Putting Countries in the Driver’s Seat—With the Keys

By Christina Villella, MPH, MEASURE Evaluation

I always appreciate the annual Global Digital Health Forum as a time to mindfully step back from my work in digital health to observe the trends and the opportunities for alignment and collaboration. One trend prominent this year, in my view, was the interest in furthering country ownership and management of digital health—to reduce fragmentation among many competing systems and to ensure sustainability.

In June, I wrote about governments taking more responsibility for planning and implementing digital health. This year, we saw that trend continue as health ministry representatives, program implementers, and donors advocated for continued investment in country and regional digital health agendas.

It was clear that countries continue to take control of digital health—evidenced by the increasing number of countries with national eHealth strategies. Uganda’s Ministry of Health, for example, owns the digital health process by approving digital strategies before they are introduced. And, in East Africa, stakeholders have come together to develop a regional framework and roadmap for digital health, called the Digital REACH Initiative,  to create an enabling environment for strategic regional digital health programs in six partner states.[1]

Yet, it was also evident that despite years of calling for country leadership and coordination, we—digital health implementers and donors—are often guilty of continuing to propose, fund, and implement duplicate or fragmented systems that make it harder for countries achieve their eHealth goals. As an example, one attendee from the Democratic Republic of the Congo (DRC) spoke of four different instances of DHIS 2 that could not speak to each other. And, even in Uganda, a health ministry representative said that digital health projects still do crop up without being coordinated by the ministry.

Also, at the Forum, I saw a lot of attention paid to “global goods.” Donors, implementers, private sector tech companies, and others are increasingly using their resources and expertise to build digital health platforms as global goods, using open source software. They set up communities of practice to foster use of these digital goods, they add additional features, and they build capacity to use these platforms. They’re designed to address a pressing health information need, such as electronic medical records, health worker registries, or lab information systems.

But, looking a bit farther down the road may show that these platforms and features may not always be compatible with country eHealth strategies and contexts. We—the global digital health community—may be fulfilling a strategy that competes with the country’s strategy or existing systems, which carries the risk of perpetuating the fragmentation pattern and thwarting country ownership. Digital global goods—however excellent—cannot be adopted if they lie outside a country’s national agenda or are incompatible with its health system infrastructure. And, therefore, valuable technical and financial resources and goodwill may be wasted.

So, the question is: How can we combine the push for country ownership with the excitement about global goods? In other words, how can the global digital health community align its technical and financial assistance to support putting countries in the driver’s seat and give them the keys to develop stronger digital health information systems? Here are three possible solutions:

• Empower eHealth leadership in countries to ask the right questions and advocate for the right resources and technical assistance. This includes empowering them to object to programs that don’t fit their needs.  
• Pay attention to who is driving the agenda for digital global goods. This includes considering if in-country professionals in digital health and health systems are at the table when decisions are made regarding what is developed as “global goods” and are equipped to sustain them.
• Share lessons. This should include sharing unsuccessful work so the digital health information systems community can help countries build better solutions with less time and money wasted.

Our clients are the countries where we work. My hope is that at next year’s Forum, even more countries will showcase how investments and growing expertise in digital health have supported their strategies and achievements.

For more information, visit https://www.measureevaluation.org/our-work/health-informatics

Christina Villella, MPH, is a senior health informatics specialist supporting MEASURE Evaluation, USAID’s flagship health information system strengthening project.