Multistakeholder Dialogue on National Digital Health Transformation

Summary

This discussion focused on the importance of digital public infrastructure (DPI) in transforming health systems and achieving universal health coverage. Experts from various countries and organizations shared insights on the challenges and opportunities in implementing digital health solutions.

The conversation emphasized three key pillars for successful digital health transformation: governance, architecture, and financing. Speakers highlighted the need for country-led digital strategies, strong regulatory frameworks, and sustainable funding models. The importance of interoperability, data sharing, and user-centered design was stressed throughout the discussion.

Examples from countries like Estonia, Kenya, and India demonstrated how digital solutions can improve healthcare access and efficiency. These included digital identity systems, health information exchanges, and streamlined registration processes. The potential of digital technologies to enhance assistive technology access was also explored, with Ireland’s initiatives serving as a case study.

Participants addressed challenges such as fragmentation in digital health systems, data privacy concerns, and the need for better tracking of digital health investments. The importance of involving communities and end-users in the design and implementation of digital health solutions was emphasized.

The discussion concluded with a call for global collaboration and knowledge sharing to accelerate digital health transformation. Speakers urged for increased investment in digital public infrastructure and emphasized the potential of digital solutions to reduce health inequities and improve healthcare access for all.

Keypoints

Major discussion points:

– The importance of digital public infrastructure and architecture for transforming health systems

– The need for governance, financing, and coordination to enable digital health transformation

– Assistive technology as a use case for digital health infrastructure

– The importance of putting people and communities at the center of digital health efforts

– Examples of digital health initiatives from countries like Estonia, Kenya, Rwanda and India

The overall purpose of the discussion was to explore how investing in digital public infrastructure can accelerate progress toward universal health coverage and equitable health systems, with a focus on assistive technology as a key use case.

The tone of the discussion was largely optimistic and forward-looking, with speakers emphasizing the potential of digital technologies to transform health systems and improve access to care. There was also a sense of urgency about the need to coordinate efforts and invest strategically in digital infrastructure. The tone became more practical and example-focused toward the end when discussing specific country initiatives.

Speakers

Speakers:

– Leah Ekbladh (Moderator) – Executive Director at Digital Square

– Nele Leosk – Ambassador-at-Large for Digital Affairs, Ministry of Foreign Affairs, Estonia

– Shane Stevens – First Secretary, Permanent Mission of Ireland to the United Nations

– Alain Labrique – Digital Health Director and Innovation Director, Science Division, World Health Organization

– Lisa Lewis-Person – Deputy Assistant Secretary for Technology Policy, Office of the National Coordinator for Health IT, United States

– Hani Eskandar – Head of Digital Service Division, ITU

– Sean Blaschke – Senior Health Specialist for Digital Health and Information Systems Unit, UNICEF

– Mathilde Forslund – Executive Director, TransformHealth

– Kylie Shae – Team Lead for Access to Assistive Technology, WHO

– Malcolm MacLachlan – Co-director Assistant Living and Learning Institute, Maynooth University

– Vikram Pagaria – Director of IT, National Health Authority of India

Moderator:

– Leah Ekbladh – Executive Director at Digital Square

Areas of expertise:

– Digital health

– Digital public infrastructure

– Health policy

– Assistive technology

– Global health

– Digital transformation

– Health systems

– Digital governance

Digital Public Infrastructure for Health Systems Transformation

This comprehensive discussion brought together experts from various countries and organizations to explore the critical role of digital public infrastructure (DPI) in transforming health systems and achieving universal health coverage. The conversation, moderated by Leah Ekbladh of Digital Square, focused on three key pillars for successful digital health transformation: governance, architecture, and financing.

Infrastructure and Architecture

Hani Eskandar from ITU emphasized the importance of digital public infrastructure, stating that DPI enables interoperability, reusability, and trust in digital health systems. This perspective was echoed by other speakers, who provided concrete examples of successful DPI implementation.

Nele Leosk, Ambassador-at-Large for Digital Affairs at the Ministry of Foreign Affairs from Estonia, highlighted her country’s approach to digital identity and data sharing. Estonia’s success in solving interoperability issues through XRoute, addressing trust with digital ID, and creating reusable platforms was presented as a model for other nations to consider. Leosk also discussed Estonia’s national digital registration system and digitalized medical records, showcasing the country’s advanced digital health initiatives.

Vikram Pagaria from India’s National Health Authority shared the success of India’s Unified Payments Interface (UPI) as an example of effective DPI. He also stressed the importance of standards like HL7 FHIR for ensuring interoperability across different health systems. Pagaria highlighted India’s digital health initiatives, including a QR code system for hospital registration and a project to establish 100 model facilities demonstrating the use of digital health technologies.

These examples underscored a key agreement among speakers: the crucial role of digital public infrastructure in enabling efficient, secure, and interoperable digital health systems.

Governance and Legal Frameworks

The discussion highlighted the need for strong governance mechanisms and legal frameworks to guide digital health transformation and protect data privacy. Nele Leosk emphasized the importance of these frameworks in the Estonian context, while Sean Blaschke pointed to Kenya’s Digital Health Act as an example of progressive legislation in this area. Blaschke also cited Rwanda’s e-government approach with embedded ICT teams as an example of effective country-led digital transformation.

Lisa Lewis-Person from the US Office of the National Coordinator for Health IT stressed the need for country leadership and ownership in digital health initiatives. She also discussed the Global Digital Health Partnership (GDHP) and its focus areas, as well as the International Patient Summary project, which aims to standardize health information exchange across borders.

Financing Digital Health Transformation

Mathilde Forslund, Executive Director of TransformHealth, raised concerns about the current state of digital health funding, describing it as insufficient and fragmented. She emphasized the need to track and measure digital health investments more effectively and called for costed national digital health plans. Forslund also highlighted TransformHealth’s role in representing civil society and end-users in digital health discussions.

Vikram Pagaria provided a contrasting perspective, highlighting India’s significant investment of $20 million in its National Digital Health Mission. He also mentioned India’s issuance of 1.9 billion COVID certificates digitally, demonstrating the country’s capacity for large-scale digital health initiatives. This juxtaposition of views underscored the varying approaches to financing digital health transformation across different countries.

Assistive Technology as a Use Case

The discussion highlighted the potential of digital technologies to enhance access to assistive technology. Kylie Shae from WHO highlighted the large unmet need for assistive technology globally, while Malcolm MacLachlan from Maynooth University emphasized how digital solutions can help scale up access.

MacLachlan presented Ireland’s assistive technology passport as an innovative digital solution in this area. He also discussed the SHAPES project, which aims to create an integrated care platform for healthy aging. Shane Stevens provided additional information about Ireland’s investment in assistive technology, highlighting the country’s commitment to this area of digital health.

Global Initiatives and Collaboration

The discussion touched on several global initiatives aimed at promoting digital health transformation. Vikram Pagaria mentioned the Global Initiative on Digital Health (GIDH) launched by India during its G20 presidency, which aims to foster international cooperation in digital health. Lisa Lewis-Person discussed the Global Digital Health Partnership (GDHP), emphasizing its role in facilitating knowledge sharing and collaboration among countries.

Challenges and Concerns

Despite the overall optimistic tone, speakers addressed several challenges in implementing digital health solutions. These included:

1. Fragmentation in digital health systems

2. Data privacy concerns

3. The need for better tracking of digital health investments

4. Ensuring that digital health initiatives do not exacerbate existing inequities in access to care

Community Involvement and User-Centered Design

A recurring theme throughout the discussion was the importance of involving communities and end-users in the design and implementation of digital health solutions. This point was raised in response to an audience question and resonated with many speakers, who agreed that user involvement is critical for the adoption and effectiveness of digital health systems.

Conclusion

The discussion concluded with a call for global collaboration and knowledge sharing to accelerate digital health transformation. Speakers urged for increased investment in digital public infrastructure and emphasized the potential of digital solutions to reduce health inequities and improve healthcare access for all.

Overall, the discussion highlighted the complex, multifaceted nature of digital health transformation, emphasizing the need for coordinated efforts across governance, infrastructure, and financing to realize the full potential of digital technologies in improving global health outcomes. The diverse examples from countries like Estonia, India, Kenya, Rwanda, and Ireland demonstrated the varied approaches to digital health implementation and the importance of tailoring solutions to local contexts while learning from global best practices.

