WSIS Action Line C7: E-health – Fostering foundations for digital health transformation in the age of AI

Summary

This discussion focused on the role of eHealth in fostering digital transformation foundations in the age of AI, moderated by Dr. Derrick Muneene from WHO within the WSIS framework. The session highlighted WHO’s 20-year collaboration with ITU to promote equitable use of ICTs in health, beginning in 2005 with the WSIS framework establishment. Dr. Muneene outlined WHO’s Global Strategy on Digital Health, which aims to achieve universal health coverage through digital means while addressing four key objectives: capacity building, ensuring countries have strategies, fostering governance, and achieving people-centeredness.

Hani Eskandar from ITU presented the concept of Digital Public Infrastructure (DPI) as a solution to the persistent problem of fragmentation in digital health systems. He emphasized the need to shift from a solution mindset to an infrastructure mindset, focusing on enabling information flow through trust and interoperability rather than developing isolated vertical solutions. The DPI approach involves establishing minimum capabilities and building blocks that can be shared across health systems, including electronic health records, supply chain management, registry services, and insurance claims processing.

Regional perspectives were provided by panelists from Africa, Asia, and WHO programs. Steven Wanyee from HELENA discussed Kenya’s “digital health superhighway” initiative, which uses electronic claims as a driver for DPI investment through social health insurance contributions. Surabhi Joshi presented the Be Healthy, Be Mobile 2.0 initiative, focusing on digital wallets and health credentials for non-communicable diseases. Jai Ganesh from the Asia eHealth Information Network emphasized the importance of multi-sectoral coordination and convergence approaches in implementing national digital health strategies.

The discussion concluded with audience questions addressing AI governance, multi-stakeholder engagement, and the need for continued international collaboration to transform health sectors sustainably.

Keypoints

## Major Discussion Points:

– **Digital Public Infrastructure (DPI) for Health Transformation**: The shift from fragmented, vertical health solutions to integrated digital infrastructure that enables information flow across health sectors. This includes establishing foundational building blocks like electronic health records, supply chain management, registry services, and insurance claims systems that can interoperate seamlessly.

– **The “Pilotitis” Problem and Need for Systematic Approach**: Addressing the persistent issue of numerous disconnected pilot projects and experimental digital health solutions that lack integration and sustainability. The discussion emphasized moving from a “solution mindset” to an “infrastructure mindset” with government ownership and strategic planning.

– **WHO’s 20-Year Journey and Global Strategy on Digital Health**: Celebrating two decades of WHO’s work in supporting member states’ use of ICTs in health, from the 2005 resolution through the current Global Strategy on Digital Health aimed at achieving universal health coverage by 2030.

– **Country-Specific Implementation Examples**: Real-world applications including Kenya’s “digital health superhighway” using electronic claims as a driver, digital wallets for non-communicable diseases, and regional approaches in Asia and Africa for scaling digital health infrastructure.

– **Multi-Stakeholder Collaboration and Governance Challenges**: The critical need for cross-sector coordination between health, telecommunications, and other government ministries, along with addressing regulatory gaps as technology advances faster than governance frameworks, particularly regarding AI in healthcare.

## Overall Purpose:

The discussion aimed to build awareness of WHO and ITU’s collaborative work in fostering foundations for scalable digital health systems within the WSIS framework. The session focused on promoting the Global Initiative on Digital Health and demonstrating how digital public infrastructure can enable sustainable health sector transformation in the age of AI, ultimately supporting the achievement of universal health coverage and health-related SDGs by 2030.

## Overall Tone:

The discussion maintained a professional, collaborative, and forward-looking tone throughout. It began with formal presentations establishing the technical and strategic framework, then evolved into more interactive dialogue with practical examples and country experiences. The tone remained consistently optimistic about the potential for digital transformation while acknowledging real challenges like fragmentation and governance gaps. The session concluded on an encouraging note with calls for continued collaboration and concrete next steps, including upcoming meetings and working groups.

Speakers

– **Derrick Muneene**: Dr. Derrick Muneene from WHO (World Health Organization), Head of Capacity Building and Partnerships, Session Moderator

– **Hani Eskandar**: Mr. Hani Eskandar, works with ITU, focuses on Digital Public Infrastructure (DPI) and reference architecture for digital health

– **Steven Wanyee**: Mr. Steven Wanyee from Kenya, President of HELINA (Health Informatics in Africa), an organization representing more than 20 African countries focused on professionalizing health informatics and digital health

– **Surabhi Joshi**: Surabhi Joshi, Technical Officer at World Health Organization in Geneva, works on digital health and non-communicable diseases, part of the Be Healthy, Be Mobile initiative (joint WHO-ITU initiative)

– **Innocent Chiboma**: Mr. Innocent Chiboma from the Zambian Ministry of Health

– **Jai Ganesh**: Dr. Jai Ganesh from Asia eHealth Information Network (AIHIN), a regional digital health network working on governance, architecture, people and program management, standards and interoperability

– **Audience**: Multiple audience members who asked questions and made comments during the session

**Additional speakers:**

– **Ibrahim**: Director of the Digital Health Department from Senegal

– **Edna Somra**: Works for SPIDER (Center of Enablement for Inclusive Digital Development), leading a Team Europe initiative with telecom regulators in 43 African countries

– **Sanya**: Representative of an AI-based health system solutions provider

– **IT for Change representative**: From a non-profit organization in India that does research and public policy advocacy

# Comprehensive Discussion Report: eHealth’s Role in Digital Transformation Foundations in the Age of AI

## Executive Summary

This comprehensive discussion, moderated by Dr. Derrick Muneene from the World Health Organisation (WHO), examined the critical role of eHealth in fostering digital transformation foundations within the World Summit on the Information Society (WSIS) framework. The session brought together international experts from WHO, the International Telecommunication Union (ITU), regional health informatics networks, and country representatives to address the persistent challenges of fragmentation in digital health systems and explore solutions through Digital Public Infrastructure (DPI) approaches.

The discussion highlighted WHO’s two-decade collaboration with ITU to promote equitable use of information and communication technologies (ICTs) in health, beginning with the 2005 WSIS framework establishment. Central to the conversation was the shift from fragmented “pilotitis” solutions to comprehensive digital public infrastructure that enables interoperability and sustainable digital health transformation.

## Background and Context

### WHO’s 20-Year Journey in Digital Health

Dr. Derrick Muneene opened the session by contextualising WHO’s extensive work within the WSIS framework, beginning in 2005 with foundational member state resolutions. This collaboration has evolved through multiple mandates, including standardisation and interoperability initiatives in 2013 and the comprehensive digital health mandate established in 2018.

The Global Strategy on Digital Health represents the culmination of this work, incorporating four fundamental principles that Dr. Muneene outlined: government ownership of digital health initiatives, implementation of appropriate digital tools, achievement of universal health coverage, and contribution to health-related Sustainable Development Goals (SDGs). The strategy aims to address persistent challenges in digital health implementation while ensuring equitable access to health services.

