WHO publishes its global digital health strategy

The World Health Organisation (WHO) has published its Global Strategy on Digital Health 2020–2025 as it looks to “improve health for everyone, everywhere by accelerating the development and adoption of appropriate, accessible, affordable, scalable and sustainable person centric digital health solutions”.

The publication of the strategy marks an end to a long process that began with the 2005 resolution on eHealth that urged WHO member states “to consider drawing up a long-term strategic plan for developing and implementing eHealth services… to develop the infrastructure for information and communication technologies for health… to promote equitable, affordable and universal access to their benefits”. In the meantime, further resolutions had been passed at WHO level and passed by the United Nations and World Health Assembly. A draft digital health strategy covering 2020-2024 was initially published in the summer of 2020, but the strategy proper has now been published.

The strategy states that digital health will be adopted if it “is accessible and supports equitable and universal access to quality health services; enhances the efficiency and sustainability of health systems in delivering quality, affordable and equitable care; and strengthens and scales up health promotion, disease prevention, diagnosis, management, rehabilitation and palliative care including before, during and after an epidemic or pandemic, in a system that respects the privacy and security of patient health information”. It is recommended within that adoption of digital health technologies be a component of any national strategy, although it is acknowledged that this will be a challenge, especially in low- and middle-income countries. Member states are advised that exploring the potential of global solutions should be a part of their national strategies.

The purpose of the strategy is “to strengthen health systems through the application of digital health technologies for consumers, health professionals, health care providers and industry towards empowering patients and achieving the vision of health for all” and it emphasises that “health data are to be classified as sensitive personal data, or personally identifiable information, that require a high safety and security standard”.

The strategy is guided by four principles:

1. “Acknowledge that institutionalisation of digital health in the national health system requires a decision and commitment by countries”: Each country owns its digital health action plan built on the strategy within its own national context and should adopt digital health in a way that is “sustainable, respects their sovereignty, and best suits their culture and values, national health policy, vision, goals, health and wellbeing needs, and available resources”.
2. “Recognise that successful digital health initiatives require an integrated strategy”: Member states should be aware that for digital health initiatives to reach their potential, they should be “part of the wider health needs and the digital health ecosystem and guided by a robust strategy that integrates leadership, financial, organizational, human and technological resources and is used as the basis for a costed action plan which enables coordination among multiple stakeholders”.
3. “Promote the appropriate use of digital technologies for health”: The strategy “underscores the need to ground digital foundations within national strategies and emphasises the need to work with different sectors and stakeholders at all levels” and states that the “appropriate use of digital health takes the following dimensions into consideration: health promotion and disease prevention, patient safety, ethics, interoperability, intellectual property, data security (confidentiality, integrity, and availability), privacy, cost-effectiveness, patient engagement, and affordability”.
4. “Recognise the urgent need to address the major impediments faced by least-developed countries implementing digital health technologies”: There is a “pressing need” to engage with and invest in the issues developing nations face in engaging with digital health, such as “an appropriate enabling environment, sufficient resources, infrastructure to support the digital transformation, education, human capacity, financial investment and internet connectivity”.

These four principles then inform the four strategic objectives of the strategy:

1. Promote global collaboration and advance the transfer of knowledge on digital health: Member states are instructed to share their knowledge of and investments in digital health across domains in order to align countries strategically. The policy initiatives recommended to achieve this goal include the establishment of mechanisms for strengthening national digital health strategies and implementing key collaborations, the establishment of a knowledge management approach to identify and share good practices and the supporting of countries in establishing information centres for disease surveillance.
2. Advance the implementation of national digital health strategies: Under this objective, the WHO aims to “stimulate and support every country to adopt or review, own, and strengthen its national digital health strategy” through defining a national digital health architecture blueprint or roadmap and adopting open-source health data standards, while aiming for reusable systems or assets including interoperability of health information systems both at national and international levels.
3. Strengthen governance for digital health at global, regional and national levels: The WHO is seeking to strengthen the governance of digital health at local and international levels “through the creation of sustainable and robust governance structures”, including regulatory frameworks. Under this goal, the WHO calls on its member states to “coordinate investments in evidence-based approaches to assess promote and disseminate new and innovative health technologies for national scaled digital health programmes using a person-centred approach to facilitate actions and investments based on informed decisions”.
4. Advocate people-centred health systems that are enabled by digital health: This objective “advances digital health literacy, gender equality and women’s empowerment and inclusive approaches to adoption and management of digital health technologies” and “places people at the centre of digital health through the adoption and use of digital health technologies in scaling up and strengthening health service delivery”. This is to be achieved by developing approaches to the management of health at the population level through digital health applications that move health and well-being from reactive-care models to active community-based models, reducing the burden of data collection from front-line workers by reorienting reporting-based tools into service delivery tools and establishing, monitoring and evaluating models to facilitate the contribution of digital systems to health system processes.

The WHO says it will take steps to implement a measurement model to evaluate the action plan and the stated set of outputs in collaboration with national centres, the Sustainable Development Goals and the goals of WHO’s Thirteenth General Programme of Work, 2019–2023. They state that the establishment of a monitoring and evaluation framework that promotes a biennial enhancement of the global digital health strategy is “also warranted”.