Leah Ekbladh: My name is Leah Ekbladh. I’m the executive director at Digital Square. It’s an initiative out of an international NGO called PATH. I’m joined here today with many esteemed colleagues that have a lot of rich information to share with us. So I’m gonna get us started. We all set? Okay. So welcome to a multi-stakeholder dialogue on investing in digital public infrastructure for equitable future health systems with assistive technology as a use case. This is part of the Summit for the Future Action Day Two. And this has been hosted by the Permanent Mission of Estonia to the United Nations, the Permanent Mission of Ireland to the United Nations, the World Health Organization, the International Telecommunications Union, the Global Disability Innovation Hub, and finally Transform Health. We’re gonna start our session off with actually a recorded message from the Nele Leosk, the Ambassador-at-Large for Digital Affairs at the Ministry of Foreign Affairs from Estonia.

Nele Leosk: Good morning, everybody, and thank you for joining us. And it’s my real pleasure to kick off the digital discussion of the digital day also from Estonian side. And kick off, I would say, a week full of different discussions on different topics of digitalization. And I would really like to thank our co-organizers, World Health Organization, the Government of Ireland, ITU, Transformative Health, and many others who have actually today brought together two important topics. So I would say that we have two flies at once, bringing together digital health and digital public infrastructure. So as you know, Estonia is often referred to as a digital nation. And indeed, I immensely enjoy everything I can do online. Digital Signature has allowed me to participate in my city municipality council meeting. It has allowed me to vote. It has allowed me to rent my apartment, everything while being away from my own country. And some of these services, indeed, getting married, you can also do online. But let’s face it, how many times do we actually need these services? Some people get married once, maybe some get more, some never do. So actually, there are not so many times. We have a chance to use these services or these benefits that actually the government provides us, but it’s very different when it comes to health. Because every single person needs digital health care and health care services at every stage in their life. And I think this is also one of the reasons why health care has been Estonia’s priority area and will be also in the future. So we have invested heavily in making sure that every person in Estonia, no matter where they live, because it’s actually a very scarcely populated country. We have municipalities with some hundreds of people living there. And the task to bring health care services to all of them is an immense one. So we have in Estonia a national one digital registration system that would support us to see the availability of doctors all over the country. And I do have to admit, I had to use this service two weeks ago when I needed to find very quickly a surgeon to my kid. And I didn’t find availability in my own city. I had actually to drive 40 minutes to a neighboring city to visit a specialist quicker than I could in my own town. We have, and many maybe have also heard, a fully digitalized medical record. So the medical data about a person all comes together from different hospitals, different clinics. I can see my dental records, all my pictures taken, of course, given that I have given a permit to share my data. And we have also, for 10% of our patients, we have a medical record. population, a fully sequent genome. And that has really allowed us to step on the personal medicine so that our GPs don’t have to screen every patient for cancer, for example, but really those that have higher risk to be imposed to that kind of a disease or any other. But what has made all that possible is actually the second side of our topic today, and it’s digital public infrastructure. It is a rather newly coined term. It’s a good key, so it has many names. But what it really means to us is that the government has laid down, I would say, a basic foundation for digital development for everybody, not just government, but also every other partner. Is it the private sector? Is it a health care establishment? Is it even a private individual? And I would maybe bring out two reasons why we did that. So around 30 years ago, we realized in Estonia that actually the needs of our public sector for digitalization, but also private sector, are quite similar. We all needed to start to digitally authenticate ourselves. We had to give digital signature. We had to share data. And we realized that we cannot afford simply every municipality, every organization, every private sector, or even private health clinics, develop their own systems. First of all, we didn’t have resources for that. We did not have human or financial resources. But second of all, it was a matter of security. It was clear that a local municipality or a dental practice cannot simply develop systems secure enough. So this security by design principle has really helped us through to make sure that our data is protected and it is not misused. And this actually comes or takes me to the end of my opening remarks, I’m very much looking forward to hearing from the others, is that actually when we look at ourselves coming from very different countries here in this room, actually we are quite similar too. Despite our differences, we are quite similar. So since 2016, some of the systems that we are using in Estonia, for example our data sharing system, we are not developing alone. No country can do it alone, maybe with the exception of a few, but most of us cannot do it alone. So we coupled up with our closest friends, Finland, in 2016 and some of the solutions that we are using also for secure data exchange, including in healthcare sector, we are developing together with Finland. So we are saving our resources and they are saving theirs, and we make these tools also available for everybody else. We have also some international collaboration. I see Honey here from ITU. We have an initiative called GovStack that follows the same principle, that there are some solutions, for example consent service, that we all need in healthcare sector and we don’t have to reinvent it every time we need it. So I end with a call for collaboration between all of us. I encourage not only to share, but also to reuse. So thank you from my side.

Leah Ekbladh: Thank you. It’s a treat that you’re here in person. That was a wonderful surprise. So hearing a little bit about data protection, data use, and data being in our lives, and digital being in our lives, from registering your marriage to seeking health care, I think is a great way for us to start. I’m going to pass it over now to Mr. Shane Stevens. He’s the first Secretary for the Permanent Mission of Ireland to the United Nations to share his remarks.

Shane Stevens: Leah, thank you very much and thanks also to the World Health Organization for giving us this opportunity to partner with you again. It was great to hear from… Ambassador Liask there. And once again, to be reminded of what an important force Estonia is in this world of digital technology and the e-government. We have a lot to learn. It’s great. I just want to say that personally, that we consider it a great privilege to be able to contribute to this progressive and equity-based agenda. We’re all here today, of course, to explore how best digital infrastructure can accelerate progress on the achievement of universal health coverage, and more broadly, SDG 3, health and well-being for all. Ireland’s international development policy puts global health center stage, and Ireland’s partnership with the WHO is a core component of that approach. We continue to strengthen our partnership with the WHO in recognition of the leadership role it plays at the heart of the global health architecture. As we’re all aware, one of the focus areas of this action day, too, is digital futures. And in a few days, during a high-level week, our Tornista, Miho Martin, our Deputy Prime Minister and Minister of Foreign Affairs, will engage in a high-level interactive dialogue towards a digital future. So this is an important theme for us on an ongoing basis. I look forward to hearing today about the potential and opportunities of digital health infrastructure during this morning’s event. In the second session of this morning’s event, we will be exploring an important aspect of digital health infrastructure that related to digital and assistive technologies. Ireland is focused on promoting the full inclusion of people with disabilities in our society and progressing the implementation of the UN Convention on the Rights of Persons with Disabilities. We also recognize the importance of investing in digital health infrastructure to ensure that every person, including persons with disabilities, has access to the same health services as every other person throughout their life course. We are committed to taking action to improve health equality. Ireland ratified the Convention on the Rights of Persons with Disabilities in 2018 and highlighted the importance placed on access, production, and research into assistive technologies for persons with disabilities. We also recognize the recommendations of the Global Report on Assistive Technology and the role of assistive technology in ensuring improved health incomes, inclusion, and participation for about one third of the population. Ireland was present at the launch of the Global Report in 2022, and our Taoiseach, Prime Minister, gave the keynote address on that occasion. Our engagement in this area and our support culminated in the recent announcement of the Global LEAD Agreement between the WHO and Ireland in May this year. Through our Department of Children, Equality, Disability, Integration and Youth, Ireland is investing $12.5 million in partnership with the WHO over the next five years for its Digital Assistive Technology Initiative. This partnership will help strengthen affordable and equitable access to assistive technology globally, and will focus on innovation in people-centered rights-based service delivery models with the aim of harnessing the potential of digital assistive technology to strengthen the interconnected pillars of people, policy, products, provision and personnel. Through the leadership of the WHO and the engagement of other member states, Ireland strongly believes that collective action to support improvements in health infrastructure will result in driving positive change. I look forward to the rest of today’s discussions. Thank you.