### The Challenge of “Pilotitis”

A central theme throughout the discussion was the problem of “pilotitis” – the excessive fragmentation and verticalisation of digital health solutions. Dr. Muneene identified this as a persistent issue first recognised in 2012-2013, where numerous disconnected pilot projects lack integration and sustainability. He referenced Gates Foundation research from 2022 showing that despite significant investment in digital solutions across Africa, the impact has been limited due to this fragmentation.

This fragmentation results in duplicated investments, incompatible systems, and limited scalability, ultimately hindering the transformative potential of digital health initiatives.

## Digital Public Infrastructure: A Paradigm Shift

### Conceptual Framework

Mr. Hani Eskandar from ITU presented the concept of Digital Public Infrastructure (DPI) as a fundamental solution to the fragmentation problem. He emphasised a critical paradigm shift from a “solution mindset” to an “infrastructure mindset,” arguing that true digital transformation requires enabling information flow through trust and interoperability rather than developing isolated vertical solutions.

Eskandar’s key insight was that “digital is data,” and without the ability to unlock data flow, organisations cannot leverage the full impact of digital transformation. This perspective reframes the entire approach to digital health, moving from solving individual problems to creating foundational infrastructure that enables comprehensive sector transformation.

### Technical Architecture and Building Blocks

The DPI approach involves establishing minimum capabilities and building blocks that can be shared across health systems. Eskandar outlined five key building blocks that WHO and ITU are developing:

1. **Electronic Health Records**: Comprehensive patient data management systems

2. **Supply Chain Management**: Digital systems for medical supplies and pharmaceuticals

3. **Registry Services**: Population and health facility registries

4. **Claims/Insurance Claims Processing**: Digital systems for health financing

5. **Foundational DPI Components**: Digital identity, e-signature, and trusted information exchange services

Eskandar mentioned that ITU is working on the GAFSTAC project to develop foundational DPI specifications, recognising that transformational health use cases cannot operate in isolation but must connect with underlying digital public infrastructure.

## Regional Perspectives and Implementation Examples

### African Experiences

#### Kenya’s Digital Health Superhighway

Mr. Steven Wanyee from the Health Informatics in Africa (HELENA) network presented Kenya’s innovative approach to DPI implementation through their “digital health superhighway” initiative. This programme demonstrates how countries can leverage domestic financing for digital health infrastructure, using social health insurance contributions to fund DPI development.

The Kenyan model uses electronic claims processing as the primary driver for DPI investment, recognising that this creates a compelling business case for continued investment in digital health infrastructure.

#### Zambian Strategic Approach

Mr. Innocent Chiboma from the Zambian Ministry of Health briefly described his country’s systematic approach, noting that Zambia is conducting a mid-term review of its digital health strategy and developing a comprehensive digital health architecture document that will be shared with stakeholders.

#### Regional Capacity Building Through HELENA

HELENA, representing more than 20 African countries, focuses on professionalising health informatics and digital health across the continent. The organisation promotes workforce capacity development and knowledge sharing, recognising that successful digital health transformation requires skilled human resources capable of managing and maintaining these systems.

### Asian Regional Network Approach

Dr. Jai Ganesh from the Asia eHealth Information Network (AIHIN) outlined their comprehensive approach to supporting countries through four main areas: governance, architecture, people management, and standards and interoperability. He announced that AIHIN’s upcoming annual general meeting would focus on “investing in DPI for person-centred health,” demonstrating the regional commitment to moving beyond fragmented solutions towards integrated infrastructure approaches.

## Innovative Approaches and Emerging Solutions

### Digital Wallets and Health Credentials

Ms. Surabhi Joshi from WHO presented the Be Healthy, Be Mobile 2.0 initiative, which focuses on digital wallets and health credentials for non-communicable disease management. She explained that digital wallets serve as secure interfaces that enable individuals to access and share verifiable health credentials while protecting privacy and giving people ownership of their health management.

The initiative aligns with the Global Digital Health Certification Network, which enables countries to verify health credentials across borders. Joshi emphasised that the initiative develops digital blueprints for public digital infrastructure using open standards and open source tools, ensuring that solutions can be adapted and scaled across different country contexts while maintaining interoperability.

She announced that the Be Healthy, Be Mobile 2.0 initiative would be relaunched in September during the UN General Assembly in New York.

## Audience Interventions and Multi-Stakeholder Perspectives

### Capacity Building and International Support

Ibrahim from Senegal raised concerns about the absence of regular WHO-ITU training meetings for countries over the past 1-2 years, highlighting gaps in capacity building support that countries have been expecting. This intervention pointed to the need for sustained international collaboration and support mechanisms beyond strategy development.

### Cross-Sectoral Coordination Challenges

Ms. Edna Somra from SPIDER highlighted practical challenges in multi-stakeholder engagement, particularly in getting telecommunications regulators to engage with health champions. She noted that many digital health initiatives fail because they don’t adequately involve the telecommunications sector that enables data sharing, especially across regional boundaries.

### Rights-Based Approaches and Governance

A representative from IT for Change introduced critical perspectives on equity and governance, emphasising the need to translate bioethics principles and right to health concepts into digital health governance frameworks. This intervention highlighted concerns about ensuring that DPI approaches don’t inadvertently create new barriers to health services or concentrate power in ways that undermine health equity.

### AI Integration and Governance

Sanya, an AI solutions provider, asked about how artificial intelligence fits into the DPI workflow and governance frameworks. The discussion addressed growing concerns about AI governance in healthcare settings, with WHO having published comprehensive guidance on ethics and governance of AI for health. However, participants noted that many countries lack specific AI governance laws, creating challenges for health sector implementation of AI technologies.

## Key Themes and Takeaways

### Government Leadership and Sustainability

Throughout the discussion, speakers consistently emphasised that government ownership and leadership are essential for sustainable and scalable digital health implementations. This represents a shift away from donor-dependent, partner-led approaches that have characterised many previous initiatives.

### Standards and Interoperability

There was strong agreement on the critical importance of establishing common standards and ensuring interoperability across digital health systems to enable effective information sharing and system integration.

### Multi-Sectoral Collaboration

The discussion revealed the critical need for collaboration across sectors, particularly between health ministries and telecommunications regulators, to ensure that digital health initiatives are properly integrated with broader digital government strategies.

## Next Steps and Future Initiatives

Dr. Muneene announced a five-day virtual convening the following week, with registration details provided to participants through a QR code. This global initiative on digital health represents continued collaboration between WHO, ITU, and country representatives in advancing digital health transformation.

The discussion also established the framework for technical working groups focused on developing specifications for the five key building blocks of health DPI, indicating ongoing collaboration in translating conceptual frameworks into practical implementation guidance.

## Conclusion

This comprehensive discussion demonstrated significant progress in understanding digital health transformation challenges and solutions across diverse stakeholders and regions. The strong focus on moving from fragmented solutions to Digital Public Infrastructure approaches represents a fundamental paradigm change that addresses long-standing problems of “pilotitis” and system fragmentation.

