The World Health Organization (WHO) is a specialised agency of the UN whose role is to direct and co-ordinate international health within the UN system.
As a member state organisation, its main areas of work include health systems, the promotion of health, non-communicable diseases, communicable diseases, corporate services, preparedness, and surveillance and response.
The WHO assists countries in co-ordinating multi-sectoral efforts by governments and partners (including bi- and multilateral meetings, funds and foundations, civil society organisations, and the private sector) to attain their health objectives and support their national health policies and strategies.
The WHO has strengthened its approach to data by ensuring this strategic asset has a dedicated division: the Division of Data, Analytics and Delivery for Impact. This has helped strengthen data governance by promoting sound data principles and accountability mechanisms, as well as ensuring that the necessary policies and tools are in place that can be used by all three levels of the organisation and can be adopted by member states. Digital health and innovation are high on the WHO’s agenda; it is recognised for its role in strengthening health systems through the application of digital health technologies for consumers/people and healthcare providers as part of achieving its vision of health for all.
The WHO also established the new Department of Digital Health and Innovation in 2019 within its Science Division. Particular attention is paid to: Promoting global collaboration and advancing the transfer of knowledge on digital health; advancing the implementation of national digital health strategies; strengthening the governance for digital health at the global, regional, and national levels; and advocating for people-centered health systems that are enabled by digital health. These strategic objectives have been developed in consultation with member states throughout 2019 and 2020, and will be submitted for adoption to the upcoming 2021 World Health Assembly.
The Division of Data Analytics and Delivery for Impact and the Department of Digital Health and Innovation work closely together to strengthen links between data and digital issues, as well as data governance efforts. Digital health technologies, standards, and protocols enable health systems to integrate the exchange of health data within the health system. Coupled with data governance, ethics, and public health data standards, digital health and innovation enable the generation of new evidence and knowledge through research and innovation and inform health policy through public health analysis.
More recently, the COVID-19 pandemic accelerated the WHO’s digital response, collaboration, and innovation in emergencies. Some examples include: Collaborating to use artificial intelligence (AI) and data science in analysing and delivering information in response to the COVID-19 ‘infodemic’ (i.e. overflow of information, including misinformation, in an acute health event which prevents people from accessing reliable information about how to protect themselves); promoting cybersecurity in the health system, including hospitals and health facilities; learning from using AI, data science, digital health, and innovation in social science research, disease modelling, and simulations, as well as supporting the epidemiological response to the pandemic; and producing vaccines and preparing for the equitable allocation and distribution of vaccines.
The WHO is a leader among Geneva-based international organisations in the use of social media, through its awareness-raising for health-related issues. The WHO was awarded first prize at the Geneva Engage Awards in 2016, and second prize in 2017.
The WHO/International Telecommunication Union (ITU) Focus Group on artificial intelligence for health (FG-AI4H) works to establish a standardised assessment framework for the evaluation of AI-based methods for health, diagnosis, triage, or treatment decisions. https://www.itu.int/en/ITU-T/focusgroups/ai4h/
Be He@lthy, Be Mobile: Accessing the right information, when one needs it, is at the heart of this WHO-ITU initiative. In support of national governments, Be He@lthy, Be Mobile is helping millions of people quit tobacco, control diabetes and cervical cancer, help people at risk of asthma and chronic obstructive pulmonary disease (COPD), and care for older persons.
Digital policy issues
- Data and artificial intelligence
The response to COVID-19 reinforced the centrality of data and AI for the health sector and the WHO’s activities. Data and AI policies are covered by the following instruments.