Leah Ekbladh: Thank you, First Secretary Stevens. It’s very important for us to keep equity in mind as we go forward to make sure that the digital enhancements we’re talking about in the health system don’t create further divides in access to care. To follow up on that, I’m going to introduce Dr. Alain Labrique. He’s the Digital Health Director and Innovation Director at the Science Division at the World Health Organization. He’ll be telling us a bit more about fostering digital health transformation and the lessons learned from the World Summit of Information Society C7 Action, and also update us on the WHO Guide Initiative.

Alain Labrique: Fantastic. Thank you, Leah. I really appreciate everyone’s partnership. and engagement this morning, what an outstanding show of solidarity we have. I know it was a competitive process to get people into this room, but it’s a packed room, and it’s a pleasure to have you here. Thank you especially to our colleagues from the governments of Ireland, Estonia, and the U.S., the Global Disability Hub, ITU, UNICEF, and Transform Health. Distinguished colleagues and fellow digital health champions, good morning, and it’s really an exciting program with experts that you’re going to be hearing from from around the world, and let me start by setting the scene with a few focused slides. The role of digital in creating resilient health systems became increasingly clear during the pandemic. Over the last two years, WHO and partners have been working to meet the demands from countries to help shift the conversation of a decade of, let me just say very plainly, playing with digital solutions as piecemeal band-aids to vertical challenges towards now what we’re talking about, carefully planned and executed digital health systems. Digital public infrastructure is the underlying fabric, as we’ve heard from our two speakers this morning, on which other systems, whether it’s banking, education, and of course health, are built. More than 120 member states have articulated a digital health strategy, but we have struggled to convert these visions and ideals into action. A proliferation of solutions exists as a result of donor-driven investments, while the foundational elements that we’ve heard about this morning from our colleagues in Estonia that are needed for systematic digital transformation remain neglected. Who are the custodians of a national digital transformation? What is the budget to build and maintain what we call the commons or infrastructure? What are the standards on which the entrepreneurs developing digital solutions build to ensure interoperability? Together, we need to develop the architecture and and guidance, which is what we’re doing right now with WHO and ITU and UNICEF, under the guide initiative, as well as to mobilize the resources to move into this upper right quadrant of what we call strong enabling environments. We see there to be at least three foundational pillars or legs of the stool necessary for achieving sustainable and inclusive digital health transformation. These are governance, architecture, and financing. Following our moderated discussion around these three pillars today, we will zoom in on one of the many areas that could be enabled by these functions, by these critical foundations. Assistive technologies, for example, enhanced by digital, and access to assistive technologies strengthened by strong, robust digital systems. Assistive technology is an underserved area in most health systems with significant global inequities in access to coverage. We cannot keep talking about health for all and universal health coverage without, as our distinguished colleague from Ireland just said, inclusivity and equity baked into the DNA of what we do in digital. Effective financing, governance, and the foundational architecture that support digital health interventions can be powerful enablers to assistive technology, as well as many, many other domains of health. National transformation has to be guided by clear priorities with the curation of multiple stakeholders, funders, and constituents entrusted to one or more public agencies. It’s another thing that I think Estonia and several other governments have begun to do, demonstrating the leadership of the public sector in sustaining and creating that commons. The public agencies entrusted with this responsibility are responsible for building, managing, and maintaining these digital commons, public goods, and resources. Across income lines, we see countries following this approach, defining national digital transformation as agencies to curate the shift from what I called e-chaos to… e-coordination, where we have, as exemplars, the U.S., Indonesia, Kenya, and so many others, which have defined this core pillar of the stool. The World Summit on Information Society, also known as WISIS, as well as the new Global Initiative on Digital Health, you see the shameless banners on either side of me here, are platforms. These are multilateral platforms to promote country leaderships, putting countries at the center of their digital transformation. The second leg of the stool, National Digital Public Infrastructure, or DPIs, creates the environments in which entrepreneurships thrive. Core elements such as digital identity, payments, and shared services remove the burden on entrepreneurs to have to recreate these foundational pieces every time a new system is built. But also the lack of standards and interoperability exacerbates already fragmented care and creates poor user-centered experiences. Let me move to one of our sister agencies, UNDP, in their recent DPI report that came out of the India G20 process, where I know the graphic may be a little small, but it explains very nicely how there are some core DPI functions. These foundations, such as strategic leadership, strong policy frameworks, are essential to that enabling environment to ensure that DPIs are implemented successfully. Second, we have what we call foundational or core DPIs, and these are the digital commons. They are reusable infrastructural assets that strengthen digital transformation across sectors, banking, education, health, you name it. These are the things, as our colleague from Estonia said earlier, you may or may not use every day or every month, but they also are so embedded in our daily transactions that are now digital that we often don’t even realize how essential they are to smooth functioning. There’s nothing as frustrating as turning on the tap and not having water come out, or plugging in your device to charge it and realize there’s no electricity coming through the port. These are things that, in much of the world, you assume to be part of the infrastructure of societies, but in sad truth, they are not equitably distributed around the globe, and the same is now true for digital. Second, we also see on top of these core foundational infrastructure that are digital identity, digital payments, interoperability, and so forth, we also see that every sector has digital public infrastructure dedicated to that sector. In health, these are, for example, canonical registries, so lists that are definitive of the health workforce, of patients, persistent health records that allow for continuity of care across vertical service deliveries. And even as WHO recently took on the burden of hosting, last year, digital public infrastructure that allows the verifiability of health certificates as we as citizens travel across national borders and within countries that our own health records can be verified as we move around. So together, these three pieces represent public goods, which if not addressed specifically, suffer from what we call the tragedy of the commons. If they’re not financed, if they’re not governed, and if they’re not clearly architected, these are the 21st century roads, highways, and electrical infrastructure that were fundamentally responsible for unlocking industrialization and drastically improving health outcomes almost a century ago. Last but not least, let me end with the third leg of the stool, and that is financing. And to achieve sustainable and inclusive digital health transformation, we need a vast improvement in the availability and alignment of resources. We started speaking earlier about, you know, we’re playing around in digital for the last 10 years. Now is the time to get serious. And with moving from experimentation to serious infrastructure also means an accompanying serious financing commitment. And I think that’s what countries are asking us to look at. According to OECD, 0.4% of $350 billion of development assistance were dedicated to digital initiatives. That is insufficient to drive the transformation that we’re talking about today. How much of this investment is supporting the digital commons? Not the shiny objects, but the commons. How much of this is creating disease-specific shiny objects? So let’s support governments in doing more with the resources that we have and in helping to align the resources that are being put into this field. And let’s shepherd digital transformations that truly enable health for all. Thank you.

Leah Ekbladh: Thank you. We’re going to continue our discussion around these three pillars, the three legs of the stool, with a bit of a panel discussion here. We’re going to be talking about the challenges and the opportunities moving from a fragmented digital transformation to a country-led digital transformation of health systems. And we’ll be pulling on those three pillars of financing, governance, and architecture in our panel to give you a flavor of some of those challenges and opportunities. And then we’ll move on to the case study. So our first speaker, again, will be virtual for us. It’s Ambassador Alexandre Ghisleni, the head of special office for international affairs at the Ministry of Health of Brazil.

Alexandre Ghisleni: I’d like to commend the WHO for holding this timely event. on national digital health transformation. It converges with our priorities at the G20 and the work that have been doing in G20. Minister Nisa Trindade, Brazil’s Minister of Health, has chosen as the main overarching theme for the Brazilian presidency of the health track the theme of building resilient health systems, which is a multifaceted task. We have been approaching it from many different angles. We have been talking about AMR, climate change. We have been talking about health workforce, pandemic preparedness, including local production of vaccines, medicines, and diagnostic tools for neglected diseases and neglected populations. All of these tasks must converge to the same objective. And one element that is key to all of them, which helps connect them, is digital health. Digital health makes our health systems be more efficient, makes it reach underserved areas, makes it provide services that were not available before, which is why, during our presidencies, we have been discussing artificial intelligence. We have been discussing telehealth, including telemedicine, and also the implementation of a guide of the global initiative on digital health, which was launched by the WHO. We’re fully supportive of implementing this global initiative to the fullest, of making it serve the interests of developing countries, and especially people that are in the most vulnerable situations. Bringing it to the United Nations and helping the discussion move forward in the global arena is an objective that we share and we support. We’d like to wish you all a great event and lots of success. Thank you very much.

