WSIS Action Line C7 E-health Building Health Systems Resilience and Local Capacity through Digital Foundations, Learning and Partnerships (WHO)

Derrick Muneene highlighted that the eHealth action line has undergone a 20-year review, demonstrating significant progress across multiple dimensions. This includes advances in technology, the adoption of standards such as open source software, and the formation of various collaborative partnerships.

The 20-year review was discussed at the UN General Assembly in December, where progress in technology, use of standards including open source software, and the formation of partnerships such as the Global Initiative on Digital Health and the Principles of Digital Development were noted . The evolution timeline spans from the original WSIS establishment through to the Global Strategy on Digital Health, encompassing three surveys, three resolutions, one strategy, and three initiatives .

Despite progress, Derrick Muneene identified several persistent challenges that continue to hinder the full implementation of the eHealth action line. These include technical challenges around interoperability and infrastructure, as well as human capacity and regulatory gaps.

Muneene summarised these ongoing challenges as a key area of concern, listing interoperability, infrastructure, limited skills for health workers, and regulations as the primary obstacles .

Muneene expressed anticipation that the rise of AI and other emerging technologies will significantly enhance the implementation of the eHealth action line in the future. He also identified key thematic areas including digital public infrastructure and evolving collaboratives as priorities going forward.

He stated that the rise of AI and other emerging technologies is anticipated to amplify the implementation of the action line , and identified digital public infrastructure, opportunities around emerging technologies, and evolving collaboratives as key thematic areas .

Manish Pant argued that digital health cannot succeed as a standalone programme and must be integrated into broader government plans. The WSIS mechanism is uniquely positioned to convene ministries of health alongside other relevant ministries and partners to align efforts around a shared national vision.

He noted that digital health depends on ministries of ICT, digital transformation, finance, telecommunications, and public administration, as well as partners like health practitioners, civil society, and academia, who often pursue the same national objectives through separate programmes . UNDP contributes by working across different ministries and stakeholders to align them around a national vision for digital health transformation rather than disconnected initiatives .

Pant argued that digital health is still too often approached as a collection of individual software applications rather than as an integrated system. He emphasised that foundational digital public infrastructure, trusted data systems, and clear governance must be established first to enable the safe and responsible adoption of newer technologies like AI.

He observed that countries still approach digital health as a collection of individual software applications, and stressed the need for interoperable digital public infrastructure, trusted data systems, and clear governance mechanisms and regulations as prerequisites for safely adopting AI .

Pant illustrated through UNDP's work in Indonesia that investing in strong digital foundations allows systems to evolve and extend beyond their original purpose. He further argued that when these foundations are inclusive, they also contribute to reducing health inequalities.

He cited UNDP's work on the SMILE platform in Indonesia, which started as a vaccine management system but evolved into a digital public infrastructure for medical logistics, demonstrating that strong digital foundations can extend to other health priorities . He also noted that inclusive foundations help address health inequalities .

Hani Eskandar acknowledged the significance of the WHO-ITU effort to establish a reference architecture for digital health public infrastructure. However, he cautioned that publishing such architecture alone does not close the gap between global standards and actual country-level implementation.

He drew on experience from other sectors to note that a reference architecture is an important milestone but not enough, as countries still face a huge implementation gap when trying to put it into practice . He highlighted that sustainability requires local companies capable of delivering and building health solutions following the architecture .

Eskandar argued that training alone is insufficient to build the capacity of local companies to implement digital health architectures. He proposed that linking capacity building to procurement processes creates a tangible business incentive that motivates local companies to invest in developing their own skills.

He explained that if local companies do not see a business opportunity, they will not invest, and therefore training must be tied to clear business opportunities through procurement processes . He noted that companies that see a requirement to deliver on the architecture will make the effort to build their skills or partner with others .

Eskandar identified two additional priorities beyond procurement linkages: creating reference implementations as concrete examples of how complex health standards can be applied, and leveraging AI to augment the capacity of local companies. He noted that health standards such as FHIR and ICD-11 are particularly complex and require practical examples to be accessible.