- Data policy: Guidance on good data and record management practices
- Data standardisation: Resolution WHA66.24: eHealth standardization and interoperability (May 2013)
- Data sharing during health emergencies: Policy statement on data sharing by WHO in the context of public health emergencies (as of 13 April 2013) (May 2016) | Best practices for sharing information through data platforms: establishing the principles (April 2016) | Data Protection Authorities’ (DPA) guidance on COVID-19
- Data and member states: Text for inclusion in data collection forms in all data collection tools (paper-based, electronic, or other) used by the WHO to collect data from member states)
- Data sharing: FAQs on WHO data sharing policy in non-emergency contexts | Policy on the use and sharing of data collected in member states by the WHO outside the context of public health emergencies (August 2017) | WHO Statement on Public Disclosure of Clinical Trial Results (April 2015)
- The WHO/ITU FG-AI4H works to establish a standardised assessment framework for the evaluation of AI-based methods for health, diagnosis, triage, or treatment decisions. https://www.itu.int/en/ITU-T/focusgroups/ai4h/
- Digital Standards: Integration of health information exchange (HIE)
The WHO collaborates with health information exchange standardisation bodies and organisations, such as HIE and HL7 (Health Level 7), to promote sustainable investment into interoperable digital health technologies and systems. Digital health technologies, standards, and protocols enable health systems to integrate the exchange of health data within the health system. Coupled with data governance, ethics, and public health data standards, digital health and innovation enable the generation of new evidence and knowledge through research and innovation, and inform health policy through public health analysis.
Digital Accelerator Kits and computable guidelines: Ensure countries can effectively benefit from investments in digital systems, ‘digital accelerator kits’ are designed to ensure the WHO’s evidence-based guideline content is accurately reflected in the systems countries are adopting. Digital Accelerator Kits distill WHO guidelines and operational resources into a standardised format that can be more easily incorporated into digital tracking and decision support systems. This in turn enables standardised health information exchange within the health system.
WHO Guideline: recommendations on digital interventions for health system strengthening: Recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use, and equity considerations.
Classification of digital health interventions v1.0 - A shared language to describe the uses of digital technology for health: The classification of digital health interventions categorises the different ways in which digital and mobile technologies are being used to support health system needs. A shared and standardised vocabulary was recognised as necessary to identify gaps and duplication, evaluate effectiveness, and facilitate alignment across different digital health implementations
- Electromagnetic field and health protection
As the digital reality moves from ‘cable’ to wireless traffic (wi-fi and mobile), a growing number of concerns are emerging on the impact of electromagnetic fields on human health. This technology has become part of the wider public debate and has given rise to conspiracy theories such as those that claim 5G spreads COVID-19. These concerns increase the importance of the WHO’s research and policy-making within a broader evidence-based discussion on the impact of wi-fi and mobile devices on health.
Institute of Electrical and Electronics Engineers’ (IEEE) Standard for Safety Levels with Respect to Human Exposure to Radio Frequency Electromagnetic Fields, 3 kHz to 300 GHz
- Online gaming
Since 2018, gaming disorder has been included in the WHO’s International Classification of Diseases (ICD). While the negative impacts of online gaming on health are being increasingly addressed by national health policies, it has been recognised by some authorities, such as the US Food and Drug Administration (FDA), that some game-based devices could have a therapeutic effect. Given the fast growth of online gaming and its benefits and disadvantages, the implications on health are expected to become more relevant.
- Domain names: The .health top-level domain name
Health-related generic top-level domain (gTLD) names, in all languages, including ‘.health’, ‘.doctor’, and ‘.surgery’, should be operated in a way that protects public health and includes the prevention of further development of illicit markets of medicines, medical devices, and unauthorised health products and services.
- Net neutrality
The issue of net neutrality (the equal treatment of Internet traffic) could affect bandwidth and the stability of digital connections, especially for high-risk activities such as online surgical interventions. Thus, health organisations may be granted exceptional provisions, as the EU has already done, where health and specialised services enjoy exceptions regarding the principle of net neutrality.
The WHO uses digital technology intensively in its development of activities, ranging from building public health infrastructure in developing countries and immunisation to dealing with disease outbreaks. The organisation also integrates digital health interventions in its strategies for certain diseases. The WHO’s Global Observatory for e-Health[BRC2] aims to assist member states with information and guidance on practices and standards in the field of e-health.
The WHO has dedicated cybersecurity focal points, who are able to work with legal and licensing colleagues, that provide frameworks for the organisation to not only protect WHO data from various cyber-risks, but also provide technical advice to the WHO and members states on the secure collection, storage, and dissemination of data. Health facilities and health data have always been the target of cybercriminals; however, the COVID-19 crisis has brought into sharp focus the cybersecurity aspects of digital health.