Leah Ekbladh: Thank you. My first question is to Lisa Lewis-Person. She’s the Deputy Assistant Secretary for Technology Policy, the Deputy National Coordinator for Operations, the Chief Operating Officer, the Office of the National Coordinator for Health IT for the United States. Ms. Person, my first question is around the fragmented digital health systems and how they frequently stem from a long history of investment from fragmented vertical health areas. So, funding for maternal and child health, funding for HIV. What suggestions do you have for us for fostering alignment and coordination between the different owners of existing systems to ensure effective integration and data sharing across these health verticals?

Lisa Lewis-Person: Thank you for the question, Emil. Hello. Thank you all so much for having me and thank you to my esteemed colleagues and to the WHO for the Global Initiative on Digital Health and for hosting this very important conversation. I’m a believer that information is the great equalizer and our digital health systems is the way to bring equality to healthcare. So thank you all for the work that you are doing. I would say I know I chose the right field because I would rather not be doing anything than this on a Saturday morning. So although countries have different healthcare systems, we speak different languages, we have different populations that we serve, we have many commonalities. And as you’ve heard this morning, how we use our digital health systems is one of those commonalities. We also have the opportunity to move in the same direction as we advance the use of digital health to be able to address the fragmentation of systems and improve health outcomes, which is the ultimate goal. I believe the strongest way to overcome this type of fragmentation is for all of us to work collaboratively through key digital health leadership organizations that advance alignment of digital health efforts and systems. We cannot solve the global digital health fragmentation problem alone. We must work in concert with other countries and global digital health groups, such as this forum, the WHO’s Global Initiative on Digital Health. The guide is focusing on how to help countries at all levels of digital health overcome obstacles in a variety of areas, and this is critical work. We also have the Global Digital Health Partnership, or GDHP, which is a collaboration of 40 country governments and the WHO, which was formed to support the executive implementation of worldwide digital health services. The GDHP’s members include digital health leaders who focus on advancing global digital health in clinical and human engagement, in cybersecurity, which we heard is critical to all of us, evidence and evaluation, interoperability, and policy environments. The Office of the Assistant Secretary for Technology Policy within the U.S. co-chairs the Cybersecurity and the interoperability work streams, and we are the immediate past chairs of the GDHP. I want to thank every country that participates either in GUIDE or the GDHP. Thank you for your membership and your partnership. I want to thank Elise Anthony for being the senior executive who is responsible for our global digital health efforts and Aisha Hassan for leading our global digital health portfolio. There are many examples of the types of projects that are the result of collaborative engagements through groups like GDHP and GUIDE, such as progressing and implementing the International Patient Summary, which allows individuals to access their patient data whenever and wherever they need to do so. That puts the care of the patient back at the center of what we are doing and puts it in their own hands. It’s important that they receive this information in a seamless, safe, and secure manner, and so we work to do that through patient-mediated and provider-mediated exchanges within countries, between countries, and across the world, such as the 2024 Hajj pilgrimage, where Indonesia, Malaysia, Oman, and Saudi Arabia were able to exchange patient data. This example demonstrates that if we work together as leaders, we can avoid digital health transformation happening in silos. The digital world knows no borders. We serve our citizens best when we work together collaboratively to improve health outcomes by addressing compelling issues in digital health, such as the fragmentation of digital health systems. Thank you so much.

Leah Ekbladh: Thank you. I’m going to turn my next question to Hani Eskandar. He’s the head of the Digital Service Division at the ITU, and hoping we can talk a little bit about ways that we can use architecture to defragment some of those health silos and making sure that we can exchange safely those digital health streams. Last December, WHO led the publication of an article in the Oxford Open Digital Health featuring the full-stack approach. This approach highlights the importance of open standards, technology, architecture, and content to adjust the challenges of fragmentation. At the Global Initiative on Digital Health Multistakeholder Dialogue in May this year, both WHO and the ITU kicked off the work on a reference architecture for digital transformation of health systems. Can you tell us more about that guidance and who the intended users are? And then, if there is time, what’s next on that agenda?

Hani Eskandar: Thank you very much, Leah, and good morning, good afternoon, everyone. Maybe just I would like to acknowledge that maybe we are not all aware we are in a juncture historical moment in the digital health history, and I am not exaggerating. For those who are involved in digital health since a long, long time ago, we’ve been always saying the same thing, the digital health fragmentation, experimentation, duplication, etc. And I would like to acknowledge in UNGA 2024, the first time architecture is the focus of the discussion. And this is, for me, is a strategic and radical shift in the mindset of the people who are involved in digital health. Let me maybe explain this in really one minute, just to try to explain why architecture is so important. We’ve been very much dominated by what you can call a solution mindset. Basically, I have a problem, I develop an application to solve my solution. There is a huge difference, and this is what we have learned after so many years, even at our agencies. We have discovered that building a solution is not the same as transforming a sector or digitizing a sector. Those are completely two different things, and the approaches are different, and investments are different. Why? Because if you are talking about digitally transform the health sector, you need to develop and deploy decentralized systems, meaning that you need to have your solution pull data and share data across the whole system and even outside of the boundaries of the health sector. And you cannot do that without doing three things. Enabling interoperability, solving the issue of reusability, and create trust. And by the way, this is not related only to health. All the countries and sectors who managed to transform using digital, they managed to solve those three things first. Estonia is a great example. What did Estonia do? They solved interoperability through XRoute, they solved the issue of trust by ID, and they solved the issue of reusability by creating those kind of shared and reusable platforms. If you don’t have those things, you cannot share data in a trusted manner. And if you are not able to share data across the system and beyond the system, you cannot talk about digital transformation. So the way to do that is the missing thing that we have never given enough focus to is the magic word is architecture. Architecture. If you, there is one thing you need to get out of this session is the word, there is a new thing called architecture. DPI, what’s DPI? Digital Public Infrastructure. Digital Public Infrastructure is basically the implementation of an architecture. The DPI has a component that can enable all those three things, reusability, interoperability, and trust. So this is not a trivial, this is not just a new buzzword, this is not just a nice thing that international agencies are excited about and brings conferences, etc. This is the core of the problem of investments in health, digital health, because everyone is doing, concerned with their own problem, but no one is looking at the overall system. So to solve this issue, what we are going to do, and actually we started to do this, we are going to create something that, long name, DPI Based Reference Architecture for Digital Health Transformation. So basically developing an architecture for digital health is not an easy task. It requires a lot of, and actually the most rare skill is the architect. I think for those who are involved in digital, they know a good architect is like a blessing. So, what we’re going to do, we’re going to do the homework for countries is to give them a blueprint, like an example, a model of an architecture. But more importantly is that this architecture is not only, is not considering that health is a silo. No. Health is part of the overall digital transformation. We need now to, not to talk about digital health transformation, we need to talk health in digital transformation. Health should be part of the overall digital transformation of a government. And that’s why developing an architecture that takes this into consideration is key. How we are going to do it? Very practically in 30 seconds. We have a call, which is still open by the way, calling for countries, experts, individuals, organizations who have any experience in developing similar architectures. There are, the good news is that there are a lot of things that have been done. We have very good examples from Estonia, from India, from so many other countries. We have initiatives, open HIE, so there are a lot. Our role as international organizations is to try to compile this and do the homework for the countries to say, let’s try to give you an example of an architecture. And by the way, this work will be driven by an excellent piece of work that WHO did, which is the SMART guidelines. The SMART guidelines, if you really understand them, it’s a reference use case. It’s an example of saying how you design care, how you deliver care in the digital era. What is missing from the SMART guidelines, and that was my comment to WHO, if you give the SMART guidelines to countries, they will end up having duplication of application. If you don’t have architecture in the middle, so this is the next step that we are going to do. We are going to pull a group, a working group, and you are all invited, if you have the expertise of course, to join this group because it’s difficult, right? So we really need to make sure that we do the hard work to give this kind of reference specification, but in doing so, we’re going to involve people from the digital government and I think Nelly mentioned the GovStack initiative and many other initiatives that are looking at the DPI in general, so we try to bring this so that health doesn’t become a silo sector. No, health needs to be part of the digital transformation. So you are all invited, it’s a call for all you to, if you have the time and expertise and the will, and by the way, this session is so important that people came on a Saturday and even being in ITU, there is a very exciting event that is happening, which is SDG Day and decided to leave it and come to this session because of the architecture.

