The Ministry of Health is currently working on a digital health strategy for the next 5 years. Several consultatory forums have been held with stakeholders to get both public and private sector perspectives on what should be included in the strategy document. The strategy is likely going to centre around the scaling of several of the ministry’s interventions which it has been working on for a while. This includes the nationwide rollout of the electronic health record and telemedicine programs. Apart from these interventions, what I would like to see are more of the intangible strategic interventions that aim to cultivate a culture and a nurturing environment for digital health.
What do good governments do? They set a conducive environment for people to flourish in. That is what I hope the digital health strategy will do – set a conducive environment for the sector’s players or participants. Let’s liken this to FIFA, the world football governing body. FIFA sets the rules of play but does not field its own football team. It withdraws to let others play on the field it has set. In fact, FIFA is so good that when watching a match, rarely are we made conscious or cognisant of FIFA’s influence on the game. FIFA is there, without being there!
Similarly, the digital health strategy could aim to create a conducive environment for accelerated growth of the emerging digital health sector. A landmark example of such a catalytic effect of policy is the Affordable Care Act a.k.a Obamacare. Obamacare introduced the Health Information Technology for Economic and Clinical Health(HITECH) provisions. These were a booster injection worth billions into digital health. It resulted in the rapid expansion of electronic health record systems in the U.S, an explosion in venture funding in digital health and brought forth dozens of digital health companies that employed thousands of people.
Lord knows we need a similar impact in Zimbabwe that creates employment and boosts the economy whilst bringing efficiency to the health system. Here are 5 things that should be included in the digital health strategy to create a conducive environment for growth of the digital health sector.
The strategy should aim for the roll out of digital health applications and solutions through PPPs. The ministry should not aim to develop from scratch its own solutions and run them. This is slower and often involves reinventing the wheel. Having the ministry running its own solutions also invites the trappings of a heavy governance structure. The e-Health directorate in the Ministry is a newly appointed office. As it shapes up, it should avoid the temptation to institute district, provincial and central officers and managers as the other functional departments in the Ministry have. The strategy should emphasise the principles of lean and smart governance. Part of that involves intentionally working with the right technology partners to roll out the digital health solutions across the country. The world revolves much smoother on its axis whenever people choose to focus on their respective core competencies and then cooperate. The core competency of the ministry should be to govern, and not to be the implementor. For quicker deployment of efficient digital health interventions, the private sector should be engaged to build, maintain and support systems through the Public Private Partnership model
2. Digital Health Roadmap
The COVID19 response witnessed a lot of duplication of efforts as many wanted to help and many also saw opportunity in the panic that ensued. It was really a case of the left hand not knowing what the right was doing. Unfortunately, this duplication of efforts is not a peculiarity to COVID19. At one point the HIV and TB programmes had separate electronic health record systems developed and running yet the 2 conditions have a strong correlation. The digital health strategy should aim to address this through delineating the playing field by clearly articulating a roadmap of digital health interventions the ministry intends to implement in the coming years. By bringing it out to the open what the ministry wants to do, partners can be guided accordingly. This roadmap can be used to ensure that foreign funded donor agencies roll out solutions that integrate with other solutions on the roadmap to avoid duplication. Open communication of the progress made along this roadmap is also key. Several of the Ministry’s interventions seem to be done in secret. Many still wonder about the status of the telemedicine pilot that was started in Nyanga or the electronic heath record system that was initially rolled out in Uzumba district. Regular clear communication of the roadmap interventions guides away entrepreneurs from trying to build what already exists. Instead, entrepreneurs can invest in building solutions that compliment or integrate into those on the national roadmap. For example, if the roadmap includes a national EHR system, then entrepreneurs could work on building clinical decision support systems or digital imaging systems that integrate with the national EHR system to make it more robust.
Obamacare offered billions of dollars in incentives for adoption of Health IT systems. Understandably, it can be argued that Zimbabwe is not in a position to offer a financial stimulus of that magnitude. However, there are options. A simple solution could be to waiver the annual registration fees health facilities have to pay when renewing their operating licenses on condition that they install and use an electronic health record system. This would have a tremendous effect on the use of EHR systems countrywide, especially in the private sector. An EHR is the foundation of digital health because applications such as Big data and artificial intelligence are built on the backbone of digital health data. Such an intervention doesn’t involve bankrupting the RBZ but could yield massive return on investment in the next 5 years. Widespread use of electronic health records enables the gathering of insights on disease trends and health expenditure, efficient monitoring and evaluation of ministry programs and better coordination of resources in the event of outbreaks such as COVID19.
4. Regulatory and policy framework
The digital health strategy could set the conducive environment for growth of a digital health industry by establishing policies and legislation for e-Health governance. There are currently a lot of grey areas that leave interested entrepreneurs in limbo with their solutions. There is need for clarity on such important areas as interoperability, medical devices and health data privacy, data security and ownership. With clarity on these areas, entrepreneurs can be guided as they develop and take their solutions to market. Such policies set product standards. Standards give arise to interoperable efficient systems of a high user experience and acceptability. This sifts out the wishy-washy, mickey mouse solutions out there that put a stinker on the digital health collective. Confusion chases away investment. Hence, having clear regulatory frameworks gives reassurance to investors as they seek to enter the digital health sector.
5. Digital Health Professionals
ICT skills training among health care workers is critical. Personally, I have encountered healthcare colleagues who do not have email addresses, do not know how to download an app from the playstore, who cannot update their phone’s operating system and prefer to keep their passwords on a piece of paper. This is not conducive for growth of the digital health sector. To address this the digital health strategy could include a policy through the human resources department that favours the recruitment of cadres with basic ICT skills training. In addition, an incentive on Continuous Professional Development that accredits more points for participating in digital health courses or seminars can be introduced. This will cultivate an increasing interest in digital health among health professionals. The beauty is that such simple interventions require no significant financial investment from the ministry’s account yet yield tremendous returns.
Above all, the digital health strategy as it is being drafted, should not be one that public sector focused but one focused on growing the entire digital health ecosystem. This would create a lot more jobs, attract investment and boost the economy in a much-needed way.
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