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

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A commuter uses his smartphone in Buenos Aires, Argentina. © Juan Ignacio Coda / World Bank
Pasajero hace uso de su teléfono inteligente en Buenos Aires, Argentina. © Juan Ignacio Coda / World Bank

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,.

Authors

Federica Secci

Senior Health Specialist

Join the Conversation

Hector Enriquez
August 06, 2021

I’m convinced that real collaborative work between all stakeholders of Healthcare supply chain, will guide to a effective Health System.
As Manager of a Pharmaceutical Company want to learn and understand more deeply all requirements.

Ramesh Kumar Nanjundaiya
July 28, 2021

Efforts by India in 2021

Current digitized healthcare sector in India and new tools decoded
One does not fail to notice that the entire medical services sector and hospitals in India are undergoing a major transformation in delivery of services, monitoring and patient care. New hospital are springing up as super speciality hospitals in tier 2 and tier 3 towns across India at a rapid pace.
While this sector has been in the growth traction for over a decade now with super speciality hospitals springing up all over India, what has catapulted this to still higher levels in the last 12 months is the noticeable ongoing technology support and digital transformation for the healthcare sector. This is exuberated mainly due to the aftermath of the covid 19 pandemic and its tracing mechanism.
Government of India's top priority is to ensure, facilitate and encourage timely manufacture and delivery of covid 19 vaccines to the local population as well as undertake exports to about 50+ countries across the globe. Some of the exports are pure commercial while some free donation supply to various countries appropriately termed vaccination diplomacy.
While one does notice very positive efforts in developing covid 19 vaccinations, challenges have also come in hand- in-hand including manufacturing delays, raw material shortages, manufacturing capacity constraints, balancing demands, staggering rollout mechanisms, transportation and logistics. Suppliers are ensuring that proper safeguards are in place via the use of digital tools and telecommunication, data storage and standards, hospital listing, data protection frameworks, encryptions and identification systems.
For the delivery of vaccinations from the manufacturing site to the patient involves a huge supply chain management service. The country urgently needs technology support to ramp up the vaccination activity to double from the present 3 million /day to at least 6 million/day. For this to happen, one needs strong access to digital technologies, mobile devices to expand capacity via secured cloud based services for such a huge vaccination campaign across India.
Digital technologies is playing a critical role to support the production, planning, monitoring, delivery and management of vaccination programs on a pan India basis by successfully using digital logistics application via electronic communication, mobile networks and special app to reach the nook and corner of India. The digital vaccination recording and follow-up systems has started working well lately by using standard (Pan and Aadhar) ID systems to determine eligibility and track patients between doses.
Most of us have heard about the Aarogya Setu app. An Indian COVID–19 contact tracing, mapping and self-assessment digital service. It is primarily a user friendly mobile app, developed by the National Informatics Centre under the Ministry of Electronics and Information Technology (MeitY).
Statistics indicate that by September 2020, the Aarogya Setu app, has more than 15.7 crore registered users and is growing month on month . This in itself is a success story. It was widely clarified in the media that the app's data is fully secured to protect confidentiality and encrypted in transit as well as at rest. Fully encrypted personal information is stored with necessary firewalls and protocols and transparency as appropriate. The World Health Organization has lauded the Aarogya Setu mobile application for helping healthcare sector and departments in a vast country as India to identify COVID-19 clusters. This clearly shows that the healthcare industry has seen a massive shift in its dependency on technology.
Today in India, the digital transformation efforts and its adaptability in this sector has moved forward in leaps and bounds which about a decade ago was starting with just using computers in hospitals for billing, appointments and scheduling.
In addition, technically savvy hospitals in the metros not only have high sophisticated medical devices, mri machines but also fully interactive websites and online platforms. Technology and digitizations is enabling error free online appointments, consulting, video consulting and conferences and telemedicine. Apart from these, the highly sophisticated medical devices that modern hospitals across the country use for detection and curing means that hospitals have up skilled themselves via integration of medical knowledge with Al-enabled medical devices and electronic health records.
In a nutshell, what this tells us is that the whole doctor-patient relationship and communication is undergoing a huge transformation via timely decision making regarding planning treatments schedules, operation theatres optimal use, data sharing and outcomes to bring in the "patient is the king" mindset.
Thus data integration is being actively used in extending medical services and for the increase in data aggregation that can assist in the activity of preventive care, proper staff allocation and monitoring and reduction of medical errors so as to provide a high level of care. Of course, the medical expenses have also increased with inflation. Today the focus of the hospital management is to build loyal patients. To this end, hospitals are using technology to arrive at patients predictive analytics via medical records data, family history, health insurance cover via cashless treatments.
When applying predictive analytics to the data generated by each patient and combining this data with those points collected from medical health records, healthcare providers will be able to build loyalty with their patients. What is needed is to address challenges and rectification via use of technology.
Today in view of increasing costs, covid restrictions, patients, more so in the urban area seem to equip themselves to the use of digital technology with self monitoring of BP and sugar and oximeters and temperature monitoring, house visit for blood sample collection. Patients want to increasingly make use of digital devices for their self care. All these is to ensure that they receive continuing healthcare facility at their homes due to shortage of hospital beds and increasing expenses. This has given rise to telemonitoring devices and virtual consultations.
The object therefore will be for hospitals and medical practisers to integrate digital technology in up skilling and installing health records and information systems. This will help in real time monitoring and remote diagnostics or tele home care. The technology that are used includes telemedicine and diagnostics, mobile device healthcare, RPM sensors, using webcams, video-conferencing, videophones and WebPages for monitoring of patients.
Another area coming up fast are the Wearable's for recording heartbeat, pulse rate, blood pressure, blood sugar etc.
In conclusion the foregoing indicates that digital Healthcare holds tremendous promise and opportunities and will be cost effective in the long run.
Ramesh Kumar Nanjundaiya