaborative donor actions like the Principles of Donor Alignment for Digital Health.
  • Commit to having a digital agenda as part of any development partner-backed intervention, giving digital health the same status as gender/social inclusion.
  • Provide a platform for all health and digital health stakeholders to discuss and share requirements, best practices and solutions.
  • Work with governments to enable them to track progress on their initiatives.
  • Create a strategic plan with the government based on health systems rather than a programmatic approach, and design the digital health architecture, blueprint or roadmap needed to deliver it.
  • Support the government to build the technical capacity it needs to develop and deliver the digital health agenda.
  • Support governments to slow the spread of COVID-19 and provide social protection for vulnerable populations, promoting a whole-of-government and whole-of-society response to complement efforts in the health sector.
  • Share timely and accurate data with data privacy in mind.
  • Collaborate with government and other health stakeholders to assess the unique social and economic impacts of COVID-19 in a country, take urgent recovery measures to minimize the long-term impacts and help societies to recover.
Work collaboratively to enable sustainable solutions
  • Be clear about what is to be delivered and show how it can become sustainable and scalable.
  • Be more agile with decision making and willing to try new solutions.
  • Improve coordination and share strategic documents and information to avoid siloed solutions.
  • Work collaboratively with start-ups and mobile operators to solve problems together, rather than innovating separately.
  • Cooperate with innovators who are working on sustainable solutions.
  • Be open to matched funding models in which development partners provide a grant if the start-up also has an equity investment.
Help to extend the reach of digital health
  • Work with all stakeholders to help extend the reach of digital health services to the BOP.
  • Take the first financing and planning steps to extend the reach of service provision.
  • Provide the skills and introductions for start-ups to make contracts with the government.
  • Help map out the benefits of investing in digital health.
  • Support in the provision of tools and resources for strengthen their health systems. This includes helping to procure much-needed medical supplies, leveraging digital technologies and ensuring health workers are paid.
  • Leverage existing and established digital health platforms and digital technologies to avoid reinventing the wheel and link these to the national system. A proliferation of new tools, such as information collection systems, can complicate efforts to align information infrastructure and threaten sustainability.


Focus on problems that people care about
  • Create a proof of concept based on local ideas, but build for broader (potentially global) ecosystems.
  • Be innovative in developing solutions that are good for patients/staff and the bottom line.
Understand the processes involved in supporting innovations in digital health
  • Polish the proof of concept and use incubation centers to test ideas and potentially attract funds.
  • Combine digital with analogue models for health solutions. This is more likely to work than converting entirely to digital.
  • Build trust and engage with the government to influence policy. Soft skills, perseverance and dedication is also needed.
Leverage partnerships
  • Identify mutual benefits for start-ups and mobile operators, as collaboration can deliver customized digital health services.
  • Understand mobile operators' cost structures.
  • Align services with the corporate social responsibility (CSR) activities of development partners.
  • Have demonstrable products and a roadmap to attract attention from the government.
  • Approach mobile operators with a proven product. Acting as a consortium (e.g. development partners) can be more powerful.
Develop realistic business cases
  • Be focused and do not attempt to run several businesses simultaneously.
  • Understand that investors and banks are averse to risks in digital health, and be prepared to deal with an unsupportive policy environment.
  • Investigate the market and how to grow – who is going to buy the service and how is it aligned to the country's needs. Be aware of national and international regulatory barriers.
  • Understand the implementation landscape and realize that investors are more likely to focus on companies that use brick-and-mortar as part of their solutions.

Mobile operators

Pursue partnerships
  • Be open to partnering and collaborating with start-ups. Working with them to extend the reach of digital health can be beneficial and profitable for both mobile operators and start-ups.
  • Partner with digital health platforms to leverage existing ecosystems, infrastructure and personnel.
  • Continue to open APIs and customer bases to innovators.
  • Gather feedback on user growth and offer these insights to the start-ups.
Make a long-term, large-scale business case for digital health
  • Adopt best practices from mobile operator-led/supported digital health solutions (examples include Tonic in Bangladesh and M-Tiba in Kenya)
  • Explore providing preferential rates and decreasing costs per call as volume increases.
  • Adopt a three- to five-year view. There is huge potential to grow and reach millions as everyone needs healthcare.
  • Leverage relationships with the government on behalf of other stakeholders.
Make digital health services more user friendly
  • Simplify payment processes and ensure dependable connectivity
  • Nurture local ecosystems, for example, by providing basic health education to customers when they come to distribution centers to recharge their phones.
Extend the reach of digital health services
  • Understand that digital health is a channel for attracting new customers. Like identity, civil registration and rural connectivity, digital health is also a way to build a customer base.
  • Use CSR to extend reach, for example, by providing more toll-free hotlines, and by showing the government how it will benefit from the CSR resources being committed.
  • Share non-confidential data so that all stakeholders can find ways to partner and extend digital health to the BOP.
  • Recognize emerging opportunities for collaboration with the government and development partners/NGOs in the areas of disease prevention and health promotion, provided coordination mechanisms with the government are in place.
  • Foster well-performing, widespread network coverage to aid long-term recovery, disseminate information and support technology in healthcare infrastructure.