He stressed the need for a reference implementation - a model showing how complex specifications like FHIR standards and ICD-11 can be applied - because without such an example, companies will find it very difficult to adopt these standards . He also highlighted ITU's work on using AI to enable integration as an example of how AI can augment company capacity .

Melissa Jenny Cederqvist Njihia described the Global Initiative on Digital Health as a WHO-hosted network created in response to the need for greater alignment and harmonisation in the digital health space. The network has grown to 90 institutional members distributed across government, non-profit, and private sectors.

She noted that GIDH was established in 2024 to address the need for alignment, harmonisation of efforts, prioritisation of country needs, and collaborative support for digital health . Since its establishment, the network has grown to 90 institutional members, with most representation from government and non-profit sectors, and only three private sector members so far .

The third global convening of GIDH brought together 304 participants from 54 countries and 123 institutions in a hybrid format, demonstrating the platform's continued relevance. The convening facilitated knowledge exchange and the co-development of a shared work plan among members.

The convening had 54 countries represented, 304 participants, and 123 institutions participating, with wide representation across both in-person and online formats . A members-only day allowed members to co-develop the GIDH work plan, which will be harmonised into a co-designed plan to advance collective efforts .

Cederqvist Njihia reported that a recurring theme at the GIDH convening was the necessity of political will to achieve strong digital health governance. Without political commitment at the highest levels, advancing digital health with robust governance structures is extremely difficult.

She noted that the importance of political will for strong digital health governance was frequently discussed at the convening, with Kenya's establishment of a Digital Health Act cited as a concrete example of political commitment translating into governance action .

Cederqvist Njihia highlighted that ensuring inclusiveness was a frequently discussed issue at the GIDH convening, with particular emphasis on youth, women, and other marginalised groups. A framework for digitally enabled health was also launched in this context.

She reported that the issue of inclusiveness - ensuring that youth, women, and other marginalised groups are included - was frequently discussed at the convening, and that a framework for digitally enabled health was launched .

Andrew Kashoka drew on Zambia's experience as the first GIDH first-mover country to argue that technology is not the primary driver of successful digital transformation. Instead, governance structures, multi-stakeholder partnerships, human capacity, and strong country ownership are the critical success factors.

He stated that Zambia's experience as the first GIDH first-mover country reinforced the lesson that successful digital transformation is not primarily about technology but about governance, partnerships, capacity, and country ownership . Zambia's national digital health strategy, based on the seven digital health building blocks from the WHO-ITU National eHealth Toolkit, provided a clear vision for an integrated, interoperable, and people-centred digital health ecosystem .

Zambia undertook a digital health maturity assessment with support from WHO and the Commonwealth, which provided an evidence-based understanding of the country's strengths and critical gaps. This assessment became an important reference point for national planning and investment prioritisation.

The maturity assessment, conducted with support from WHO and the Commonwealth, gave Zambia evidence-based understanding of its strengths and identified critical gaps that helped prioritise investments, serving as an important reference point for national planning .

Kashoka highlighted Zambia's use of the WHO Digital Health Atlas as a tool for documenting and assessing digital health implementation across the country. This tool proved valuable in improving transparency, reducing duplication of efforts, and enhancing coordination among the many partners involved.

He noted that Zambia has actively utilised the WHO Digital Health Atlas to document and assess digital health implementation across the country, which improved visibility of ongoing investments, reduced duplication, and strengthened coordination among implementing partners .

Kashoka emphasised that digital transformation is ultimately about people, and that Zambia has placed significant emphasis on digital health literacy and workforce capacity development. Without investing in the people who will use digital tools, technology investments cannot achieve their intended impact.

He stated that Zambia has placed significant emphasis on digital health literacy and workforce capacity development, and that through GIDH and WHO, health professionals and national stakeholders have benefited from digital health training programmes strengthening competencies required to plan, govern, implement, and sustain digital health initiatives . He stressed that when you invest in technology, you need the people to utilise these tools .

Kashoka concluded by affirming that Zambia's experience demonstrates that meaningful digital transformation is not only possible but achievable when countries take ownership and partners align their support behind national priorities. He expressed hope that Zambia's experience as a first-mover country could encourage others.

