Digital health solutions in primary health care during COVID-19: Lessons from Latin America

COVID-19 (coronavirus) has resulted in disruptions in the provision of essential health services across the world, including those provided at the primary health care (PHC) level. At the same time, the health and social distancing measures imposed by the pandemic have forced a rethink of health care delivery solutions to ensure continuity of services. In this sense, the pandemic has offered an opportunity to accelerate the implementation of digital health solutions, and to better understand the (pre)conditions that favored them, as well as the mechanisms that will favor their sustainability beyond COVID-19.

Recognizing that digital health interventions will be increasingly important, the World Bank signed the Principles of Donor Alignment for Digital Health, launched at the World Health Summit in Berlin in October 2018. And the World Bank is developing a digital health implementation strategy, as part of its wider efforts to support countries with reimaging their PHC systems  and elevating disruptive technology as a key feature of service delivery.

As part the World Bank’s work with the Primary Health Care Performance Initiative, we are exploring some of the key challenges and lessons learned on digital health solutions in Latin America, by analyzing country experiences such as the ones of Uruguay and Colombia.

Here are our 5 key take-aways so far:

1. Create a digital ecosystem

This means positioning the health sector in the so-called “age of digital interdependence” by developing governance and stewardship mechanisms, investing in digital education of healthcare personnel and patients, and improving connectivity within and outside the health system.

In Latin America and the Caribbean, more than 200 million people have inadequate connectivity to receive telecare. The promises of providing long-distance healthcare to the most vulnerable, while reducing costs, will not be fulfilled without minimum standards of connectivity and digital literacy.  Digital transformation can only be achieved with a multisectoral approach.

2. Digital transformation must be a strategic and sustained process, not just a response to public health emergencies

The countries that have deployed digital health solutions effectively during COVID-19 started the digital transformation process long ago.  For example, in 2012, Uruguay created Salud.uy, the government initiative that promotes the intensive use of information and communication technologies in the health care sector as part of its digital health agenda. The development of a national electronic health record (Historia Clínica Electrónica Nacional) followed. 

These progressive steps prepared the ground for subsequent digital health solutions to fight COVID-19. These have included, among others, a substantial increase in telecare, contact tracing and a traffic-light system of clinical risk, and the Coronavirus UY application providing citizens with key information and contact with healthcare providers. Remarkably, Coronavirus UY has reached more 650,000 downloads in a country of 3.5 million inhabitants.

3. Telecare is key to delivering PHC during epidemics, particularly for at-risk populations

Colombia is providing PHC services via telecare and homecare to patients seeking medical assistance for general or respiratory symptoms during COVID-19 . From January to September 2020, the telecare services approved in Colombia increased by 192%. The Colombian service delivery model included specific processes for patients with pre-existing, chronic conditions and for pregnant women, recognizing the health of the most vulnerable as a priority.

4. Timely investment in capacity building is crucial

Even in regular times, one of main reasons for failure of digital health solutions is a lack of capacity building and change management. In order to deliver effectively, healthcare personnel must be trained on changes to delivery models and referral systems, data confidentiality issues involving digital tools, and standards for the use of telecare, among others.

5. This is a good time to assess the digital maturity of PHC systems, as part of a comprehensive digital health assessment

Taking a multisectoral approach, key assessment indicators should not be limited to PHC systems but encompass the overall digital health transformation process in a country. For example, rather than simply measuring the percentage of PHC facilities using electronic health records in a country, wider consideration should be given to the existence of a national e-health strategy, normative instruments, standards for interoperability, etc. The assessment should take into account other relevant sectors such as the population’s digital literacy, connectivity, and bandwidth.

The pandemic has had devastating health, social and economic impacts on all countries, but focusing on what has worked will enable us to shape health systems for the future , with PHC at the center.

We believe systematic implementation of digital health solutions in PHC will be key to the sustainability of the efforts made in Latin America during the past months, well beyond the pandemic.

Digital health ought to be an integral part of health systems, and the pandemic has shown that this can and should be done. The real question that we need to address now is how to implement digital health solutions effectively, to deliver more person-centered and integrated care, and to tailor the models to each country’s needs, leaving no one behind.

This blog features key topics addressed in the webinar “Primary Health Care and Digital Health during the COVID-19 Pandemic: Experiences from the Latin America and the Caribbean Region”, the first of a series of webinars organized by the World Bank team working on the Primary Health Care Performance Initiative. The webinar provided an overview of the key challenges and lessons learned in the Latin America and the Caribbean region and showcased the country experiences of Uruguay and Colombia.

The authors would like to acknowledge webinar contributors including Michele Gragnolati, Practice Manager for Health, Nutrition and Population, Latin America and the Caribbean Region at The World Bank; Luis Gabriel Bernal Pulido, Independent Consultant, Former Director of Human Resources for Health, Ministry of Health and Social Protection of Colombia; Joaquin Andres Blaya, Digital Health Specialist at The World Bank; Marcelo D’Agostino, Senior Advisor for Information System and Digital Health, PAHO; and Pablo Orefice, Director of Salud.uy and Senior International Advisor in Digital Health,.