The WHO-ITU collaboration, now in its twentieth year, has successfully built shared understanding across regions and stakeholder groups. The next phase of this work focuses on translating this understanding into practical implementation support for countries, with particular attention to the technical working groups and capacity building initiatives outlined during the discussion.

As the health sector continues to grapple with opportunities and challenges presented by artificial intelligence and other emerging technologies, the foundations established through this collaborative work will be essential for ensuring that digital health transformation contributes to universal health coverage and health equity goals.

Derrick Muneene: Good afternoon, everyone. Thank you so much for joining us. My name is Dr. Derrick Muneene. I’ll be moderating this session on Action Line eHealth within the WSIS framework. It’s my pleasure to also introduce the four-man panel that will be taking the floor after me. Let me just introduce the topic. We’ll be discussing the role of eHealth in as far as fostering foundations for digital transformations is concerned in the age of AI. And the purpose of this particular session is to really build awareness on our work as WHO with the ITU in terms of fostering foundations that enable the scaling of digital health systems and tools. So I’m Dr. Derrick Muneene, once again from WHO, and I am head of capacity building and partnerships. I’m joined by Mr. Hani Eskandar, who introduced himself. There will be four speakers in this session, and we hope we can have a good dialogue. Mr. Innocent Chiboma from the Zambian Minister of Health. Mr. Steven Wanyee, who is to my left, who is president of a network on informatics in Africa called Helina. And we’ll also be joined with Surabhi Joshi from the World Health Organization. And lastly, online from Mr. Jay Ganesh. We hope we can have a good 45 minutes or so together in discussing this topic. Allow me to just introduce what we’ll be dealing with. So from the World Health Organization’s perspective, we have worked with the WSIS platform with the ITU to ensure the equitable use of ICTs in health. And as you know, health affects all of us. We are all part and parcel of the health system’s delivery. And so member states gave us a 20-year cycle of supporting the transformation of the health sector. We’re actually pleased to be celebrating the 20 years of and the 20 years of WHO in supporting member states on the use of ICTs in health. We actually started in 2005, the same year that the WSIS framework was actually put in place. And so our member states gave us a resolution on the use of ICTs in health in 2005. This was complemented by another action in 2013 that was around standardization and interoperability. And then finally in 2018, our member states gave us another mandate of an encompassing mandate called digital health that gave birth to an implementation arm called the Global Strategy on Digital Health. And all these mechanisms are really intended to help achieve the SDGs, the health-related SDGs by the 2030 Agenda. Just to recap, as has been discussed throughout this forum, the role of digital is to ensure equitable access to services, whether it’s health, education or agriculture. And so the vision that member states gave us on the Global Strategy on Digital Health is really around achieving universal health coverage by using digital means and modalities. There are principles that we have put in place or otherwise member states have put in place in achieving of this particular strategy. They include government ownership. They include the whole issue of ensuring that their strategy is put in place to inform the implementation of strategies. They also include the whole issue of ensuring that we have appropriate digital tools that are fit for purpose and contextualize as appropriate. There is also a dimension that deals with making sure that our needs of countries are assessed and addressed appropriately. There are four objectives or four points on the strategy, which include capacity building, the whole issue of ensuring each country has a strategy, fostering governance, and at the same time, ensuring that we are using digital to achieve the people-centeredness that we’ve talked about. Now, we just came out of an exciting set of two meetings. We did have our executive board. and the Information Society. It sort of recognizes the existence of this particular framework. Now, in terms of the current issues that we see as opportunities, we realize that countries get the use of digital health in the health sector. The biggest challenge that we see coming up is that the technology is moving so fast that the regulations, as you’d expect, are sort of lagging behind. And with the ease of developing digital solutions, we are seeing a lot of fragmentation. And so this particular diagram you see is a research that the Gates Foundation had conducted in 2022, assessing the state of digital solutions and integration in the African region. The findings here basically were that there were so many pilots, so many experiments that were being conducted. And by the way, this 2022 research is not different from what we saw earlier in about 2012, 2013, where Sean Blaschke, our colleague in UNICEF, also conducted an observation of digital implementation in Uganda, where they discovered the same fragmentation. We then called it pilotitis during that time. So we see that the issue of pilotitis or verticalization is still with us, especially in this age of AI, where digital solutions can be built quite rapidly without a holistic approach. And so we recognize that the global digital compact has a call towards investing in foundations like we heard today from Tanzania. Tanzania got a So, let’s start with the first question. What is the transformation of the health sector holistically? There are four points. A, what are country needs and gaps, as it was discussed in the Global Studies and Digital Health? And how can we match these needs to available resources from developing partners? And the foundational question is, over the past 20 years, WHO has given a lot of guidance in this area. How do we ensure that we can guide countries in those tools that are needed for them to achieve the transformation they’re looking for? And then lastly, convergence at the global, regional, and national level, such as this area, to have some knowledge exchange activities. The Global Initiative on Digital Health is a way for us to engage with different partners. And just to point out that there are three points, transparency, DPIs, which is what my colleague, Mr. Hani Eskandar, will be talking about, focusing on those foundations, and also making sure that we have, we strengthen the equitable deployment of the transformation of the health that we’re looking at. These are the three points of the Global Initiative on Digital Health, which we’re using as a vehicle to… implement our option line on e-health to ensure that there’s a robust sustainable transformation of the health sector. The second bullet is what the speakers will be speaking about. What’s digital public infrastructure? How can we use this digital public infrastructure agenda to ensure that country implementations on digital health are sustained, whether these be telemedicine, electronic medical record systems, e-learning and et cetera? How do we ensure that they sit on foundations to foster sustainability? I’ll just flash some of the achievements global initiative has enhanced. We have created an avenue to track country requests and that’s still work in progress. That’s based on pillar number one. And then based on the second pillar, we have had a number of convenings like this one. There’ll be another one happening next week for five days on the global initiative on digital health. This is really around ensuring that there’s knowledge exchange and that partner needs are being mapped. We have also ensured that tools such as the global digital health monitor are available for countries to monitor their progress on the transformation, including a database of digital health solutions. We also have ensured that countries have a strategy on digital health. As we speak, more than 129 countries have posted digital health strategies globally. They still work to be done to make sure that these are implementable. Also to just point out that as we look at the remaining gaps in the maturity of countries, people skills still remain to be a gap. And so that’s one area that we hope we can actually emphasize. And then to just speak to the whole issue of country focus, we are working with Zambia and Bangladesh and you hear from Zambia on ensuring that we have tangible results from these two countries. I’ll just pause on this slide. We do have a five day meeting, which is virtual. We invite you all to join us for five days next week. And that’s the QR code. And this particular second convening is intended to bring this agenda we’re discussing today.

Hani Eskandar: Thank you very much, Derrick. By the way, I sent you the presentation, if you can…

Derrick Muneene: Okay, so we just change gears here.