He stated that the Global Initiative on Digital Health has shown that when countries lead and partners align behind national priorities, meaningful digital transformation is not only possible but achievable . He also noted that Zambia's participation in the third global GIDH convening reaffirmed that countries around the world are ready to invest in digital health and that peer learning and coordinated technical assistance accelerate implementation .

Katia Pinto argued that government-led partnerships like the Global Digital Health Partnership play a unique role in digital health transformation by bridging the gap between national ownership and global alignment. This bridge is essential for helping countries translate their national strategies into actual delivery of digitally-based health systems.

She described GDHP as a government-led partnership with 44 countries and WHO as a founding member, whose specific role is to provide a bridge between national ownership and global alignment . She noted that GDHP was created because countries understand that digital public infrastructure is key to advancing health systems digital transformation and achieving health for all .

Pinto emphasised that digital public infrastructure is not merely a technical concept but encompasses a broad range of governance and regulatory dimensions. GDHP members recognise that a secure and functional digital foundation requires addressing governance, digital identity, cybersecurity, and the rules under which digital services operate.

She stated that GDHP members understand that digital public infrastructure is not only a technical concept, and that the foundation needed for people and professionals to connect securely involves governance, digital identity, cybersecurity, and rules for digital services to operate .

Pinto argued that government-to-government networks like GDHP create a trusted environment where countries can learn from each other's practical experiences without simply copying solutions. This peer learning approach helps reduce fragmentation in global digital health efforts while still respecting each country's national context and sovereignty.

She described GDHP as creating a trusted space for governments to learn from each other - not about copying national solutions but about learning what has worked in different countries facing similar challenges such as scaling digital services, governing health data, ensuring interoperability, and avoiding vendor lock-in . She noted that through shared principles and peer learning aligned with international standards, government-led networks support a more coherent approach to digital public infrastructure development that still respects national sovereignty .

Pinto argued that the private sector has a vital and complementary role in digital health transformation, particularly in developing and maintaining technology that governments cannot fulfil on their own. The roles of government and private sector are distinct but mutually reinforcing, with government ensuring public interest and the private sector driving innovation.

She stated that partnerships between government and private sector are needed to advance digital transformation, with the government's role being to ensure the public interest and the private sector's role being to advance and innovate with digital solutions that allow health systems to thrive . She cited many successful public-private partnerships across GDHP member countries in areas such as standards, AI solutions, digital systems, and basic infrastructure .

Aferdita Bytyqi argued that young people's relationship with digitally-enabled health systems and AI is fundamentally different from that of older generations, and this difference must be recognised. Rather than treating young people as passive users of digital systems, they should be empowered as decision-makers in shaping healthcare transformation.

She noted that young people are growing up in a way most people in the room never did, and their relationship with digitally-enabled health systems and AI is fundamentally different from how it is assumed to be . She argued that this requires a shift from passive recipients to decision-makers in healthcare transformations .

DTH Lab conducted extensive research with young people across the globe to understand what digitally-enabled health systems should look like from a youth perspective. Despite diverse contexts and experiences, young people consistently identified four core values that should underpin digital health governance.

Over three years, DTH Lab worked with over 600 young people across 80 countries through workshops and focus groups to explore what digitally enabled health systems should look like from a youth perspective . Despite different contexts and experiences, young people consistently highlighted four core values: trust, equity, inclusion, and accountability . These values were also echoed at the UN Global Dialogue on AI Governance plenary .

Bytyqi made a concrete call to action for WSIS, GIDH, ITU, and national governments to embed youth co-design as a structural requirement in digital health and AI governance frameworks. She argued that meaningful inclusive digital transformation requires youth participation to be built into processes from the outset rather than added as an afterthought.

She made a direct ask to WSIS, GIDH, ITU, and national governments that as they move from strategy to implementation, youth co-design should be made a standing structural requirement in digital health and AI governance frameworks, not an afterthought .

Based on the research with young people, Bytyqi identified four specific governance priorities that young people consistently highlighted. These priorities reflect young people's desire for digital health systems that protect their wellbeing, include them meaningfully, reduce inequalities, and preserve the human dimension of care.