Leah Ekbladh: Well, we know that countries themselves need to both govern and invest in this architecture. And my next question is for Sean Blaschke, he’s the Senior Health Specialist for Digital Health and Information Systems Unit at UNICEF. And we’re going to stay on that topic of architecture. And Sean, many of us have experienced the shift in political commitment to interventions with a change in government. How can a complex and expansive journey of digital transformation survive and transcend electoral and political shifts in the countries where we work and live?

Sean Blaschke: Thanks, Leah. I’m going to try to apply the same architecture framework to legislation, policy, compliance, building block, and talk a bit about a couple of countries that I think have demonstrated how they’ve done this successfully. So first, I’d like to talk a bit about Kenya. Kenya has been working for a while in terms of both devolving healthcare delivery, but also providing a roadmap, a superhighway for digital transformation. But the Kenya government had been challenged under the previous administration. The Digital Health Act had been stuck in draft for, I believe, five or six years. Technology was changing. The needs of the government was changing. But the Ministry of Health, they were constrained quite significantly without having a national vision codified into law to help guide the country. When the current president, President Ruto, was campaigning, this was something that his advisors were asking, well, you know, how do we get the interest of the youth, the young people, entrepreneurs? And he pledged during his campaign. campaign to prioritize digital transformation, technology, digital health, and as soon as he was elected, his staff and his constituents held him to task. And in almost record time, I think six, seven months, they were able to take an act that had been stagnated for many years and quickly turned that into legislation and policy. I’d note a few things that the Digital Health Act in Kenya also included linked to architecture and has helped, I think, accelerate work over the last few months. You know, one is that it’s heavily grounded in the Health Information Exchange architecture and standards, but without being prescriptive. Prescriptive around architecture and standards, not prescriptive around solutions. Kenya is a devolved country and the Ministry of Health did not want to dictate every last solution to the counties. What they did want and need to dictate were the rules of the game. What needs to be shared, how it needs to be shared, and with whom. And so I think this has been something that has really contributed to Kenya capitalizing on a lot of the opportunities that they had that were nascent without that national act in place. The second country quickly to talk about is Rwanda. And Rwanda, I want to talk about the governance side of this. Rwanda has been investing for many years in a e-gov approach where they have the Ministry of Health and then they have an authority under the Ministry of Health which is responsible for operationalizing the national laws and policies. Key to this is that they’ve embedded teams within each of the sectoral line ministries. There are people from the ICT authorities sitting within the Ministry of Health, Ministry of Education, Ministry of Water. These are senior architects and business analysts. These aren’t software engineers, but people who can see the big picture, can connect the dots. and can identify and corral a lot of very different divergent interests towards, again, a common set of public goods. The one thing I would note, or the example I’d note that has, I think, accelerated health sector work in Rwanda was investment in digital identity. Birth registration in Rwanda in 2017 was 56%. As of today, it’s over 93%. This is a huge increase in a handful of years. This was done in part due to business process optimization, cutting unnecessary extra steps. It was done through policy reform that mandated the health sector to issue birth certificates, IDs, at the point of birth. So a one-stop shop where the mother did not need to take their child to a separate location, and digitization. And we’ve seen, during the COVID response, for example, how Rwanda was able to identify and monitor the delivery of every last dose and report on it. And again, this would not have been possible without years’ worth of investments in terms of that overall governance architecture, the multi-sectoral governance architecture, and investments in key DPI as a result of it, including digital identity. So I think echoing many other speakers here, there’s really a need for development partners, funders, donors, to rethink how we are supporting member states to invest in digitally transforming the health sector, not in a piecemeal, program-by-program, vertical fashion, but at minimum contributing to a larger architecture and strengthening the legislation, the policies, the infrastructure, the human resources required for it to be successful. Thanks.

Leah Ekbladh: It’s great to have a story to put behind it. I think that’s really helpful to kind of ground us in where we are and to think about how even a change in government can enhance a lot of the work that we’ve been doing. Something else that can enhance the work we’re doing is on the financial side. And I’m going to invite Mathilde Forslund from TransformHealth, she’s the executive director of TransformHealth, to talk about one of the key challenges to digital health transformation and that being the lack of information about what is funded and then what resources still remain to be funded. And that can lead to not only fragmenting how we implement digital transformation, but fragmentation among donors who are helping on that journey. What would you like to see from governments, from the multilateral agencies, including one sitting to your left and right, and other donors in the room, prioritize in the light of the global digital compact and the summit of the future to advance better tracking and optimization of funding toward universal health coverage?

Mathilde Forslund: Thank you. That’s a big question. Good morning, everyone. Thank you for the opportunity to speak here today. So as Lea said, I’m the executive director of TransformHealth. And for those of you that don’t know TransformHealth, we’re a global coalition of more than two hundred organizations working to harness the potential of digital transformation to achieve universal health coverage by 2030. So as we all gathered here at the UNGA in New York, at the sidelines of the summit of the future, and as I think the only representative of society on this panel, we must recognize that we are at a pivotal moment for bold, coordinated action to close the digital divide and drive progress towards universal health coverage. We need to ensure that digital transformation and the use of AI is built on equity and rights-based principles that truly serve everyone, everywhere. We need to invest in strong legislative and regulatory environments to guide digital transformation of health, including stronger health data governance regulation to govern the collection and use of data and spur responsible innovation. So as Alan said also earlier in his presentation, we also need to ensure that investment in digital transformation is coordinated and aligned, which is why our call as Transform Health, a key call to action over the last few years, has been to call on governments, donors, and private sector leaders to come together and align resources and efforts. And this is in response to a common focus on tech solutions and isolated pilot projects that have emerged in the absence of national digital health strategies and tracking of resources. Interventions may address a vertical disease area rather than the wider ecosystem, and this leads to an expensive and fragmented approach to the digitalization of health services. So as we move forward from solutions-focused digital health initiatives to holistic national digital health transformation of health systems, having clear and costed plans in place will ensure that stakeholders prioritize areas most in need of funding and most available to deliver health impact for all. So in 2022, Transform Health published a conceptual framework titled Closing the Digital Divide, More and Better Funding for the Digital Transformation of Health Systems. To better understand the sustainable digital transformation of health systems, and our engagement around the G20 India, G20 Brazil, and the Global Initiative on Digital Health have centered around the key recommendations from this report. We know that digital transformation is critical investment areas in health, and yet investment in digital health are falling short of the estimated 12.5 billion that is needed for digital transformation of health in low and middle income countries. So beyond the funding shortfall, another challenge is that digital health investment is not measured or tracked routinely or in a standardized way. This information is often across different data sources and categories, and this makes it challenging to quantify the funding needed, make the case for resources, coordinate funding, and to hold different stakeholders accountable. So, at this week’s UNGA, the Global Digital Compact also calls for increased investment for the development of digital public goods and digital public infrastructure, especially in developing countries. The compact highlights that digital transformation should be integrated to development assistance. But ultimately, we cannot increase what we cannot measure. As long as investment in digital health continues to be wrapped into vertical silos and programming, governments will struggle to identify and strengthen digital public infrastructure for health. So, if we instead integrate the tracking of digital health investment as part of the routine process for health systems planning and budgeting, we will give leaders better data to make funding decisions in the face of budget tradeoffs, ensure that digital health investment reinforces the UHC agenda, and support advocates, civil society, and health workforce in holding governments accountable so that funds reach the priorities and those most in need. It will be really important that we build the evidence base on what the digital health ecosystem can learn from other successful efforts to track financing for other complex investment areas such as climate, gender equity, PHC, HIV and AIDS, and nutrition. We also need to leverage existing tracking mechanisms such as the OECDAC reporting and the national health accounts. Ultimately, driving investment to DPI, DPI health, and digital health, equipped with a clear framework to measure and quantify the need while ensuring resources are directed to the greatest priorities, is critical to advancing the digital transformation of health systems and achieving universal health coverage. Thank you.