Hani Eskandar: Yes. Okay, so I will really focus on one of the things that is very much in line with the global digital health strategy of WHO around the concept of digital public infrastructure. For those who are from the digital community, you will definitely know that DPI or digital public infrastructure is an emerging kind of focus, though it is not new. But I think it gained with particularly the G20 of India, like two years ago, a significant interest. And it’s essentially started in the area of digital governance. But I think now other sectors, including health, are now trying to understand how they can embrace the concept of digital public infrastructure. In that sense, we started with WHO recently, a work to establish a reference architecture for this digital public infrastructure, with all the kind of relevant standards that are important for the health sector digital transformation. So let me maybe just guide you to give you a little bit of information about what is this kind of reference architecture. As Derek mentioned, the health, digital health has been suffering from this kind of fragmentation, siloing, vertical solutions that are really focusing on one particular issue, on one particular problem. I think now all the sectors are moving towards a broader concept of digital transformation for health. What is it? What is the difference? The main difference is that we are looking here at transforming the health sector as opposed to solving one particular solution. The underlying thing that you need to unlock for digital transformation is unlocking information flow. This has been the number one problem in all different types of digitalization. And as I always say, digital is data. And if you are not able to unlock data flow, then you cannot really leverage the full impact of digital. So the whole idea of this DPI is to enable two things that are important for information flow, trust and interoperability. So the whole concept of DPI is to allow the digital infrastructures that allow information flow to really talk about digital transformation, where we are talking about information flow across the health sectors, across the use cases, and not only locked in one particular thing. Our approach is not to propose to countries solutions, whether open source or non-open source, but really try to understand first the framework so that countries set the reference architecture with all the types of regulations and governance issues that are attached to it. This kind of change, it’s a kind of a more radical mindset shift from this solution mindset to an infrastructure mindset, which we can call the DPI approach. And this has implication on how you invest in digital. Believe me, even if people understand what’s DPI and when they start to develop solution, they go back and develop it with the traditional monolithic way of developing solution. So you need much more change in the mindset to really enable how do you run your investments and procurements. to enable component-based solutions that are maybe those components are not even developed by the same provider. And each provider is developing a separate product. How all those kinds of products and components interact and interoperate in a way that they seem to be like one big thing and not discrete solutions. What we hope to have is to say, if you are going to invest in digital for health, please put in place what we can call the minimum capabilities. What are the main, what we call building blocks or components instead of spending and duplicating the investment in different solution. And this, by the way, applies also for non-health sectors. All the other sectors are suffering. Even digital governors are suffering from the same issue. How we invest in putting in place the minimum capabilities to ensure that those investments will stay and they will not be duplicated and they will not be replicated and even become obsolete in some cases. We really very much focus on knowledge transfer. We would like to make sure that governments, countries own and understand and steer the investments themselves. So we really much put a lot of emphasis on capacity building. Another thing which is super critical is that if you look at most of the transformational health use cases, like for example, universal health insurance or other types of health use cases that are really truly transformational, they cannot be developed and operate without connecting with the underlying digital public infrastructure. Because any applications that needs trust and interoperability will need services like digital identity, e-signature, trusted exchange of information, consent based type of interactions. So all those are not necessarily services that are developed only for the health sector. Those are. more broader, and the health sector needs to be part of that. What happens, unfortunately, in most of the sectors is that each sector thought that they can do it alone. I think many people realize now that a sector cannot transform itself alone, and you don’t need to build the whole stack within each sector, simply because you don’t have the expertise, you don’t have the resources, you don’t have the time even to build a whole stack per sector. So you need to have one stack that is common for the whole of government. This stack, it’s not about this DPI for health should not be like a super complicated, like a Mercedes to cross the road. You need to be fit for purpose. And here with our starting point is really the type of use cases that you need to enable and what kind of outcomes and based on that you develop and design your DPI. So, of course, don’t reinvent the wheel because, you know, many of the things of the health sector has been already developed. So we have established those kind of working groups. And one of the big first things that we are interacting with working groups is to tell them, please don’t think that you need to develop everything alone because many of those things have been developed outside of the health sector and you need to develop it and leverage what has been done. So let me maybe skip or maybe summarize additional points. More and more we’ll have less funding coming at least from the donor community. I think we saw a very good example recently. So I think it’s about being very careful in rationalizing the investment. You cannot continue to depend on donors’ funding. You cannot depend on duplicating investments. And you need to shape the market, meaning you need to steer the public, sorry, the private companies to develop things based on your own. and five building blocks that are very relevant for health. Those are related to electronic health records, supply chain, which are very important for, you know, avoiding stockouts, particularly for very important drugs like malaria and others. The third component, sorry, is registry services. There are very key important services, registries for health. I think there are maybe five or six that are key, health professionals, health facilities, patients, products, catalog, and other types of registries. And then the other one is the claims, insurance claims. So this kind of shareable common components within the health sector needs to interoperate with the underlying, what we call foundational DPI. We have worked at ITU. I was personally part of this other project that we call GAFSTAC, which basically provides specification and open APIs definitions for the underlying DPI, foundational DPI. We started really from the cloud till the digital ID payments, exchange, consent, e-signature, et cetera, et cetera. So we want to make sure that the sectoral DPI fits very well with the underlying type of infrastructure. So what we are trying to do now is that we have established those five different technical groups with one architecture group who are developing started to develop the specification for all those kinds of health specific and you are all more than welcome to join these types of technical working groups if you are interested and of course I can provide you more information later on. Thank you.

Derrick Muneene: All right, a big hand for Mr. Hani Eskandar here. Thank you so much. We would shift now to hearing from our panelists. We do have others online, Mr. Innocent Chiboma who is trying to get registered and then we have Surabhi Joshi, we have Stephen and we have Jai. We would perhaps start with the interventionists that are in the room. So I’ll be asking Stephen to introduce himself and the role of the panelists is to really contextualize this in terms of what it means in their respective sectors. So Mr. Stephen, your three minutes.

Steven Wanyee: Thank you Derrick and good afternoon everyone. So my name is Stephen Wanye from Kenya and I’m currently in this panel as the president of HELENA. So HELENA stands for Health Informatics in Africa. It’s an organization where we’ve got more than 20 countries who are members of our association. Basically we exist to professionalize health informatics and digital health by promoting workforce capacity development. I mean so I think with respect to this topic, I mean I think as has been clearly spelled out by Derrick and by Hani, what we’re seeing in Africa and I have the privilege of working in a couple of countries, we’re seeing a lot of ministers of health actually working more broadly with the governments. So as a very specific example, for any of you who’s worked in Kenya, you probably come across a new term called digital health super highway. So the ministry of health in Kenya has actually found domestic financing to build up the DPI for health and the use case in Kenya is actually electronic claims. So I think as Hani mentioned, in the green block there, you have to latch on DPI onto something that actually means something to that country. You know, so the UHC agenda for Kenya is a very clear strategy for access, and access is about affording payments. And so the way the country is looking at this is, how do we then invest the DPI for health in Kenya and use electronic claims as a driver? You know, so there’s a new bill, so we are all contributing to something called social health insurance. And out of our contributions, part of that is funding the DPI for health. So that’s really how it’s working. As one example of what I’m seeing currently going across Africa. So I think to wrap up, Derrick, I think it’s about two minutes or three minutes. What we’re seeing is that digital health and DPI is being driven not necessarily for health purposes, but for either social health enablement strategies, you know, so can you pay for it, and that becomes a driver. I think digital health has suffered a lot because we’ve been looking a lot more at just health outcomes only, but we need to look at associated drivers for digital health investment for DPIs to succeed. Thanks, Derrick.