Young people identified four governance priorities: mental health safeguards addressing the impacts of digital environments on mental health and well-being; meaningful co-design embedded through policy, design, and implementation processes rather than one-off consultations; equity and inclusion to reduce rather than exacerbate inequalities; and hybrid approaches where technology strengthens services while preserving human relationships, trust, and care .

Sophie Delaigue acknowledged that academia's traditional role of generating evidence through studies and publications remains valuable. However, she argued that the sheer volume of evidence — including contradictory results — has itself become part of the problem for decision-makers who need clear, actionable insights, especially in a context of scarce funding.

She used the image of a funnel to describe the landscape, noting that at the top there are hundreds of projects, stakeholders, and tools, and that decision-makers face a flood of papers with contradictory results . She noted that with scarce funding, decision-makers cannot afford to fund new pilots that will be discontinued like previous projects, making actionable evidence more critical than ever .

Delaigue argued that beyond generating new evidence, academia plays a crucial role in organising and synthesising what already exists. She cited the Digital Health Atlas, developed in collaboration with WHO, as an example of how academia helps map the digital health landscape to identify reusable and scalable solutions.

She described the Geneva Digital Health Hub's collaboration with WHO on the Digital Health Atlas as an example of academia organising existing evidence to understand which tools meet interoperability standards, have been evaluated, have generated evidence, and are still . This was also referenced by Andrew Kashoka from Zambia as a tool that has helped improve visibility of investments and reduce duplication .

Delaigue described a third role for academia at the bottom of the funnel: supporting decision-making by bridging implementation, evidence, and policy. Through tools like the Digital Health Atlas, academia collects implementation data, learns from those who implement, and produces policy briefs tailored to policymakers' needs.

She described how the Digital Health Atlas, in collaboration with WHO, is used not only to map what exists but also to use implementation data to learn from implementers, gather their challenges and insights, and produce policy briefs - documents made for policymakers - to better inform policy decisions .

Dr. Andrew Kashoka argued that AI models in healthcare must be trained on data that accurately reflects the specific disease conditions of the region in which they will be used. He highlighted that disease conditions vary significantly even within sub-Saharan Africa, making regionally representative historical data essential for effective AI models.

He noted that in sub-Saharan Africa, disease conditions may vary from the east, west, and north of the continent, and therefore AI models must be trained on historical data reflecting the disease trends of the specific region . He also raised the question of how WHO regional offices - such as WHO Africa and WHO Europe - can compare data sets and contextual factors to ensure models are appropriate for their environments .

Kashoka emphasised that the physician must remain central to AI-assisted healthcare, even as AI models are developed and deployed. He argued that AI models must be continuously trained and validated over time within their specific clinical environments to ensure they are satisfactory and safe.

He stated that the physician is very critical even as AI models are built, and that models need to be trained over time for us to know that they are satisfactory . He also noted that providers will make decisions based on the environment they are in, underscoring the importance of context-specific validation .

Melanie Bertram outlined the purpose and agenda of the session, framing it as an opportunity to demonstrate how the WSIS eHealth action line is being implemented in practice. The session was designed to cover multiple dimensions of digital health progress, from global initiatives to country-level experiences.

She stated that the plan for the session was to talk through how implementation is happening, specifically by showcasing outcomes of the third global convening of GIDH, highlighting country experiences, promoting alignment, strengthening partnerships, and identifying priorities .

Melanie Bertram clarified the institutional home of the WSIS eHealth action line implementation within WHO, identifying the specific unit responsible and its collaborative relationship with ITU. This framing established the organisational context for the entire session.

She introduced herself as the unit head of the Insight Capacity and Operation Unit of the Department of Data, Digital Health, Analytics and Artificial Intelligence at WHO, and noted that this unit houses the implementation of the WSIS eHealth action line in collaboration with ITU .

Bertram drew attention to a newly published randomised control trial examining AI models in clinical care, suggesting it had significant implications for understanding how AI can and should be used in health settings. She encouraged all attendees to review the findings.

She mentioned that the first randomised control trial of AI models in clinical care had recently been published in Nature Medicine, noting it had very interesting conclusions about the utility of AI in the clinical setting, and encouraged all attendees to check it out .