ICTworks

The use of digital health is not uniform across the world. In international cooperation, respectful engagement starts with ‘how we talk about digital health’. As technologies and intervention models emerge mostly from a so-called Global North, there is a risk that narratives of modernity and a dominant eurocentrism conceal or misrepresent the needs and capacity in a so-called Global South.

Digital health is in need of inclusive, transdisciplinary language and guidance. During 2020, a dedicated group of experts from highly diverse environments (including, for instance, Burkina Faso, Dominican Republic, India, Switzerland, and Zambia) co-developed strategic and practical guidance on how to approach collaboration in digital health.

They convened workshops, distributed surveys, held online meetings, and listened to voices from communities in the South. This work resulted in a unique, transnational framework digital health in international cooperation. The framework was subsequently adopted by Non-Governmental Organisations working in digital health through Medicus Mundi in Switzerland.

1. De-centering

The central theme of the framework pivots around the theme ‘de-centering’. De-centring counters the hegemony of so-called universal truths that neglect the diversity of experiences. It problemises data-extraction, the threat of surveillance, and economic exploitation, questions never-ending pilots, lock-in technologies, extortive licences, and the transfusion of dependencies. De-centring focuses on ethics, philosophies, and the value of being together.

International cooperation involves languages and views from at least two perspectives: the international ones and those from the local settings. De-centring involves a recalibration of contemporary paradigms, moving the (Overton) window of which policies are politically acceptable, as well as a change in contemporary practices and orientations – from us-we-know to both-we-know.

2. Community Engagement

Inclusion and participation are essential elements of community engagement, which is the political dimension of de-centring. Engagement thrives on inclusion, shared values, and shared purpose.

In digital health, community engagement enables co-development and is a hallmark of sustainability and humanity. Community members are the channels of development, harnessing local resources from conceptualisation through to the moment of realisation. ‘Handing over projects’ becomes needless when ideas, designs, and implementation are already socially embedded in communities.

Community engagement involves dynamic and integrative approaches, focuses on local agency, seeks reciprocity, and needs a healthy dose of conviviality and stamina.

Engaged and entrusted communities disempower token cooperation (in which plans are forced onto beneficiaries and local researchers are mere providers of raw data). Community engagement replaces a ‘mirror’ (in which benefits are reflected towards the patron) with a ‘window’ (through which people see, engage, and collaborate with each other).

3. Workforce enhancement

Workforce advancement, the practical dimension of de-centring, recognises, kindles and expands local capacity for the development of digital health. This advancement thrives on a love of humanity and commitment to respectful dialogue, as well as empathy and alignment with local meaning making, norms and values.

Enhancing the local workforce emancipates the local economy. It builds on what is going well and expands upon existing capacity and agency, dreams, and visions. Crossing disciplinary boundaries, the inclusion of polyvocality, diversity, multiple perspectives and experiential data, scoping across all stake- and relationholders and facilitating indigenous ways of addressing digital health debunks constructed bifurcations and narrow assumptions.

4. Thought Leadership

Thought leadership enacts the ethical dimensions of de-centring. It puts on display what is known and how it is enshrined in embodied knowledge. Through thought leadership, communities of practice contribute to conversations in international health cooperation, influence public policy, and use relevant experience to complement the skills of health professionals.

Thought leadership discloses local knowledge, resulting from evaluation in situ. It provides guidance for other communities and on digital health practices. Thought leaders express and act locally, and then further afield. Thought leadership is the key to social innovation and transfer of solutions to other communities. It puts local capacity on display and provides inspiration by validating the enabling and empowering aspects of digital health interventions.

5. Systems Conciliation

Digital health interventions are produced through integrated systems. They are the product – the embodiment – of human thought and choices.

System imports and digital oligopolies carry significant risks for adverse integration. The foundations of technologies and systems like 5G, the Internet of Things, clouds, digital platforms and artificial intelligence are firmly rooted in unequal global power dynamics. They often reflect and reinforce colonial legacies and promote the interests of international partners. The framework pinpoints the issues and provides guidance on how to address them.

Conclusion

De-centring alters the centre of gravity in the development of digital health interventions. It empowers local specialists to lead in complex system integrations aligned with local needs, using local resources.

This transnational approach caters for stability, inspires synergy and trust, and brings together various perspectives on realities. It opens up opportunities for redemption and the use of local capacity, rather than the imposition of digital health systems by powerful, often Northern based entities.

Regardless of where they are established, digital health systems should emerge from embedded engagement, an involved and local workforce, and authoritive thought leadership from the communities involved. From such a base, digital health systems can bolster health services and bring us closer to universal health coverage, ensuring good practices in local, national and international health cooperation.

By Gertjan van Stam, Masvingo, Zimbabwe