Derrick Muneene: Thank you so much, Stephen. A big hand for Stephen as well. We shall turn to Sharabi Joshi online to give us another use case. So we just said from the African region in terms of the specific instance on DPIs in a country for claims and identifying of people, and so ask Sharabi Joshi to also give us a programmatic use case. Sharabi, over to you. We’ll ask the technicians to also unmute Sharabi Joshi to make her interventions. You have three minutes as well.

Surabhi Joshi: Thanks very much, Derrick, and hello, everybody. I’m Sharabi Joshi. I’m a technical officer in the World Health Organization here in Geneva, and I work on with a focus on digital health and non communicable diseases. And I work as part of an initiative called the Be Healthy, Be Mobile initiative, which is a joint initiative between WHO and the International Telecommunications Union. It has a mandate to scale up digital health for non communicable diseases. And we are currently in a refresh mode, we will be relaunching the Be Healthy, Be Mobile 2.0 initiative in September, during the UN General Assembly in New York, on the sidelines of the high level meeting on NCDs as well. And at the moment, we have four areas of priority to focus on. And one of them is on digital public infrastructure, basically developing digital blueprints for public digital infrastructure, and supporting countries develop scalable and secure systems that build on open standards and open source tools. So one of the visions is to contribute to the massive ongoing efforts, both by WHO and ITU towards a more interoperable and person centered ecosystem, also in alignment with the global digital health initiative, GIDH, that Derrick spoke about previously. And this, you know, something that we’ve recently begun to explore is digital wallets, and how non communicable diseases like diabetes and cancers, hypertension, and also their risk factors, how they can be added to the ongoing efforts and initiatives in this broad area of work. So to take digital wallets as a case, when we talk about digital wallets, we are referring to more than just an app, as we heard from Hani. It’s a secure interface that lets people access and share verifiable health credentials, like your vaccination record, for example, in a way that protects the privacy of the person, but also gives him a sense of ownership about managing his own health. So we’ve been thinking about what this could mean for chronic, non-communicable diseases, because they’re lifelong in nature, right, like diabetes. So this could be, for example, a credential that confirms cervical cancer screening for a person, or his participation and successful completion in a tobacco use again and again for a type 2 diabetes treatment. Or it could be also eligibility for a follow-up service at a, let’s say, a tertiary healthcare center. So there could be so many use cases, but all as part of a trusted and integrated digital infrastructure. And something that WHO has been working a lot since the past couple of years, along with the European Commission, is the Global Digital Health Certification Network, which is also a foundational layer of digital public infrastructure that enables countries to verify health credentials across borders. So a use case that has been very successful is the HUDGE health record. And also over time, something that will be done is work on e-prescriptions and immunizations. So what we are hoping to do is to ground our work in this broader effort, and with open standards and interoperability, and also in alignment with the Global Digital Health Certification, taking very practical steps, while keeping on…

Derrick Muneene: Thank you so much, Serbi. Can you still hear us? Thank you so much for that programmatic use case, a big handful, virtual handful actually. So thank you very much. Dear participants, we just have one more speaker and then we open it up to hear your reflections on this topic. And Mr. Jai, Dr. Jai Ganesh will be calling us to give us the Southeast Asia, you know, implementation or thoughts or reflections on this particular topic.

Jai Ganesh: Thank you, Derrick. This is Jai. I’m from Asia eHealth Information Network, which is a regional digital health network, which has been working closely with WHO, ITU and many other partners here in terms of supporting countries for the national digital health programs. Primarily, we have been focusing on the four main areas of governance, architecture, people and program management, standards and interoperability. So the DPA approach is very much aligned with what we have been doing in the region. And we have countries officially representing in terms of working council and convergence approach is another way of bringing various sectors, like, for example, multi sectoral coordination, cooperation and collaboration to have a coherent approach in terms of national digital health strategy and its implementation. So one of a couple of things that we are looking at at DPA is like also identifying there are countries in the region who have already leveraged the DPAs for health sector. And then there are others who are yet to do. And then there are some. who are actually thinking in terms of how to do. So we are, because AIHIN actually has been also specialized in training capacity building in the region, we are looking at how we could support countries. And then, so WHO had recently also shared the reference architecture for digital health, and which I have also posted in the chat. So that is something that we are closely looking at how we could actually support countries towards looking up the reference architecture, how they can actually implement it at the country level. And then we see also the, our convergence workshop is also a nice forum where we could actually look at how countries are leveraging DPIs or not, and then how they could actually do. So that’s where like we are currently, our focus is towards supporting countries in terms of how they can leverage the DPIs. In fact, very interesting that in another three months, like we will have our annual event, there will be announcement very soon. And the theme of the event, the general meeting, AIHIN’s general meeting is actually focused on investing in digital public infrastructure for health and person-centered health. So this is very much like the discussion in the panel is very much aligned with what we have been working and then what we are looking forward. And then I would say that look forward to work together with WHO, ITU and partners in terms of taking this to implementation. Thank you very much, Derrick, Hani and team.

Derrick Muneene: Thank you so much, Dr. Jai Ganesh. Last round of applause to the speakers. All right. We have now about 10 minutes to spend our time together reflecting, getting your views. Again, this is the eHealth Action Line. We’ve actually come from very far based upon the timetable I gave. And right now we’re looking at foundations and we have listened to the ITU’s work with WHO. We’ve also heard from the Helena Network. We’ve also had the programmatic example from Surabhi. And then last, we also heard from Jay Ganesh from the Asia eHealth Network. The floor is open both virtually and also in the room for your reflections on how we can actually take this forward. So let’s start from the room and we’ll be keeping an eye on the interventions. We did have one more speaker who hasn’t been able to join from the Zambian Minister of Health. And if he joins, I’ll give him the floor as well. Okay, the floor is open, both virtual and also in person. Okay, on the left side of the room. Checking on the right side. Okay, there is a point on my right side.

Audience: Thank you. My name is Ibrahim. I come from Senegal. I’m the Director of the Digital Health Department. I have just one question. Generally, WHO and I to invite us in Geneva in order to improve, in order to train, et cetera. Since one year or two year, we don’t see this meeting. When they’re inviting this meeting, I don’t know, it is linked by the lack of resources that you mentioned, or what is the problem? Because generally, WHO and I to help the countries sometimes in some topics, in some project. They lead some project, they open the door and after countries can know what is happened and how they can carry on. But since one year and a year and a half, we don’t have this meeting, I don’t know why.

Derrick Muneene: Thank you so much. Let’s maybe take. a few more and then we’ll answer them together. Thank you so much, Dr. Derrick, for that.