Ransomware attacks threaten the proper functioning of hospitals and other healthcare providers. The global Wannacry ransomware attack in May 2017 was the first major attack on hospitals and disrupted a significant part of the UK’s National Health System (NHS). Ransomware attacks on hospitals and health research facilities have accelerated during the COVID-19 crisis.
Considering that data is often the main target of cyber-attacks, it should come as no surprise that most cybersecurity concerns regarding healthcare are centered around the protection of data. Encryption is thus crucial for the safety of health data: It both protects data from prying eyes and helps assuage the fears patients and consumers may have about sharing or storing sensitive information through the Internet.
- Content policy: Infodemic
An infodemic is an overflow of information, including misinformation, that prevents people from accessing reliable information; in the context of the COVID-19 pandemic, it hampers the ability of people to know how to protect themselves. Our current infodemic cannot be eliminated, but it can be managed by: producing engaging reliable content and using digital, traditional media, and offline tools to disseminate it; engaging key stakeholder groups in co-operative content creation and dissemination; empowering communities to protect themselves; and promoting community and individual resilience against misinformation. Digital health technologies and data science can support these activities by: analysing the information landscape and social dynamics in digital and analog environments; to deliver messages; supporting fact-checking and countering misinformation; promoting digital health, media, and health literacy; and optimising the effectiveness of messages and their delivery through real time monitoring and evaluation (M&E), among others.
At the Munich Security Conference (15 February 2020), WHO Director-General Tedros Adhanom Ghebreyesus stated: ‘We’re not just fighting an epidemic; we’re fighting an infodemic.’ This translated into many WHO initiatives to counter the infodemic, such as working with the public and the scientific community to develop a framework for managing infodemics; bringing the scientific community together for the first WHO infodemiology conference; the development of a draft research agenda on managing infodemics, co-operation with UN agencies and the AI community; promoting reliable WHO information through a co-ordinated approach with Google, Facebook, Twitter, and other major tech platforms and services; and campaigns to counter misinformation.
- Emergency preparedness and response: The WHO maintains a portfolio of digital tools and methods for emergency preparedness and response, for example: GoData, Epidemic Intelligence from Open Sources (EIOS), and Ethical considerations to guide the use of digital proximity tracking technologies for COVID-19 contact tracing.
- WHO Digital and Innovation for Health online community to fight COVID-19: a platform for discussion and sharing experiences and innovative responses related to the COVID-19 pandemic.
- Health Equity Monitor: a platform for health inequality monitoring which includes datatabases of disaggregated data; a handbook on health inequality monitoring; step-by-step manuals for national health inequality monitoring (generally and specifically for immunisation inequality monitoring);
- Health Assessment Toolkit: software application that facilitates the assessment of health inequalities in countries. Inequality data can be visualised through a variety of interactive graphs, maps, and tables. Results can be exported and used for priority-setting and policy-making.
- Harmonised Health Facility Assessment (HHFA): a comprehensive, external review tool for assessing whether health facilities have the appropriate systems in place to deliver services at required standards of quality.
- District Health Information Software & Toolkit for Analysis and Use of Routine Health Facility Data: open source, web-based health management information system (HMIS) platform. The toolkit provides standards and guidance for the analysis of Routine Health Information Surveys (RHIS) data for individual health programmes, as well as integrated analysis for general health service management.
- WHO Health Data Hub (under development): a single repository of health data in the WHO and establish a data governance mechanism for member states.
- Digital Health Atlas: The Digital Health Atlas is a global registry of implemented digital health solutions. It is open and available to anyone to register and contribute information about digital implementations. The registry provides a consistent way to document digital solutions, and offers functionalities in a web platform to assist technologists, implementers, governments, and donors for inventory, planning, co-ordinating, and using digital systems for health. The Digital Health Atlas includes a special focus on listing digital technologies related to the COVID-19 pandemic. The repository of information is open to all users to register projects, download project information, and connect with digital health practitioners globally.
- Civil Registration and Vital Statistics (CRVS): registering all births and deaths, issues birth and death certificates, and compiles and disseminates vital statistics, including cause of death information. It may also record marriages and divorces.
- WHO Classifications and Terminologies: operates a ‘one-stop-shop’ for WHO classifications and terminologies and is delivering and scaling use of terminologies and classifications.
