Digital Health Technologies (DHT) and Universal Health Coverage in Nigeria
Digital health (also referred to as eHealth) is the field of knowledge and practice associated with the development and use of digital technologies to improve health (WHO, 2023). DH could be applied to several areas of medicine and public health including patient and public health data management (electronic health records), provision of remote health care services (telemedicine/telehealth), health information and services through mobile telephone technology (mHealth), health knowledge management, the connection of medical devices (internet of things), improved planning, organization, and management of health services particularly at the sub-national level (Digital Watch, 2023; WHO, 2021).
The Sustainable Development Goals (SDGs) are universal and applicable to all countries. They envelop most concurrent development issues and are grounded on the principles of equity (leave no one behind), human rights, accountability and sustainability (United Nations, 2023). The same principles underpin global work in health and are central to the current drive for Universal Health Coverage (UHC), the target for the third SDG. UHC means that all individuals and communities receive the health services they need, at good quality and without suffering financial hardship (WHO, 2022). There are, however, many impediments to attaining UHC in Nigeria, the WHO (2021) annual report on UHC highlights these challenges across different health outcomes in the country.
Current service delivery approaches may not deliver UHC because of these impediments. Innovative approaches to deliver services which can ensure UHC with essential services, in current social and economic environments are therefore needed. In recent times, Digital Health (DH) has gained a lot of momentum globally as an engine for innovation to address these challenges and speed up the attainment of SDGs and UHC (WHO, 2016-Global Diffusion of eHealth). “There is a growing consensus in the global health community that the strategic and innovative use of digital and cutting-edge information and communications technologies will be an essential enabling factor towards ensuring that 1 billion more people benefit from universal health coverage, that 1 billion more people are better protected from health emergencies, and that 1 billion more people enjoy better health and well-being” (WHO, 2021).
Providers and other stakeholders are using digital health technologies in their efforts to, reduce inefficiencies, improve access to healthcare, reduce costs, and increase the quality of healthcare services (United States Food and Drug Agency, 2020; WHO, 2021). Furthermore, DH facilitates the rapid transmission of public health information in real-time for timely decision-making and enhances the capacity for monitoring the performance of interventions and the health system as a whole (European Center for Disease Prevention and Control, 2021). DH thus has the potential to expand good and affordable health services to the last mile, a prerequisite for UHC. However, the application of DH is optimized when they are offered at a large scale, context-specific, cost-effective and aligned with sustainable development (WHO, 2021).
Remarkable achievements in the sphere of ICT have created an enabling environment for widespread deployment of DH in Africa. For instance, it is estimated that about 5.16 billion people globally use the internet at the start of 2023, which is equivalent to 64.4% of the world’s population (DataReportal, 2023). In Sub-Saharan Africa about 40% of the adult population are now connected to mobile internet services, However, another 44% live in areas covered by mobile broadband networks but do not yet use mobile internet services (GSMA Intelligence, 2022). Conversely, because DH sits at the nexus of two key sectors namely health and information and communication technologies (ICT) New intergovernmental arrangements between Ministries of Health and ICT have been initiated.
In Nigeria, this is evident in the assessment report conducted in 2014. The report, Assessing the Enabling Environment for ICTs for Health in Nigeria, identified the need for a coordinated Health ICT Strategy. In addition, the report concluded that Nigeria is transitioning from ‘experimentation and early adoption’ to ‘developing and building up’, thus birthing the Health ICT Strategic Framework (FMOH, 2016). Similarly, as part of the WHO’s efforts to support regional and national scale-up of DH, the African Regional Office of WHO (AFRO) partnered with ITU to strengthen intergovernmental coordination between ministries of health and ICT, and to strengthen private sector engagement, especially with the telecommunication operators in 2017 (WHO AFRO, 2017). Whilst many African countries have developed and adopted DH strategies, implementation of many such strategies remains slow due to a lack of requisite governance framework, institutional capacity, and funding.
Implications for Practice and Policy
DH could contribute to the sustainable attainment of UHC if there is an appropriate DH governance framework, and it is implemented within the broader framework of resilient health systems, communities and access to the social, economic and environmental determinants of health. In 2019, the World Health Organization (WHO) released the first-ever evidence-based guidelines for digital health. The guideline provides nine recommendations on select digital health interventions that involve the use of a mobile phone or device. It also provides information on implementation considerations, quality and certainty of extant evidence, factors related to the acceptability and feasibility of the intervention, and gaps in the evidence that can inform future research. Given the pivotal role digital health can play in supporting health systems, these guidelines can help provide a roadmap for governments and policymakers in introducing and scaling up DH interventions to support population health outcomes (WHO, 2019).
Bridging the communication, coordination and knowledge gaps between public health and ICT stakeholders is also imperative as well as training a critical mass of human resources for managing and maintaining the DH architecture and infrastructure (Olu et al., 2019). Nigeria could learn and adopt lessons from the successful deployment of DH technologies in other similar settings such as Asia to rapidly advance its quest for DH development. For instance, the development and use of offline DH applications could help to address internet connectivity challenges in rural Nigerian communities (World Economic Forum, 2019).
Given the contextual factors of DH, their deployment in Nigeria would require both intrinsic and extrinsic health systems inputs, high-level political commitment, national ownership and appropriate capacity for inter-sectoral coordination, planning, implementation, monitoring, and evaluation.
Further assessments of the opportunities, challenges and scalability for DH in Nigeria and Africa as a whole are required to provide evidence-based information for the formulation of sustainable UHC agenda among African political and health leaders. Furthermore, advocacy for stronger DH governance, leadership, funding and development, and implementation of foresighted DH strategies could provide opportunities for monitoring, impact assessment and outcome evaluations.
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