Audience: Hi, my name is Edna Somra. I work for SPIDER, which is the Center of Enablement for Inclusive Digital Development. And I’m so happy to see Hani and Derrick and Steve. I’ve missed you guys. And also, Hani, I’m sorry. I always come here and I’m not the whole way around. I’m currently leading a Team Europe initiative, working with telecom regulators in 43 African countries. And it really resonates with me, this intersectionality across. It can be within the same country, within the same ministries even. And I think we really have to focus that going forward. I remember a few years back, you kept hammering in systems thinking, system thinking, and I think we’re there now. So I think now multi-stakeholder engagement at all levels of government of digitalization is really key. So I am happy to rejoin some of the working groups, but one of the things I still do, even though it’s not in my mandate to do so, is I think working with the national regulatory associations and the regional regulatory organizations in Sub-Saharan Africa. One of the things I keep driving is, do you know your digital health champions? And they say, why? No, we just sit with documents. Yes, but without you sitting with those documents, enabling data sharing across region, you know, boundaries, we will never get there. So I think it’s really critical that we do engage other sectors and health does affect also. Thank you.

Derrick Muneene: Thank you so much for that comment. We’ll take one last intervention and then come back to Dr. Kim.

Audience: Thank you. Mine is in the nature of a comment, but I would be very grateful if there are comments from the floor. I wanted to say that we’ve been working on health-related APIs in India, and we are a non-profit organization that does research and public policy advocacy. It’s called IT for Change. One of the concerns I have is that in the presentations and in your comment as well, we do need to see that the right to health and right to universal access to health for all are part of a continuity of discourse which also needs to find echo in the way in which we conceptualize digital health governance. For instance, bioethics principles in the WHO become extremely important and what they have to do when we translate those principles into the techno-social context of digital health policy is very important. The second I think that’s important is we’ve had many, many debates across time, particularly on issues of intellectual property with respect to health and generic health drugs, for instance, and how those principles will translate into public digital goods or digital infrastructure would be instructive because the principles are the same. The whole idea of populations and their right to health and preventing big pharma from capture is very similar to the way we need to think about digital public goods and health and prevent capture in some ways. Thank you.

Derrick Muneene: All right. Thank you so much for the comments. Why don’t we get two more and then Dr. Dia will come. We’ll make Dr. Dia’s question the crowning response because we do have an answer that we’d like to provide. So take the two hands and then we’ll get back.

Audience: Maybe I will just turn a little bit to artificial intelligence, not specifically digital health, but integrated it with AI. A lot of countries actually do not have really an AI governance law. But some of the countries, they do have regulations sectoral, especially in the health sector, like Canada, for example, they have some regulations by sector. So I just wanted to know if the ITU or or the WHO, they have any kind of guidelines or principles or regulations for the health sector, especially that a lot of government, actually, they want to move forward with their digital health use cases.

Derrick Muneene: Thank you. All right, and then last intervention and then we have a conversation.

Audience: Thank you. Thank you so much about talking about AI. My name is Sanya. I represent an AI-based health system solutions provider. I think I actually wanted to talk about how does AI fit in this workflow. A lot of times AI also becomes an intermediate layer which connects different digital infrastructures and adds more value to it, which we have seen working in different under-resourced settings as well. So, just want to understand how are you thinking about this in this entire scheme. Thanks.

Derrick Muneene: I think we should close the floor. All right. Yes. So, we have a few minutes, three minutes to go actually. Let’s now go into the response. Let me ask Mr. Hani Eskandar. Yeah. Two minutes.

Hani Eskandar: Yes. Okay. I’ll try to respond to some questions very quickly. There is already, for the question from Dr. Ahoda, the WHO guidance on ethics and governance of AI for health. It’s a published paper. I think it was published probably more than a year ago. And it contains at least the type of ethical issues that needs to be governed in the use of AI for health. It doesn’t provide specific type of regulations, but it gives us a foundation for what kind of regulations should be considered at least. There was a lot of other questions in this side for the question from India. Very, very briefly, we looked very much for the work that has been done for by the digital health mission in India for the DPI for health. And we got a lot of inspiration and actually some of the working groups are from India.

Derrick Muneene: We will talk about the guide in Zambia and reflections in one minute. All right. If we may mute the microphone.

Innocent Chiboma: Thank you very much. I think agreeing with what the previous speakers have said, for Zambia we are using this opportunity with the guide to strengthen collaboration, to strengthen governance. I think it is very important that whatever we are doing in the area of digital health, that we are in the middle of a digital health strategy. We are doing a mid-term review. Thank you very much.

Derrick Muneene: Thank you. Thank working with colleagues from WHO and many other partners, we’re reviewing that and we’re soon also going to develop our digital health digital health architecture document that that we’re going to be able to share with everybody, but really the important thing is having government leadership in all that we do for the sake of sustainability and also for the sake of scalability we really need to make sure that governments are leading these processes as opposed to what we’ve seen in the past where it’s really partner-led. Thank you. Well, thank you so much. Thank you so much. We almost got to the Swiss timing arrangement. We’re one minute past the hour. I just want to thank all the participants virtual and in person for the enrichment of this conversation and all the panelists for the conversations that have brought to the table. The call to action is we would want to ensure we use action like LINE on eHealth to collaborate effectively to really make the transformation of the health sector a reality in pursuit of university health coverage. I thank you so much. I’ve been your moderator, Dr. Derrick Muneene from WHO and so wishing you a pleasant WSIS engagement. Thank you so much.

Agreement points

Need for Digital Public Infrastructure (DPI) to Transform Health Systems

Speakers

– Derrick Muneene
– Hani Eskandar
– Steven Wanyee
– Surabhi Joshi
– Jai Ganesh

Arguments

The Global Strategy on Digital Health aims to achieve universal health coverage through digital means, incorporating principles such as government ownership and the implementation of appropriate digital tools. This strategy is designed to help achieve health-related SDGs by the 2030 Agenda.

DPI represents a fundamental shift from fragmented, solution-focused approaches to an infrastructure mindset that enables information flow across health sectors. The key difference is transforming the entire health sector rather than solving individual problems, with the main goal being to unlock data flow through trust and interoperability.

Countries are increasingly investing in digital health infrastructure using domestic financing, as demonstrated by Kenya’s digital health superhighway initiative. This investment is funded through social health insurance contributions, with electronic claims serving as the primary use case driver.

Digital wallets represent more than just applications – they are secure interfaces that enable people to access and share verifiable health credentials while protecting privacy and giving individuals ownership of their health management.

Asia eHealth Information Network (AIHIN) supports countries through four main areas: governance, architecture, people management, and standards and interoperability.

Summary

All speakers agree that digital health transformation requires moving from fragmented, vertical solutions to comprehensive digital public infrastructure that enables interoperability and information flow across health systems.

Topics

Infrastructure | Development | Legal and regulatory

Importance of Government Leadership and Ownership

Speakers

– Derrick Muneene
– Steven Wanyee
– Innocent Chiboma

Arguments

The Global Strategy on Digital Health aims to achieve universal health coverage through digital means, incorporating principles such as government ownership and the implementation of appropriate digital tools.