Leah Ekbladh: Thank you, Mathilde. We heard a lot from our panel around those three pillars that Elan mentioned. had spoken about at the beginning of our session around the financing of the investment case, the country-led investment that needs to be involved, around the government’s needs, what are those national needs, and what partners and local capacity strengthening need to happen in order to realize the governance that needs to happen around digital transformation, and then, again, three cheers for architecture, and talking about that digital public infrastructure, and then the quality assurance and making sure that the data is that equalizer. What I’d like to do now is have everyone hold questions around that digital transformation. We are going to have some Q&A, but before we do that, we are going to talk about that use case and talk about assistive technology as that use case. So I’m going to introduce Kylie Shae. She’s the team lead for access to assistive technology at WHO.

Kylie Shae: Thank you very much, Leah, and yes, I’m now bringing you to the cold face, you know, why are we doing all of this with just one example, and the montage of photographs on the screen is there to remind us all that assistive technology encompasses a very broad and diverse range of assistive products, including those that support people in the functional domains of cognition, communication, hearing, mobility, daily self-care, and also vision, and on the slide, you will see people of all ages in different settings using assistive products such as wheelchairs, walking aids, glasses, hearing aids, and memory devices, and these are just a few common examples of assistive products. However, there are many more, and the successful provision and use of these devices requires systems and policies that ensure people can access affordable, quality, safe products appropriately fitted and maintained with the support of trained personnel. So, WHO estimates as many as 2.5 billion people need at least one assistive product, so that is one in three of us, and the ratio increases as people age with as many as two to three of us needing assistive technology after the age of 65, but despite the need and all the benefits to individuals, communities, and society as a whole, there is a stark inequity of access, with as few as 3 to 10 percent of people in low-income countries having the assistive technology they need, compared to 90 percent having access in high-income countries. Many barriers exist, including a lack of awareness and understanding of the need, and indeed the potential savings for health care delivery. when people have timely access. And of course, critical challenges in terms of services and workforce capacity and the reach to deliver assistive technology, which extends to the ability of countries to respond to the surge in need during humanitarian crisis. WHO recognizes access to assistive technology as an integral component of universal health coverage. And we are working with countries, with UN partners and others to support integration of assistive technology throughout the health system, addressing areas including better data, supply chain issues, policy and provision systems and workforce. Our work includes looking to the future to see how we can ensure that assistive technology is seen as a priority use case for the application of digital health initiatives. And most importantly, is factored into the design and the implementation of digital public infrastructure for health so we become part of this integrated collaborative solution. We are particularly proud of our partnership with the government of Ireland and the opportunity of the global award that the first secretary mentioned earlier, which is intended to help address that global inequity of access to assistive technology with a deliberate focus on digital technologies addressing the most problematic of those access barriers. And we very much look forward to sharing our progress at future digital health forums. And with that, I would like to hand over to Professor Malcolm MacLachlan, who is the co-director Assistant Living and Learning Institute from Maynooth University and an advisor to the Irish health system, who although he could not be with us in person is gonna share just a few perspectives and examples of work in Ireland in this area. So thank you.

Malcolm MacLachlan: Good morning, everyone. And thank you, Kylie. And so I want to talk to you about. how much digital can add to the impact of assistive technologies. If we consider the WHO Global Initiative on Digital Health, it’s focused very much around universal health coverage and the health-related sustainable development goals. So in other words, coverage for all and leaving nobody behind. And surely these two central ideas are going to be key indicators of our success with digital health. So I believe assistive technology is a really compelling use case for digital public infrastructure. And especially so to be discussed at this summit of the future. I think it’s important for you all to have some idea of the scale of need for assistive technology. Kylie has already touched on this. But who does need assistive technology? So people with disabilities clearly need assistive technology. And the WHO 22 report on global health equity for persons with disability has highlighted that this group has the worst health outcome of any particular group. Really important to understand these poor health outcomes are not because of an intrinsic disability, but rather they’re because of barriers that people face in accessing health services. Also the ageing population, obviously with more ageing people, there will be more functional difficulties. And assistive technology can help alleviate and allow people to operate with these conditions. Also more people living with chronic illnesses. So here we’re often talking about habilitation rather than rehabilitation. People living well. with a difficulty and enjoying a better quality of life. And of course, then there’s people with acquired injuries. Just think of the thousands of people at present injured through current conflicts. Many of them in the short term will need assistive technologies, but many will also need them well into the longer term. So I believe that digital technologies offer huge opportunities to remove barriers. For instance, if we look at the sort of five pillars around promoting inclusive assistive technology, digital can help us promote a person-centered approach. It can help us enhance a supportive policy framework, and it can help with the supply of appropriate assistive products. This also relates to the effective provision system, and this must be integrated throughout health and welfare systems at the different levels. And digital has a huge role in supporting an appropriately trained workforce. Some practical examples of work in Ireland we’re exploring with WHO through our global collaboration with them on digital and assistive technology. And these are about, for instance, analyzing population data regarding the need for assistive technology, so that that can inform policy and crucially financing decisions, including assistive products in existing stock management systems. Using digital tools to streamline assessment and referral processes around assistive technology, and developing online platforms and digital communication. to train and support rural workforces. In Ireland, we’re actively working to explore the full potential of digital technologies and to reduce waiting times and enhance services for children and adults and to increase, I guess, their sense of control and involvement in their own service provision. Just a couple of quick examples. One, a project called SHAPES, which stands for Smart and Healthy Aging through people working through empowered systems. Sorry about that. So I had the pleasure of being the PI on that project, and it worked across 14 different countries within Europe. And what we did essentially was we brought together a huge range of assistive and digital technologies through an open digital platform. So the platform is the enabler for the rollout of assistive technology, particularly to those most marginalized groups, and crucially within the community. So rather than going into hospitals, effective digital infrastructure facilitates the provision of these sorts of services in the community. A second example from Ireland, then, is the assistive technology passport. Again, a digitally mediated platform. And this was supported through a project through the Irish Health Service called CREATE. And interestingly, I think in our context here, is CREATE sought to support digital initiatives that, one, made a difference to individuals, but two, made a difference to the system’s ability to supply quality assistive products. So the assistive technology passport really enhances a person’s access to all types of assistive technology and their associated supports. So it’s in its pilot phase still, but it really represents a digital solution that places the user at the center of their own assistive technology journey, including self-assessment, potential self-referral, access to information, advice, and ongoing support and training and technical support for them and their associated helpers. This project is led by Enable Ireland and Freedom Tech, crucially co-designed with assistive technology users and collaborating with Microsoft and Maynooth University. But in essence, the assistive technology passport embodies how digital can better support access to and use of assistive technology. So in Ireland and throughout the world, assistive technology is a compelling use case for achieving more equitable health systems with greater coverage, further reach, and leaving nobody behind for promoting universal health care and achieving the health-related Sustainable Development Goals. But, and there’s always a but, assistive technology services and systems can only scale these barriers, can only achieve the coverage that we all seek for it and make the impact that it’s potentially capable of making if it is digitally supported by the necessary public digital infrastructure. We ask you to join us in contributing to making that a reality. Thank you very much.

Leah Ekbladh: It’s good to bring it back to people, especially people who can really benefit from these enhanced technologies. So thank you for that. I’m going to open it up to the floor for unfortunately only about five minutes so that we have plenty of time for our closing remarks from our colleague from India. But if there is one or two questions from the floor, oh, I see two hands over there. Perfect. Ladies first, if that’s okay.

Questions: I appreciate that. Hi, everybody. I’m Nancy Munchen. I’m the founder of the AI group. I’m in the studio to announce the position that we have. So first of all, thank you for all your sharing and kudos for the work. We have been discussing a lot about the macroscopic level and about the technology to solve these problems. But as everybody knows here, healthcare is huge about the human. And sometimes that is the most challenging part. So I have one unified question regarding the human engagement. First of all, is the end user engagement. Right now, how we’re kind of marrying or evaluating the end users adoption by market adoption of the digital technology. And the second, because I know we already have a multilayered world, you know, like efforts on encouraging the countries to share the data and have the technology, the platform to communicate that data. But healthcare data is so sensitive that it concerns many, many countries like national security. So how can we, especially, you know, these days with the geopolitical tensions and all this wreck of the nationalism, how are we going to encourage or incentivize all these countries on an individual basis to contribute their data to integrity and slightly more transparency? Thank you.

