ICTworks

Let us all celebrate the amazing transition that’s happening in health systems across low- and middle-income countries. Increasingly, data previously locked in paper systems are now available electronically for distribution and analysis at all levels, and human capacity to manage digital tools allows countries to think more ambitiously about how to utilize data.

However, there is a high degree of fragmentation, duplication, and lack of interoperability that characterize many developing country digital health systems.

For example, a recent landscape analysis in Tanzania found over 120 software systems, with many bespoke solutions creating islands of isolated data sets, instead of extending existing systems and increasing interoperability.

Alignment of Donor Investments in Digital Health

We are now at an inflection point where significant advances to enable improved health, economic and gender equity, and achievement of the Sustainable Development Goals will require greater coordination among donors that fund digital systems and the country governments where those systems are deployed.

It is essential and urgent for donors to align their investments to country digital health strategies that are in support of national health strategies to enable countries to:

• Pursue an integrated approach to strengthening health systems
• Enhance and extend the delivery of quality health services
• Improve data, and the capacity to use it, for improved health outcomes.

That’s why representatives from the Bill & Melinda Gates Foundation, CDC, Gavi, Global Fund, IDRC, Norad, PEPFAR, the Rockefeller Foundation, Spider, USAID, and Vitol Foundation, came together at a series of events in mid 2017-early 2018 to develop the first draft of the Principles of Donor Alignment for Digital Health.

Following a lengthy consultation process, 10 principles were finalized in May 2018 to align donor investments in digital health solutions to reduce fragmentation and duplication and increase interoperability within and across developing countries

These principles are now endorsed by 30 different organizations (see below for a full list).

Donor Investment Principles for Digital Health

The endorsers of the Principles of Donor Alignment for Digital Health endeavor to work through existing global and regional efforts and adhere to the Principles for Digital Development to:

1. Collaborate: Collaborate to align investments with national digital health strategies.
2. Prioritize National Plans: Prioritize investments in national plans that incorporate “digital global goods” and avoid bespoke systems.
3. Quantify Costs: Engage early to determine and quantify long-term costs of operating, maintaining, and supporting digital health systems for sustainable country ownership.
4. Track & measure: Track investments, progress, learnings and successes in digital health systems in a transparent manner.
5. Strengthen Donor Skills: Strengthen donor technical skills and core capacities, including awareness of the Principles for Digital Development.

At the same time, donors will invest in:

6. National Strategies: The creation and evolution of a country’s national digital health strategy, policies and regulatory framework. Strategies include components such as architecture, standards, investment frameworks, privacy protection, and detailed operational and monitoring plans.
7. Maturity Continuums: Systems at a level appropriate to the country’s progress along the digital health maturity continuum.
8. Country Capacity: Sustainable country capacity for digital health leadership, governance, implementation, oversight, global good adoption, and donor coordination.
9. Global Goods: Scalable, sustainable, accessible, interoperable, and evidence-based digital health global goods that meet country priorities.
10. Sharing and Peer-learning: Diverse stakeholder information-sharing and peer-learning networks at country and regional levels to foster coordination and alignment of implementation activities.

What Do the Principles Mean in Practice?

I spoke with Merrick Schaefer of USAID and Tim Wood of the Bill & Melinda Gates Foundation who participated in the development of these donor investment principles, and here is their (lightly edited) responses to my questions:

The United States Agency for International Development

USAID is putting these principles into practice by launching a new Digital Health Vision for Action for the Agency. It focuses on operationalizing these principles in its planning, procurements, and programming.

The guidance in this Vision is grounded in lessons from the past decade of investments in digital technologies for global health and looks to sharpen Agency investments in order to unlock significant gains for health systems, health workers, citizens, and host governments alike.

The Bill & Melinda Gates Foundation

At the Bill & Melinda Gates Foundation, the Data Use Partnership programs in Ethiopia, Malawi, and Tanzania are actively fostering investments in systems grounded in nationally-set priorities in close coordination with other donors working in those countries.

Along with other donors, the Gates Foundation has also made a multi-year investment into the Digital Square initiative at PATH to strengthen the digital global good software tools that provide the technical foundation for health data systems in developing countries.

How Can Implementers Help Drive Adoption?

While we often enjoy playing “Blame the Donor,” in reality, implementing partners often have great influence on donors and their priorities. We should use that power to:

• Engage with national digital health technical working groups to inform donors (and the rest of us) about what their discussions, priorities, and decisions.
• Track all of our digital solutions in the Digital Health Atlas and other community forums to give visibility to our ideas and efforts.
• Focus on expanding and extending existing digital health global goods, like OpenHIE technologies, and not reinvent the wheel with our own bespoke solutions.

Above all, we should hold donors accountable to these Donor Investment Principles by pointing out to donors when they are thinking of funding projects in countries that are:

• At odds with national priorities, guidelines, or efforts.
• Not aligned with the efforts of existing projects or other donor investments.
• Not sustainable beyond the length of the project.
• Duplicates existing platforms or their functionality
• Not interoperable with existing government systems.

Donors Endorsing the Digital Health Investment Principles

As you can see from the following list of agencies and organisations, the Digital Health Investment Principles launched at the World Health Summit last week with an amazing breadth of buy-in around the world. You can add your organisation to the list here.

• African Development Bank
• Bill & Melinda Gates Foundation
• Children’s Investment Fund Foundation (CIFF)
• CDC’s Center for Global Health
• Department for International Development (DFID)
• Doris Duke Charitable Foundation
• Elma Philanthropies
• European Union
• Gavi, the Vaccine Alliance
• German Federal Ministry for Economic Cooperation and Development (BMZ)
• Global Financing Facility
• Global Fund
• Health Data Collaborative
• Inter-American Development Bank
• International Telecommunications Union
• Johnson & Johnson
• Norwegian Agency for Development Cooperation (Norad)
• The Rockefeller Foundation
• Swedish International Development Cooperation Agency (Sida)
• Skoll Foundation
• SPIDER
• Tableau Foundation
• UN Foundation
• United Nations Programme on HIV/AIDS (UNAIDS)
• United Nations Population Fund (UNFPA)
• United Nations Children’s Fund (UNICEF)
• United States Agency for International Development (USAID)
• United States President’s Emergency Plan for AIDS Relief (PEPFAR)
• Vitol Foundation
• World Bank