Countries are increasingly investing in digital health infrastructure using domestic financing, as demonstrated by Kenya’s digital health superhighway initiative.

Zambia is conducting a mid-term review of its digital health strategy and developing a digital health architecture document that will be shared publicly. The emphasis is on government leadership in digital health processes for sustainability and scalability, moving away from partner-led approaches.

Summary

Speakers consistently emphasize that government ownership and leadership are essential for sustainable and scalable digital health implementations, moving away from donor-dependent, partner-led approaches.

Topics

Development | Legal and regulatory | Infrastructure

Need for Standards and Interoperability

Speakers

– Derrick Muneene
– Hani Eskandar
– Surabhi Joshi
– Jai Ganesh

Arguments

WHO has collaborated with the WSIS platform and ITU for two decades to ensure equitable use of ICTs in health, beginning in 2005 with member state resolutions. This work has evolved through multiple mandates including standardization and interoperability (2013) and the comprehensive digital health mandate (2018).

WHO and ITU are developing a reference architecture with five key building blocks for health: electronic health records, supply chain, registry services, insurance claims, and foundational DPI components.

The Be Healthy, Be Mobile 2.0 initiative focuses on developing digital blueprints for public digital infrastructure using open standards and open source tools. This work aligns with the Global Digital Health Certification Network, which enables countries to verify health credentials across borders.

Asia eHealth Information Network (AIHIN) supports countries through four main areas: governance, architecture, people management, and standards and interoperability.

Summary

All speakers agree on the critical importance of establishing common standards and ensuring interoperability across digital health systems to enable effective information sharing and system integration.

Topics

Infrastructure | Legal and regulatory | Development

Similar viewpoints

Both speakers identify the same core problem of fragmentation and ‘pilotitis’ in digital health implementations and advocate for the same solution – moving to a comprehensive infrastructure approach rather than isolated vertical solutions.

Speakers

– Derrick Muneene
– Hani Eskandar

Arguments

The health sector suffers from ‘pilotitis’ – excessive fragmentation and verticalization of digital solutions, with technology advancing faster than regulatory frameworks can keep pace.

DPI represents a fundamental shift from fragmented, solution-focused approaches to an infrastructure mindset that enables information flow across health sectors.

Topics

Infrastructure | Legal and regulatory | Development

Both African representatives emphasize the importance of domestic financing and government-led approaches to digital health, demonstrating a regional shift toward self-reliance and sustainability in digital health investments.

Speakers

– Steven Wanyee
– Innocent Chiboma

Arguments

Countries are increasingly investing in digital health infrastructure using domestic financing, as demonstrated by Kenya’s digital health superhighway initiative.

Zambia is conducting a mid-term review of its digital health strategy and developing a digital health architecture document that will be shared publicly. The emphasis is on government leadership in digital health processes for sustainability and scalability, moving away from partner-led approaches.

Topics

Development | Legal and regulatory | Infrastructure

Both speakers from WHO and regional networks emphasize the importance of open standards, governance frameworks, and capacity building as foundational elements for successful digital health implementation.

Speakers

– Surabhi Joshi
– Jai Ganesh

Arguments

The Be Healthy, Be Mobile 2.0 initiative focuses on developing digital blueprints for public digital infrastructure using open standards and open source tools.

Asia eHealth Information Network (AIHIN) supports countries through four main areas: governance, architecture, people management, and standards and interoperability.

Topics

Infrastructure | Development | Sociocultural

Unexpected consensus

Cross-Sector Collaboration Beyond Health

Speakers

– Hani Eskandar
– Audience

Arguments

Transformational health use cases like universal health insurance cannot operate without connecting to underlying digital public infrastructure. Health sectors need services like digital identity, e-signature, and trusted information exchange, which are broader than health-specific and require cross-sector collaboration.

Multi-stakeholder engagement across sectors and government levels is critical for successful digital health implementation. This includes collaboration between health champions and telecom regulators to enable data sharing across regional boundaries, as digitalization affects multiple sectors.

Explanation

There was unexpected consensus that digital health cannot succeed in isolation and requires deep integration with broader government digital infrastructure and collaboration with sectors like telecommunications. This represents a significant shift from traditional health-sector-focused approaches.

Topics

Infrastructure | Legal and regulatory | Development

AI Governance and Ethics in Health

Speakers

– Hani Eskandar
– Audience

Arguments

WHO has published comprehensive guidance on ethics and governance of AI for health, providing foundational principles for what kind of regulations should be considered.

The right to health and universal access principles must be translated into digital health governance, incorporating bioethics principles from WHO into techno-social contexts.

Explanation

Despite the technical focus of the session, there was unexpected consensus on the critical importance of ethical frameworks and governance principles for AI in health, with both technical implementers and policy advocates agreeing on the need for rights-based approaches.

Topics

Legal and regulatory | Human rights | Development

Overall assessment

Summary

The discussion revealed strong consensus across all speakers on the need to move from fragmented, vertical digital health solutions to comprehensive digital public infrastructure approaches. There was unanimous agreement on the importance of government leadership, standards and interoperability, and cross-sector collaboration. Regional representatives from Africa and Asia demonstrated aligned approaches despite different contexts.

Consensus level

Very high level of consensus with no significant disagreements identified. The implications are positive for global digital health transformation as it suggests a mature, unified understanding of the challenges and solutions needed. This consensus provides a strong foundation for coordinated international action and suggests that the WHO-ITU collaboration has successfully built shared understanding across diverse stakeholders and regions.

Different viewpoints

Funding and Resource Allocation Approaches

Speakers

– Derrick Muneene
– Hani Eskandar
– Steven Wanyee

Arguments

More and more we’ll have less funding coming at least from the donor community. I think we saw a very good example recently. So I think it’s about being very careful in rationalizing the investment. You cannot continue to depend on donors’ funding.

Kenya’s ministry of health found domestic financing to build DPI for health using electronic claims as driver, with new social health insurance contributions funding the DPI for health

Summary

While Hani emphasizes the need to move away from donor dependency and rationalize investments, Steven presents Kenya’s approach of using domestic financing through social health insurance. The disagreement lies in the emphasis – Hani focuses on reducing donor dependency as a constraint, while Steven showcases successful domestic financing models.

Topics

Economic | Development | Infrastructure

Unexpected differences

Cross-sector Collaboration Emphasis

Speakers

– Audience
– Hani Eskandar

Arguments

Multi-stakeholder engagement across sectors and government levels is critical for successful digital health implementation. This includes collaboration between health champions and telecom regulators to enable data sharing across regional boundaries.

Health sectors need services like digital identity, e-signature, and trusted information exchange, which are broader than health-specific and require cross-sector collaboration.

Explanation

While both recognize the need for cross-sector collaboration, the audience member emphasizes the practical challenges of getting telecom regulators to engage with health champions, suggesting current collaboration is insufficient. Hani acknowledges the need but presents it more as a technical integration challenge rather than a stakeholder engagement problem.