Leah Ekbladh: Thanks, and I’ll just summarize. I hear two in there. One is around how do we evaluate end user engagement, and then how can we encourage countries to share data across systems. for global learning. Is that, did I get it right? Yes. Super. Okay, who wants it? All right, Alain, please.

Alain Labrique: The first one, which is, I think, easier, because for us, digital is the opportunity to put people at the center. When the health experience today, for most people, is extremely fragmented, is extremely discoordinated, and the opportunity, why we’re talking about infrastructure, why we’re talking about interoperability, because we see this as the key to unlock the continuity of care that we’ve talked about for so many years, but without those shared services, without the common language, where the patient is at the center, as the custodian of their own health record, to be able to have them go through that patient journey in a way that’s person-centered, not hospital-centered, or at the convenience of the clinician, but at the convenience of the patient. We look at what the financial sector has done, and nobody has the patience or time to stand in a five-hour queue to access their bank balance. They want banking at their fingertips. The same we’re now seeing post-pandemic is what people expect from health, and that’s what this public infrastructure, interoperability is going to help us achieve. So people are absolutely at the center. It’s the value proposition that drives this forward. It’s not the financial benefits, but it’s the people at the center. So thank you for emphasizing that.

Leah Ekbladh: It was an excellent question. The gentleman in the back corner there.

Questions: Thank you very much. I’m a new physician, and I’ve been for a long time in Africa, and I’m excited to be back in Europe. I was excited to have this initiative, and I’m thinking also, looking at the types of multi-stakeholder, I was trying to figure out where communities would be manufactured, one, because at the end of the day, communities are the end users of these products, and two, we also very much need to kind of of be aware of the sustainability issue, because one, at the end users, then we can also upgrade, modify this digital health tools we’re talking about. And also making sure that success at community level means that success is achieved everywhere. So to what extent are we considering communities when we talk about multi-stakeholders? Thank you.

Leah Ekbladh: Thank you. Yes, we talked a lot about architecture and financing and governance. Where does the community fit in those three pillars? Mathilde, please.

Mathilde Forslund: Yeah, yeah. Great question. Thank you for that. I think that’s actually why we established TransformHealth, because we felt that the end user wasn’t really represented in these conversations. And so TransformHealth is actually an organization of 200 civil society based organizations to bring these communities and the representatives of these communities, whether it’s people living with HIV and AIDS, whether the data and the privacy of the data is being affected, or as we design these systems for the future, their needs and perspectives are heard in that design and architecture. So I concur with you completely. It’s really important. And we do a lot of stakeholder consultations to bring in the end users perspectives in the different dialogues, as we design these systems and architectures and financial mechanisms that we need in order to enable better digital transformation. Thank you.

Nele Leosk: I actually wanted to just comment on some of the questions that had been asked, and maybe also follow up a bit on what Hani was saying, because Hani was giving this picture that you need these three things to have a successful digital society. And I wish it was so simple. But actually, it is not, because we are increasingly seeing misuses. technology and there was a question around the privacy and and all the other issues that come especially with health data that is a sensitive data and and I would actually like to add here actually the importance of a legal framework and and I would say the entire governance mechanism and I think this is a global issue that has also gathered us all here today to discuss global digital compact and I can tell also from Estonian size that despite the facts that we had our privacy regulation we have a since 90s in in place that would also take into account I would say this virtual world we had a very clear data governance mechanism we would know exactly who is responsible for the collection of which data how it can be used how it needs to be shared and so forth but I would say that it was still not enough we really had to show people that their data is used properly so we actually gave the right for every person in Estonia to see what kind of data is being collected by them and how these data was being used of course I don’t see who exactly has seen my data but I but I but I have a log so I can track down if my data has been used so for example if I’m stopped by police I should have a log there that that somebody has checked whether I have the right to drive so this is a very important question actually that was raised considering the world we are currently living.

Leah Ekbladh: Thank you I recognize your hand I’m afraid I’m gonna have to move on but if you want to hold it you see all of our faces I encourage you to find us afterwards I do want to give our last five minutes to mr. Vikram Pagaria he’s the director of IT for the National Health Authority of India.

Vikram Pagaria: Distinguished delegates colleagues and friends it’s an honor to be here today I would like to extend my heartful appreciation to the organizers for putting out this session so well and I also compliment all the speakers who have given us their insights. I’m sure that this session has made us more knowledgeable than we were before this session, at least for me, the talk on architecture. As you may be aware, India had the privilege of launching the global initiative on digital health on August 19, 2023, during its recently concluded G20 presidency. This initiative represents a pivotal step in democratizing digital health technologies, particularly for the global south, and ensuring equitable access to health services through robust digital public infrastructure. India is deeply committed to building equitable digital health systems, placing people at the heart of our efforts. I would like to share one example of our digital public infrastructure, which is the UPI, Unified Payments Interface, which has really revolutionized payments across the country by making it very simple to make payments. Today, Indians no longer need to carry their cards or wallets when they go outside to buy something. With just a smartphone and low data costs, they can transact seamlessly not just in India, but also in other countries like Singapore, France, UAE, Sri Lanka, Mauritius, Bhutan, and Nepal. To date, UPI facilitates over 10 billion transactions per month with 600 banks, which are live on this platform. In health, about 1.9 billion COVID certificates have been issued digitally by India. And I think the The discussion about foundational infrastructure to enable these transactions is very important. In the realm of healthcare, the commitment to use technology to make easy the life of the citizen is the same. India has started early. This is exemplified through the National Digital Health Mission, which was launched in 2021 with an initial outlay of $20 million. This initiative is aimed at enabling creation of digital health records and promoting interoperability. This mission keeps the individual at the center. By being consent-based, it empowers citizens to take charge of their health data. It also has taken into aspects of data privacy by being built on a federated data architecture. That is, the records are stored at the health facilities where they are created, and our architecture only enables the transfer of those records from one health facility to another, when the user, when the patient gives their consent. The ABDM, the ABDM, that is the Digital Mission Framework, aligns closely with GIDH’s mission, further strengthening our commitment to fostering equitable health access. India has pledged $10 million to GIDH to support countries interested in adopting our DPIs. To ensure that India’s digital health journey aligns with global efforts, the adoption of HL7 FHIR standards have been inbuilt within our ecosystem. We are also strongly recommending SNOMED City standards adherence for the various digital health software which are being used in the country. Accessibility. and augmented care coordination is at the heart of our digital health intervention. I would like to give an example of a use case, Ireland’s assistive technology use case was given, but what in our country we have provided to our citizens is that there is a lot of crowding at our public hospitals. So what happens is that the patients are waiting in the registration area, and they have to go to a registration counter, and they have to share what their name is, what their address is, what their mobile number is, and they have to say that, oh, I want to visit a orthopedic. And what happens is that the register counter, they enter all their details, and they give them a slip. What we have done through the QR codes, which are very, very common in our country, is that through any app, there are about 12 apps which are there where the citizen can go, and when they are there near the registration area, they can scan the QR code, and all their demographic details are given to the registered counter, and they get a token, say 42. And when the 42 number token comes, the citizen can go, and they can just say that, oh, I want to go to the orthopedic, or I have a dental ailment, and all the other details that are not required to be collected. So from about the waiting time of about 40 to 50 minutes, we have been able to reduce it to four to five minutes, and about 300,000 people daily use this technology and get quick OBD registrations. Through innovative financing models, we are ensuring that the investments in digital health align with national priorities and contribute to a sustainable country-led transformation. In our country, the level of digitization in health is still. So what we are trying to do is we are working on 100 model facilities project, wherein we are trying to understand the complexities of digitization, and we are focusing on making 100 facilities across the country as end-to-end digitized, so that we learn on this process, and then we will try to use those learnings to digitize the entire health ecosystem. I thank you for your time, for your patience, and I hope it was a good session. Thank you so much.