The new Survey Count Optimise Review Enable (SCORE) for Health Data Technical Package: published during one of the most data-strained public health crisis responses ever – that of the COVID-19 pandemic, score can guide countries to take action by providing a one-stop shop for best technical practices that strengthen health information systems, using universally accepted standards and tools.
The WHO has numerous platforms, instruments and monitoring mechanisms involving data exchanges and classification among its member states.
The WHO’s digital and data efforts contributing to both sustainable development goal (SDG) 3 and Universal Health Coverage focus on identifying, understanding, and tracking progress in communities left behind. Measuring inequalities is crucial to identify differences in health between different population subgroups, which provides evidence for policies, programmes, and practices that tackle health inequities. Recognising this, the WHO has developed a number of tools and resources to build capacity for health inequality monitoring at global and national levels.
All materials are publicly available through the WHO Health Equity Monitor, the WHO’s platform for health inequality monitoring, and include:
- A large database of disaggregated data;
- A handbook on health inequality monitoring;
- Step-by-step manuals for national health inequality monitoring (generally and specifically for immunisation inequality monitoring);
- Statistical codes for calculating disaggregated data using household survey data; and
- A software application for assessing health inequalities (HEAT and HEAT Plus).
Building on these materials, the WHO delivers regular training workshops to build capacity for health inequality monitoring in WHO member states and regions.
The Health Equity Assessment Toolkit is a software application that facilitates the assessment of health inequalities in countries. Inequality data can be visualised through a variety of interactive graphs, maps, and tables. Results can be exported and used for priority-setting and policy-making.
There are two editions of this toolkit and further references are below:
- HEAT, the Built-In Database Edition, which contains the Health Equity Monitor database and
- HEAT Plus, the Upload Database Edition, which allows users to upload and work with their own databases.
Health Equity Monitor database: http://apps.who.int/gho/data/node.main.nHE-1540?lang=en
Health inequality monitoring handbook: https://www.who.int/data/gho/health-equity/handbook
Manual for health inequality monitoring: https://www.who.int/data/gho/health-equity/manual
Manual for health inequality monitoring in immunisation: https://www.who.int/data/gho/health-equity/manual_immunization
Statistical codes: https://www.who.int/data/gho/health-equity/statistical_codes
Health Equity Assessment Toolkit: https://www.who.int/data/gho/health-equity/assessment_toolkit
Capacity building: https://www.tandfonline.com/doi/full/10.1080/16549716.2017.1419739
Global and national reports: https://www.who.int/data/gho/health-equity/publications
Harmonized Health Facility Assessment modules – digital data collection and analysis of health service quality
The Harmonised Health Facility Assessment (HHFA) modules represent a comprehensive, external review tool for assessing whether health facilities have the appropriate systems in place to deliver services at required standards of quality.
Availability and quality of health services are integral to universal health coverage (UHC) and contribute to achieving the SDGs. The HHFA modules provide an in-depth assessment of facility service availability and quality, based on global health service standards, and using standardised indicators, questionnaires, and methodologies. HHFA data contribute to health sector reviews, planning, and policy-making and enable evidence-based decision-making to support the strengthening of health service delivery in a country.
There are four HHFA modules: 1) service availability, 2) service readiness, 3) quality and safety of care, and 4) management and finance. A module is defined as a set of questions (in questionnaire format) that aim to collect information for a defined set of indicators for a specific disease, programme, or service management area.
The standardisation of indicators and data collection methods promotes the alignment of health facility survey approaches among partners and enables comparability of results over time and among geographic areas.
The modular approach enables countries to adapt the HHFA to their needs based on the selection of core and additional indicators and targeting of various health facility levels. The implementation of the HHFA requires health facility visits to collect data through a variety of methods including facility audits, record reviews, provider interviews, observation, and client interviews. The HHFA can be carried out as a census of all facilities or as a representative sample of facilities.
Data collection is conducted using hand-held devices and questionnaires configured in the Census and Survey Processing System (CSPro), a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. A comprehensive digital data analysis platform is in development to enable the efficient and secure analysis of data and the calculation of indicators with automated visualisation and report-creation functions.
The HHFA modules comprise a comprehensive package of downloadable tools: reference manual, questionnaires, indicator inventory, CSPro data collection tool, data analysis platform, implementation guide, and training materials.
