Why is digital health important?

The global expansion of digitalization

In sectors ranging from banking to media to transportation—as well as health—services are becoming increasingly digitized. This transformation has been supported by increased smartphone use, better connectivity, and a younger, tech-savvy population.¹ As of 2021, mobile broadband coverage reached 95% of the world’s population.²  In line with these trends, over 120 countries globally have developed a national eHealth strategy since the early 2010s.³

The COVID-19 pandemic accelerated the implementation of digital health approaches, which offered ways to respond to the emergency and maintain routine health services while limiting in-person contact.⁴ The COVID-19 Response Exemplars research delved into the role of digital health tools in pandemic response, with a focus on data sharing, aggregation, and analysis. Although it was difficult to conduct rigorous, real-time monitoring and evaluation of interventions that were implemented on an emergency basis, it was clear that digital health increased access to affordable, high-quality health care and empowered patients to manage their own health.

Early evidence of digital health's impact on health systems outcomes

Health systems in many low- and middle-income countries face obstacles to the delivery of high-quality health services that everyone can easily access and afford and wants to use. Digital health has the potential to clear away many of these obstacles and improve health care delivery, health outcomes, and overall efficiency in health systems.⁵ However, empirical proof of digital health interventions’ impact on outcomes is sparse; this provides a strong opportunity to build evidence in the field.

Evidence of the impact of digital health in the context of primary health care (PHC) is still emerging. While studies have examined the effectiveness of digital solutions to improve service delivery, quality, coverage, and cost-effectiveness at the PHC level, results remain largely inconclusive. Despite this, the World Health Organization’s 2019 guideline on digital systems for health systems strengthening recommends a range of digital strategies that could be employed to strengthen health systems. The guidelines posit the contexts in which specific digital health interventions are most effective, based on a systematic review of digital health impact research studies. The evidence from the studies at the time showed a range of effects, from ‘no effect’ to ‘positive effects’ describing the relationship of specific digital health interventions and health outcomes. These conclusions were drawn under specific conditions, and with a certainty range of ‘very low’ to ‘low’, reflecting a low degree of confidence overall.⁶

Despite challenges in the evidence-base, many digital health interventions have been rolled out. The enthusiasm for digital health has driven a proliferation of short-lived interventions and an overwhelming diversity of digital tools. This concern was highlighted most notably in the consensus statement of the World Health Organization Global eHealth Evaluation Meeting, which opened by stating: “To improve health and reduce health inequalities, rigorous evaluation of eHealth is necessary to generate evidence and promote the appropriate integration and use of technologies.”⁷ When recognizing the innovative role that digital technologies can play in strengthening the health system, it is vital to evaluate their impact and ensure that they do not divert resources from needed nondigital approaches.

Over the last five years, additional studies have emerged since initial systematic reviews that investigate the impact of various digital health interventions under specific conditions and within certain settings. Presently, the Johns Hopkins University Center for Global Digital Health Innovation is working to update a systematic review, with support from the Gates Foundation. While measuring the impact of digital health interventions remains challenging due to their complex causal pathways, the evolution of interventions to be more direct-to-consumer has helped shed light on potential behavioral improvements under certain conditions.

Why is digital health important?

Digital health has the potential to address common health system challenges

The PHC Exemplars study highlights some key challenges facing health systems, which could potentially be addressed by digital health. While evidence of impact is still emerging, a broader vision exists for how digital health could transform PHC systems in the future.

Digital health can improve health financing and keep health care costs from increasing

It is estimated that PHC spending per capita needs to increase over 250% in low-income countries to achieve universal delivery of high-quality essential PHC services.⁸ To add to the challenge, many countries do not spend all their PHC budgets (low budget execution) due to poor public financial management. However, digitally powered data and analytics can equip advocates and policymakers with concrete evidence, actionable insights, and compelling narratives to demonstrate the impact of health funding, making their case more persuasive and data-driven. Additionally, health finance-related information systems can help track budget execution, streamline payments, and store, categorize, and facilitate the administration of finance-related data. In Kenya, Nigeria, and South Africa, health systems can potentially save 15% of total health system costs by increasing telemedicine and electronic health records.⁵

Digital health can help ensure adequate supply of human and material resources to meet increasing demand, and increase health system efficiency and productivity

Population shifts, rapid urbanization, and poverty are putting ever-greater demands on health systems already facing shortages of commodities, equipment, and qualified health workers. Digital tools, especially logistics management systems, can help health systems manage inventory to ensure reductions in stockouts and wastage. Meanwhile, digital training tools can save staff time and make health workers more productive and efficient, enabling them to meet increased demand for services. Additionally, one study concluded that physicians who use digital health techologies are 14% more likely to be satisfied in their jobs and 20% more likely to have good work-life balance, which can reduce staff turnover and absenteeism.⁵

Digital health can support reductions in the fragmentation of health system governance

In many low- and middle-income countries, the roles and functions of various government ministries, departments, and agencies are not always clear, undermining performance management and accountability. Challenges include a lack of high-quality data, limited access to and use of data, delayed event reporting, poor communication, and the absence of unique identifiers for individuals. Data interchange and interoperability solutions can help by connecting applications and services across institutions.

Digital health interventions can help reduce fragmentation and inefficiencies in patient care and drive earlier and better public health actions

Health care providers need access to patient health and treatment histories so that care from multiple providers in various places can be coordinated, complementary, and responsive to a patient’s changing needs. Patients need transparent, clear, coordinated communication from providers. Digital health tools can help track a person’s health status and services with electronic health records and transmit targeted alerts with streamlined communications systems. Patient access to their own health data could lead to reassurance, reduced anxiety, positive impact on consultations, better doctor-patient relationships, increased adherence to medication, and improved patient outcomes.5 Time spent by providers inputting, managing, and interpreting data across systems and services detracts time from patient care. Further, with digital systems in place and higher digital adoption prior to the COVID-19 pandemic, countries observed fewer COVID-19 deaths and cases.⁵

Digital health can help PHC systems improve and ensure provider accountability for quality of care

If physicians, nurses, and community health workers are not properly trained and motivated, the care and services they provide will be inadequate. A study of health care workers in 18 different countries found that the average clinician performs around 40% of the recommended actions for maternal and child care. Digital health tools can help address quality issues by providing prompts and alerts based on protocols, checklists, and decision support, as well as helping health care workers continue their professional and medical education online.⁵

Digital health can help improve patient confidence in the health system by creating alternative methods to access high-quality care

Research shows that patients who feel heard, respected, and valued (via shorter wait times and clearer communication with caregivers, among other things) are more likely to seek care and adhere to the treatments their caregivers prescribe. Through high-quality telemedicine, digital health can help providers reach more people with care that follows these best practices.