Understand the investment climate
  • Adopt a long-term view and be willing to take more risks. The digital health sector takes at least three to five years to see returns, in terms of both finance and impact.
  • Understand the dynamics and regulations of the digital health market.
  • Recognize that digital health provides ample opportunity for social impact investors to support millions of people.
  • Coordinate investments to avoid a proliferation of similar digital health tools.
Understand the local context
  • Understand the implications of local startups having to take unconventional, innovative approaches to improve service delivery.
  • Refrain from investing in digital health companies without understanding the local context. What works well in one country may not in another.
  • Remember that what works well in an incubator environment may not scale if local conditions have not been fully considered.
Nurture the investment climate
  • Be clear with all stakeholders about the conditions for investment, for example, that government must be clear about its policy priorities.
  • Capitalize on positive feedback. When end users spread the word that an innovation is working well, find ways to accelerate the spread of that information to open up other monetization channels and encourage return on investment.
  • Recognize that certain countries are positioning themselves to be leaders in digital health.

Governments and Ministries of Health

Develop digital health policies and strategies
  • Develop health and digital health policy and obtain approval from stakeholders, including the Ministry of ICT.
  • Create an enabling environment for digital technologies through new workflows, new policies, and institutional changes and capacity.
  • Map out where technology is likely to have the greatest benefit, and ensure there is a policy ecosystem in place to support it, such as legislation that requires patient records to be stored electronically.
  • Secure agreement from all stakeholders, including mobile operators, on the digital health architecture, blueprint or roadmap needed to deliver the strategy.
  • Help development partners identify where they are in the value chain. This will help start-ups and investors understand what to focus on, and how to contribute (such as opening up their APIs).
  • Appoint a high-level digital health officer(s) who may have interim external funding to build capacity for digital health policy and strategy, to support the government and to ensure development partners and NGOs understand what they need to achieve.
  • Take a strong technical leadership position and act as a central point for collecting, analyzing and disseminating information for COVID-19 and future disease outbreak.
Laws and regulation
  • Draft laws and regulations that address sector-wide information and data governance issues, and address specific sub-sectors of digital health, such as telehealth, online prescriptions and microinsurance (so that small, affordable premiums can be collected electronically). Data platforms, training and innovation are also areas where laws and regulations are needed.
  • Establish enforcement mechanisms provided by digitally enabled services, such as inspection and regulation of the quality of care and information management.
Behavior change
  • Identify stakeholders' challenges and make arrangements to work with all stakeholders to devise solutions.
  • Collaborate and adhere to governmental roles and responsibilities.
  • Be more open to collaborating with the private sector and actively promoting digital health innovations and partnerships. Be willing to work with innovators directly and avoid creating bureaucratic processes that delay decisions.
Encouraging investment
  • Advise development partners on how they can support and strengthen the government's management capacity.
  • Recognize the value of existing data and improve assessment of the impact of digital health, including success stories, which will help to attract investors.
  • Encourage more investment in the public health sector to bring them up to private sector levels (which only serve those at the top of the pyramid). Keep in mind that improvements to private sector quality can take 10 to 15 years.

The report also discusses the role of frontier technologies and healthcare: "Frontier technologies are powerful tools with transformative potential to deliver healthcare in developing countries. These technologies, when combined with mobile, have the potential to bridge gaps in health systems and enhance health outcomes."

Moreover, "Artificial intelligence and big data enable complex healthcare data and information to be analyzed and used to predict future care plans, as well as expedite and increase the accuracy of triage, diagnosis, screening and interventions. They can also aid the management of disease spread patterns and optimize the time of health workers."

The report encouragingly adds: "Blockchain has the potential to secure healthcare data systems and enhance the management of EMRs. The nature of healthcare, which has distributed stakeholders, calls for a decentralized management system. Blockchain technology can help make data and patient records more secure, private and transparent, and enable traceability and authentication of medical and pharmaceutical products."

Regarding connected devices, "Internet of Things (IoT) and drones have the potential to increase the number of patients that can be treated. IoT-enabled remote diagnostic capabilities can maximize existing capacity and extend care to isolated areas where hospitals and doctors are scarce. One advanced IoT solution is the use of drones for transporting medical supplies. Drones have the capacity to transport vital medical necessities to underserved and rural areas, resolving access issues or easing the challenges associated with a lack of hospitals and pharmacies. Drones are expected to have a critical impact on the health systems of developing economies."

I concur with the report's assertion that "[d]igital solutions have proven to be excellent tools to address systemic challenges, particularly by enabling communication within and between various parts of the healthcare value chain." Do you agree with the report's recommendations on how to utilize digital health as a health system strengthening tool for developing countries?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

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