Monitoring health trends often requires numerators and denominators, and where possible in real time. Key denominators include birth and death registrations, and data from censuses. This type of monitoring is increasingly using digital technologies.
Move information not people: The WHO advocates for the use of electronic devices for the notification of vital events (births and deaths). Local informants (community health workers or village chiefs) can use mobile devices (phones or tablets) to notify the health facility or civil registration office of a birth or death in the community. However, the registration of a birth or death is more a legal act that must be done in the presence of the next of kin and/or with witnesses in some countries. Where registration is electronic in some countries, it should be accompanied by an appropriate legal framework to protect the confidential information of individuals while the info circulates in the cloud.
Enforcing standards: The WHO has leveraged digital technology to enforce standards in health facilities for obtaining cause of death information. For example, its open source platform District Health Information Software (DHIS2) supports the transfer of real-time mortality information. It has also contributed to rapidly enforcing standards in medical certification and coding of the cause of death through the Startup Mortality List (SMoL) package in low-resource settings.
Contributing to learning: The WHO contributed to the Civil registries and Vital Statistics (CRVS) e-Learning course – which the World Bank spearheaded in 2017 – as the online facilitators for the module on mortality.
Other online training initiatives include webinars on COVID-19 mortality reporting to the WHO.
Key areas of work
- The Toolkit for Analysis and Use of Routine Health Facility Data provides standards and guidance for the analysis of Routine Health Information Surveys (RHIS) data for individual health programmes, as well as integrated analysis for general health service management.
- Digitalisation of the existing Toolkits for strengthening data quality, standards, and use of information in countries. The WHO has an ongoing collaboration with the University of Oslo to develop the DHIS2 digital packages.
- Harmonisation and integration of data to strengthen analysis and data use.
The WHO’s role
- Development of a global public health good of standards for routine Health Information Softwares (HIS) and data quality with training materials
- Collaboration with University of Oslo (UiO) in strengthening DHIS2 as a digital tool
- Integrated health information platform
- Support strengthening of country health information systems
- WHO three-level co-ordination for support on the WHO’s Thirtheen general Programme of work (GPW13)
DHIS2 implementation in collaboration with University of Oslo
- DHIS2 and RHIS data packages provide easy-to-install standards for countries to download and implement
- Help facilitate better co-ordination across programmes and HIS team to strengthen governance and data system
- On-site technical assistance and capacity building with the DHIS2 Health Information Systems Programme (HISP) network
- Technical assistance by the UIO’s DHIS2 global standard framework for updates and global community of practice
- Linkages between routine HIS and other data sources to strengthen Universal Health Coverage (UHC) monitoring framework
Country Implementation of the DHIS2 Standard Packages, July 2020 (map) https://dhis2.github.io/dhis2-in-action/#who
The WHO is stewarding semantic interoperability in global health by setting health information standards, and strengthening health information system capacity, functioning, coverage, and data quality through the provision of appropriate technical advice, policy dialogue, tooling, training, information packages, and workflows. This includes a range of digital tools.
It operates a ‘one-stop-shop’ for WHO classifications and terminologies and is delivering and scaling use of terminologies and classifications.
WHO core health information standards comprise the following reference classifications:
1. International Classification of Diseases (ICD-11): Includes content coding beyond just diseases, such as injuries, sites, activities, WHO medicaments (INN), and devices.
3. International Classification of Health Interventions (ICHI): Identifies health-related interventions at the individual and population levels for treatment, diagnosing, and prevention.
The information standards come with a common digital tooling infrastructure for proposals, authoring, and dissemination (API, terminology services).
· Are clinically relevant and scientifically up-to-date;
· Use state-of-the-art a digital infrastructure for easy, fast, and accurate digital (and human) consumption;
· Are based on ontological structures that deliver detail at the level of terminologies for several use-cases;
· Allow aggregation of the health data to inform all levels of health systems;
· Have intrinsic user guidance and can be accessed by software (API/terminology server) or humans (coding tools and plug ins); and
· Are maintained and regularly updated.
