How are countries using digital health strategies to support UHC?

Since 2013, Central American Health Informatics Network (RECAINSA), a network integrated by volunteers and health sector professionals, has been seeking to open spaces of exchange for experiences and good practices in Digital Health in Central America, working with key actors of public and private sectors, Academy and agencies for international development to improve National eHealth governance through promoting the necessity of legal and strategic frameworks and the creation of spaces for health professionals’ formation in Digital Health matters as well. The gap in digital health is still big in most of the countries compared with advances in other regions of Latin America, but there are some significant advances in some countries like Costa Rica, El Salvador and Panama, that are currently implementing national projects of Electronic Medical Records, Tele-medicine, among others, and they are a reference for the rest of the countries in the region. In this session, we will present the most relevant projects in Digital Health and we will analyze the key factors of success they have had and the learned lessons to date. We will project main challenges for this countries and Central America overall. The methodology used for this presentation is based on analysis and synthesizing of interviews with members of RECAINSA, those who are participating direct or indirectly in these projects and the information obtained from available sources.

Universal health coverage is one of the targets under the Sustainable Development Goal 3 with the aim of guaranteeing the right to health and reducing extreme poverty. Achieving UHC means increasing the access to quality health services while providing financial risk protection. In 2018 the Government of Kenya set the target of ensuring all households have access to affordable and quality healthcare by the year 2022. Taking a tax-based approach and starting with four county governments in the pilot phase, the national government sends grants to the counties to pay for health services offered at no cost to the public. This session will discuss the efforts Kenya is making in measuring its progress towards the attainment of universal health coverage (UHC) and the process of developing and rolling out a digital tool, the national dashboard to track UHC program implementation in Kenya and the use of the dashboard to keep its policy makers informed on implementation progress and performance. The first part of the presentation will give a background on the country’s approach to achieving UHC and the consequent selection of measures to track progress. The second part will be a discussion of the key processes used to engage stakeholders and develop the national UHC dashboard at the Ministry of Health and with capabilities for direct application with county departments of health. The presentation will include a discussion on the choice of technology and the contextual issues that were considered to inform its design. In this session, the panel will also discuss the challenges, lessons learnt and other digital health interventions that could contribute to effective monitoring of progress towards universal health coverage.

After adopting federalism in 2015, Nepal established 753 autonomous local government units (urban and rural municipalities) led by locally elected leaders. For these municipalities, community health is often a conflicting priority with many political leaders showing a preference for investing in infrastructure projects, such as roads and energy, that produce quick and visible results to their political constituencies (https://www.nepjol.info/index.php/HPROSPECT/article/download/22856/19497). When they do invest in health, they typically opt for activities that generate immediate political publicity such as providing health subsidies, as compared to longer-term initiatives that have the potential to strengthen health systems. However, for many political leaders, deploying modern technologies in the public sphere is a politically attractive proposition, and our experience from Nepal shows the willingness of the politicians to adopt digital technologies in health. Strengthening public services and governance through digital technologies is a trending concept among the politicians in Nepal, and many have embraced mHealth tools, such as those developed by Medic Mobile, that empower community health workers (CHWs). For the local political leaders, the concept of CHWs using mobile technologies to provide better health care to their constituencies can be seen as politically attractive and as an example of health investment that builds political capital. Medic Mobile's tools allow political leaders and municipal health officials to access performance dashboards, which provide a snapshot of the health status of their respective constituencies. The tools enable them to monitor the performance of health workers and better plan additional community health interventions. As Medic's tools bring community health issues to the forefront, and on to the radar of the political leaders, the tools support to establish community health issues as prominent political agenda of the local governments and make the politicians more cognizant on public health — thereby creating a sustained positive impact on people’s health.