Digital health-enhancing self-care to achieve universal health coverage

The importance of empowered individuals and communities is often missing when we talk about health systems. The primary healthcare momentum built up following the signing of the Alma Ata Declaration in 1978 did not quite manage to break this mold, partly because the “whole of society approach” that it requires and particularly the need to address the social determinants of health, bring this area of healthcare up against powerful and entrenched political and economic interests (see for example the challenge of introducing taxes on sugary drinks, recommended by the WHO).  

We are now at a turning point. Digital transformations are equipping individuals with new tools and information to manage and make decisions about their own healthcare and wellbeing. However this also presents us with a set of new risks. Lack of or misinformation can be detrimental to people’s health, e.g.people seeking out unproven, “alternative facts” on complex medical issues. Information has now become a social determinant of health. The right information can provide people with the means to take better care of themselves. The wrong information can be lethal. 

Digital technology – an enabler of self-care

The application of digital technology and the use of data to support the needs of individuals to maintain their own health and well being is extensive and will continue to grow due to the rapidly evolving nature of the field. 

For example, digital tools and approaches can: 

• Facilitate targeted health messages to individuals to promote public health messages, generate demand for services and broaden contact coverage. 
• Enable remote communities and people in isolation to seek health advice and diagnoses from health workers.
• Redirect interventions from secondary and tertiary care facilities (such as monitoring and testing services) to people’s homes. 
• Provide individuals with different sources of health information and tools to manage, monitor, and improve their health.
• Increase transparency and accountability and facilitate the participation of young people, women, and marginalised communities in designing health policies and services that affect their lives.
• Provide individuals with digital identities (such as a birth certificate) to strengthen civil registration and vital statistics systems and unlock the use of healthcare data.

Digital technology is already transforming all these areas. Digital healthcare providers are responding to this opportunity to develop technology and programmes that enable people to take far greater control of their health and well being, thereby bridging that elusive gap between the health system and the community. The most effective way to do this is to provide people with the right information, at the right time and in a format that they are receptive to. Taboobreakers in South Africa for example have developed an App targeting young people with sexual health and reproductive rights information through a set of games. The App, called Love Land, provides a safe and risk-free environment for young people to learn facts, risk reduction, and to develop their decision-making skills through play. 

MonConnect is another example of a digital health programme using digital technology to provide pregnant women and mothers in South Africa with the information enabling them to take better care of themselves and their infants. MomConnect uses mobile phones to provide health information from the South African National Department of Health. Over the last seven years the service has had nearly three million women register to attend public healthcare facilities.

Programmes such as Afya Moja, an integrated medical health record system supported by Safaricom in Kenya are providing people with greater control over their own health records, increasing their ability to control their own healthcare. Afya Moja provides people with a simple, mobile based digital health passport that receives and securely stores their information. They can then access a copy of their own health information and share it with health providers. People can also provide consent for doctors to access their medical backgrounds and thereby respond more effectively to their needs. Importantly, it gives the patient control over when and with whom and when to share their health information with. 

The way ahead

Health systems, particularly in low- and middle-income countries are struggling. The health workers deficit alone is projected to reach 18 million by 2030. Governments around the world must address this as a matter of urgency to ensure universal health coverage targets are reached. 

It is now clear that a business as usual approach is unlikely to deliver the necessary changes at the scale and pace necessary to ensure UHC by 2030. Transform Health believes that digital technology and data, if effectively and equitably deployed, are enabling forces that can strengthen health systems and help people attain and maintain good health and wellbeing. However, in a number of countries, particularly least developed countries, externally-funded digital health initiatives are being applied in an ad-hoc manner and are not being sustainably integrated into health systems meaning they come to a stop when donor funding runs out. This is denying millions of people access to information and services that will provide them with an opportunity to take more control over their health and well being. Governments around the world need to ensure the right enabling environment, including legislation, regulation policies and funding are provided to enable the digital transformation of health systems so that people are finally at the centre of healthcare.   

Transform Health is a global coalition of organisations dedicated to achieving health for all by promoting the role of digital technologies to achieve Universal Health Coverage. We collaborate with the individuals, communities, governments, organisations and institutions that are most affected by the lack of access to equitable, affordable and high-quality healthcare.