The WHO’s reference classifications provide the building blocks of understanding health information. The ICD – for more than 120 years – has informed health systems in responding to disease trends and in allocating resources accordingly so diseases can be prevented or detected and treated in the best way. The ICD is legally mandated for use in mortality and morbidity by the nomenclature regulations, and has been since the inception of the WHO. The concept of the WHO Family of International Classifications and Terminologies (WHOFIC) is supported by all WHO member states, and was last reiterated in the resolution for the adoption of ICD-11 (2019).
The WHO Classification and Terminologies (CAT) Unit co-ordinates the development, implementation, and maintenance of the WHO’s Family of International Classifications (ICD, ICF, and ICHI), including the necessary training for all these tools and their correct use. The CAT Unit serves as a clearinghouse related to all questions and adapts tooling or includes of content and features required by users
The CAT Unit partners or collaborates with countries, institutions, organisations, and businesses for input for the continuous improvement of its standards. It manages and governs harmonisation efforts on common data standards under the roof of the WHOFIC and its tools.
SCORE for Health Data Technical Package
The new Survey Count Optimise Review Enable (SCORE) for Health Data Technical Package forms the cornerstone of the WHO’s efforts to strengthen health information systems worldwide, and countries’ capacity to generate, analyse, and use health data (i.e. health status and health intervention). The SCORE package was published during one of the most data-strained public health crisis responses ever – that of the COVID-19 pandemic – which is placing a huge burden on already overstretched health and health-related data systems worldwide. The SCORE package can guide countries to take action by providing a one-stop shop for best technical practices that strengthen health information systems, using universally accepted standards and tools. Digital technologies offer unprecedented opportunities to collect, analyse, and use data to drive progress in many areas of life, including health. Increasing the integration of digital systems and the use of WHO data standards (ICD, ICF, and ICHI) for data that are generated in different streams of work serve to ensure the interoperability of the information collected.
The SCORE package includes recommendations for country actions that are related to digital systems, as well as a list of tools and standards that countries can use to improve their capacity around digital systems. These recommendations include:
- Establishing a unified digital system that facilitates interoperability between different systems.
- Implementing a country HIS that should be a single country-led platform that meets all data needs and enables monitoring of progress towards UHC and the health and health-related SDGs. Development of the HIS (including digital systems) should be based on one strong country-led monitoring and evaluation plan that is an integral part of the NHSP.
- Ensure a unified digital health data infrastructure that underpins the national HIS plan and national M&E plan.
- Initiating a national digital health/e-health strategy that is based on standards.
The SCORE package also contains a number of digital-related tools and standards including:
o DHIS2: A Digital Tool for WHO RHIS standards
o Digital Health Package for DHIS2
o WHO Guidelines: Recommendations on digital interventions for the strengthening of health systems
o Guidance for Investing in Digital Health: The Asian Development Bank (ADB) Sustainable Development working paper series
o Digital Health Platform Handbook: Building a Digital Information Infrastructure (Infrastructure) for Health
WHO Health Data Hub
Comprehensive, timely, and reliable health and health-related statistics together with the use of digital innovations are fundamental for assessing a population’s health and how it is changing.
Recent developments in global health include increased focus on monitoring and accountability. The Department of Data, Analytics, and Delivery for Impact together with the Department for Digital Health and Innovation, want to ensure that the WHO and its member states continue to benefit from the best possible scientific and strategic advice and support in the collection, storage, analysis, use, and dissemination of global health statistics and data.
The WHO’s Constitution outlines a core function to set global standards for collecting data on health and health policy trends, and disseminating that information. The WHO is building a state-of-the-art World Health Data Hub (WHDH) for member states. It will serve as a single repository of health data in the WHO and establish a data governance mechanism. The WHDH will:
- Be a one-stop-shop to quickly discover all of the WHO's health data assets through a single catalog with modern features, such as chatbots and integration with search engines, and revamp Global Health Observatories for internal and external partners.
- Create two-way portals between the WHO and member states, enabling direct uploading of data from countries and providing tiered and managed access for policy-making support.
- Provide more significant insights and analytical capabilities drawn from the central data repository through reusable tools and components across all three levels of the organisation with smart and dynamic visualisations, predictive forecasting, and comprehensive analysis across health topics.
- Provide means such as geographical information systems (GIS) tools as a corporate service to the organisation.