Leah Ekbladh: I want to thank all of our panelists and our participants, particularly those who offered questions to bring us back to the community. That’s always a great way to end as well. We are only five minutes over, so I’m very proud of myself, but we do have to clear the room for the next session, but I think many of us will be around in the lobby if there’s other questions. Thanks so much.

Agreement Points

Importance of digital public infrastructure (DPI) for health systems

Hani Eskandar

Nele Leosk

Vikram Pagaria

Importance of architecture – DPI enables interoperability, reusability, and trust

Estonia’s example of digital identity and data sharing

India’s Unified Payments Interface as successful DPI example

Speakers agree on the crucial role of digital public infrastructure in enabling efficient, secure, and interoperable digital health systems.

Need for proper governance and legal frameworks

Nele Leosk

Sean Blaschke

Need for governance and legal frameworks to protect data privacy

Role of legislation like Kenya’s Digital Health Act

Speakers emphasize the importance of strong governance mechanisms and legal frameworks to guide digital health transformation and protect data privacy.

Similar Viewpoints

Both speakers highlight the need for significant and coordinated investment in digital health infrastructure and transformation.

Mathilde Forslund

Vikram Pagaria

Current funding for digital health insufficient and fragmented

India’s $20 million investment in National Digital Health Mission

Both speakers emphasize the importance of country-led approaches and embedding digital expertise within government structures for effective digital health transformation.

Lisa Lewis-Person

Sean Blaschke

Need for country leadership and ownership

Rwanda’s e-gov approach with embedded ICT teams

Unexpected Consensus

Importance of assistive technology in digital health

Kylie Shae

Malcolm MacLachlan

Unknown speaker

Large unmet need for assistive technology globally

Digital can help scale up access to assistive technology

Need to involve end users and communities in design

There was an unexpected focus on assistive technology as a key use case for digital health, with multiple speakers highlighting its importance and potential for digital enhancement.

Overall Assessment

Summary

The main areas of agreement include the importance of digital public infrastructure, the need for proper governance and legal frameworks, the significance of country-led approaches, and the potential of digital technologies in enhancing assistive technology access.

Consensus level

There is a high level of consensus among speakers on the fundamental aspects of digital health transformation. This consensus suggests a shared understanding of key priorities and challenges, which could facilitate more coordinated and effective efforts in advancing digital health globally.

Disagreement Points

Approach to digital health transformation

Hani Eskandar

Mathilde Forslund

Importance of architecture – DPI enables interoperability, reusability, and trust

Current funding for digital health insufficient and fragmented

While Eskandar emphasizes the importance of architecture and DPI for digital health transformation, Forslund focuses on the need for better funding and tracking of investments. This suggests a difference in prioritization of technical infrastructure versus financial resources.

Overall Assessment

Summary

The main areas of disagreement revolve around prioritization of different aspects of digital health transformation, such as technical infrastructure, funding, and governance.

Disagreement level

The level of disagreement among the speakers appears to be relatively low. Most speakers present complementary perspectives on digital health transformation rather than conflicting views. This suggests a general consensus on the importance of digital health transformation, with differences mainly in emphasis and approach. These differences could potentially lead to more comprehensive strategies if integrated effectively.

Partial Agreements

Both speakers agree on the importance of digital public infrastructure, but they present different national approaches and focus areas. Leosk emphasizes digital identity and data sharing in Estonia, while Pagaria highlights India’s success with digital payments.

Nele Leosk

Vikram Pagaria

Estonia’s example of digital identity and data sharing

India’s Unified Payments Interface as successful DPI example

Similar Viewpoints

Both speakers highlight the need for significant and coordinated investment in digital health infrastructure and transformation.

Mathilde Forslund

Vikram Pagaria

Current funding for digital health insufficient and fragmented

India’s $20 million investment in National Digital Health Mission

Both speakers emphasize the importance of country-led approaches and embedding digital expertise within government structures for effective digital health transformation.

Lisa Lewis-Person

Sean Blaschke

Need for country leadership and ownership

Rwanda’s e-gov approach with embedded ICT teams

Key Takeaways

Digital public infrastructure (DPI) is crucial for enabling interoperable, reusable, and trustworthy digital health systems

Financing for digital health transformation is currently insufficient and fragmented, requiring better tracking and alignment of investments

Strong governance frameworks and country leadership are essential for successful digital health implementation

Assistive technology represents an important use case that can benefit greatly from digital health infrastructure

Involving end users and communities in the design of digital health systems is critical for adoption and effectiveness

Resolutions and Action Items

WHO and ITU to develop guidance on reference architecture for digital transformation of health systems

Countries invited to join working group on developing reference architecture for digital health

India pledged $10 million to support countries interested in adopting their digital public infrastructure models

Unresolved Issues

How to encourage countries to share sensitive health data across systems for global learning while addressing privacy and security concerns

How to ensure digital health initiatives do not exacerbate existing inequities in access to care

Specific mechanisms for involving communities and end users in digital health system design and implementation

Suggested Compromises

Balancing country-specific digital health solutions with adoption of global standards and interoperable systems

Using existing tracking mechanisms like OECD reporting to measure digital health investments rather than creating new systems

We’ve been very much dominated by what you can call a solution mindset. Basically, I have a problem, I develop an application to solve my solution. There is a huge difference, and this is what we have learned after so many years, even at our agencies. We have discovered that building a solution is not the same as transforming a sector or digitizing a sector.

Speaker

Hani Eskandar

Reason

This comment challenges the prevailing approach to digital health and introduces a more holistic perspective on digital transformation.

Impact

It shifted the discussion from focusing on individual solutions to considering systemic transformation and architecture. This led to further exploration of the importance of digital public infrastructure and interoperability.

Estonia is a great example. What did Estonia do? They solved interoperability through XRoute, they solved the issue of trust by ID, and they solved the issue of reusability by creating those kind of shared and reusable platforms.

Speaker

Hani Eskandar

Reason

This comment provides a concrete example of successful digital transformation, illustrating key principles in action.

Impact

It grounded the abstract discussion in a real-world case study, prompting other participants to consider how these principles could be applied in their own contexts.

We cannot increase what we cannot measure. As long as investment in digital health continues to be wrapped into vertical silos and programming, governments will struggle to identify and strengthen digital public infrastructure for health.

Speaker

Mathilde Forslund

Reason

This comment highlights a critical challenge in digital health transformation and links it to the need for better measurement and tracking of investments.

Impact

It introduced the importance of financial tracking and accountability into the discussion, leading to consideration of how to better align and optimize funding for digital health initiatives.

I believe assistive technology is a really compelling use case for digital public infrastructure. And especially so to be discussed at this summit of the future.

Speaker

Malcolm MacLachlan

Reason

This comment connects the broader discussion of digital infrastructure to a specific and impactful use case, demonstrating the practical implications of the concepts being discussed.

Impact

It shifted the conversation to consider concrete applications of digital health infrastructure, particularly in addressing health equity and access issues.

Overall Assessment

These key comments shaped the discussion by moving it from abstract concepts to practical considerations of digital health transformation. They challenged participants to think beyond individual solutions to systemic change, highlighted the importance of measurement and accountability in funding, and provided concrete examples of successful implementation and impactful use cases. This progression deepened the conversation, making it more nuanced and action-oriented, while consistently emphasizing the need for holistic, interoperable, and equitable approaches to digital health infrastructure.

How can we evaluate end user engagement and adoption of digital health technologies?

Speaker

Nancy Munchen

Explanation

Understanding user adoption is crucial for the success and impact of digital health initiatives.

How can we encourage or incentivize countries to share health data across systems for global learning, especially given concerns about national security and geopolitical tensions?

Speaker

Nancy Munchen

Explanation

Data sharing is essential for global health improvements, but sensitive health data raises concerns that need to be addressed.

To what extent are we considering communities when we talk about multi-stakeholders in digital health initiatives?

Speaker

Unnamed physician

Explanation

Ensuring community involvement is crucial for the sustainability and effectiveness of digital health tools.

How can we strengthen legal frameworks and governance mechanisms to protect privacy and prevent misuse of health data?

Speaker

Nele Leosk

Explanation

Robust legal and governance structures are necessary to build trust and ensure proper use of sensitive health data in digital systems.