Topics

Legal and regulatory | Infrastructure | Development

Overall assessment

Summary

The discussion showed remarkable consensus on core challenges (fragmentation, need for DPI, importance of government leadership) but revealed subtle disagreements on implementation approaches, funding strategies, and the adequacy of current governance frameworks.

Disagreement level

Low to moderate disagreement level. Most disagreements were about means rather than ends, with speakers generally aligned on goals but differing on emphasis and implementation strategies. This suggests a mature field where practitioners agree on problems but are still working out optimal solutions, which is positive for collaborative progress.

Partial agreements

Similar viewpoints

Both speakers identify the same core problem of fragmentation and ‘pilotitis’ in digital health implementations and advocate for the same solution – moving to a comprehensive infrastructure approach rather than isolated vertical solutions.

Speakers

– Derrick Muneene
– Hani Eskandar

Arguments

The health sector suffers from ‘pilotitis’ – excessive fragmentation and verticalization of digital solutions, with technology advancing faster than regulatory frameworks can keep pace.

DPI represents a fundamental shift from fragmented, solution-focused approaches to an infrastructure mindset that enables information flow across health sectors.

Topics

Infrastructure | Legal and regulatory | Development

Both African representatives emphasize the importance of domestic financing and government-led approaches to digital health, demonstrating a regional shift toward self-reliance and sustainability in digital health investments.

Speakers

– Steven Wanyee
– Innocent Chiboma

Arguments

Countries are increasingly investing in digital health infrastructure using domestic financing, as demonstrated by Kenya’s digital health superhighway initiative.

Zambia is conducting a mid-term review of its digital health strategy and developing a digital health architecture document that will be shared publicly. The emphasis is on government leadership in digital health processes for sustainability and scalability, moving away from partner-led approaches.

Topics

Development | Legal and regulatory | Infrastructure

Both speakers from WHO and regional networks emphasize the importance of open standards, governance frameworks, and capacity building as foundational elements for successful digital health implementation.

Speakers

– Surabhi Joshi
– Jai Ganesh

Arguments

The Be Healthy, Be Mobile 2.0 initiative focuses on developing digital blueprints for public digital infrastructure using open standards and open source tools.

Asia eHealth Information Network (AIHIN) supports countries through four main areas: governance, architecture, people management, and standards and interoperability.

Topics

Infrastructure | Development | Sociocultural

Key takeaways

Digital health transformation requires a shift from fragmented, vertical solutions to integrated Digital Public Infrastructure (DPI) that enables information flow through trust and interoperability

WHO and ITU have successfully collaborated for 20 years on digital health initiatives, with over 129 countries now having digital health strategies globally

Government ownership and leadership are critical for sustainability and scalability of digital health initiatives, moving away from donor-dependent, partner-led approaches

Countries are increasingly using domestic financing for digital health infrastructure, with specific use cases like electronic claims driving investment (as demonstrated by Kenya’s digital health superhighway)

Multi-stakeholder engagement across sectors (health, telecom, governance) is essential for successful digital health transformation

The health sector suffers from persistent ‘pilotitis’ – fragmentation of digital solutions that duplicate investments and lack interoperability

Digital wallets and verifiable health credentials represent promising approaches for chronic disease management while protecting patient privacy

Regional networks (HELENA, Asia eHealth Information Network) play crucial roles in capacity building and knowledge sharing across countries

Resolutions and action items

WHO and ITU will host a five-day virtual Global Initiative on Digital Health convening the following week (QR code provided for registration)

Technical working groups are being established for five key building blocks: electronic health records, supply chain, registry services, insurance claims, and foundational DPI components

Be Healthy, Be Mobile 2.0 initiative will be relaunched in September during UN General Assembly in New York

Zambia will complete mid-term review of digital health strategy and develop digital health architecture document to share with stakeholders

Asia eHealth Information Network will announce their annual general meeting in three months focusing on investing in DPI for health and person-centered care

Participants were invited to join technical working groups for developing health-specific DPI specifications

Unresolved issues

Lack of recent WHO-ITU training meetings for countries, with participants noting absence of such meetings for 1-2 years

How to effectively translate bioethics principles and right to health concepts into digital health governance frameworks

Integration of AI as an intermediate layer connecting different digital infrastructures and its governance within DPI framework

Specific regulatory frameworks for AI in health sector, as many countries lack comprehensive AI governance laws

How to prevent capture of digital public goods in health similar to intellectual property issues with pharmaceuticals

Addressing the gap in people skills and capacity building that remains a challenge for country digital health maturity

Suggested compromises

Countries should leverage existing DPI components from other sectors rather than building everything from scratch within health sector

Focus on fit-for-purpose solutions rather than overly complex systems (‘not a Mercedes to cross the road’)

Use specific health use cases (like electronic claims, universal health insurance) as drivers for broader DPI investment rather than health outcomes alone

Combine sectoral approaches with foundational cross-government digital infrastructure to avoid duplication while meeting health-specific needs

Balance open standards and interoperability requirements with practical country implementation needs and existing systems

This has been the number one problem in all different types of digitalization. And as I always say, digital is data. And if you are not able to unlock data flow, then you cannot really leverage the full impact of digital.

Speaker

Hani Eskandar

Reason

This comment cuts to the core of digital transformation challenges by identifying data flow as the fundamental issue. It reframes the entire discussion from focusing on individual solutions to understanding the underlying infrastructure needed for true transformation.

Impact

This insight shifted the conversation from discussing fragmented health solutions to emphasizing the need for interoperability and trust mechanisms. It provided the conceptual foundation for understanding why DPI is necessary and influenced subsequent speakers to focus on integration rather than isolated implementations.

This kind of change, it’s a kind of a more radical mindset shift from this solution mindset to an infrastructure mindset, which we can call the DPI approach. And this has implication on how you invest in digital.

Speaker

Hani Eskandar

Reason

This comment identifies a fundamental paradigm shift required for successful digital health transformation. It challenges the traditional approach of building individual solutions and calls for a completely different way of thinking about digital investments.

Impact

This observation elevated the discussion beyond technical considerations to strategic and philosophical ones. It influenced subsequent speakers like Steven Wanyee to provide concrete examples of how countries are actually implementing this mindset shift, such as Kenya’s digital health superhighway approach.

I think digital health has suffered a lot because we’ve been looking a lot more at just health outcomes only, but we need to look at associated drivers for digital health investment for DPIs to succeed.

Speaker

Steven Wanyee

Reason

This comment provides a crucial insight into why many digital health initiatives fail. It suggests that focusing solely on health outcomes is insufficient and that broader socio-economic drivers (like payment systems) are necessary for sustainability.

Impact

This perspective broadened the discussion scope significantly, moving from technical architecture to understanding the political economy of digital health. It influenced the conversation to consider how DPI investments need to be tied to tangible benefits that governments and citizens can immediately recognize and value.

The whole idea of populations and their right to health and preventing big pharma from capture is very similar to the way we need to think about digital public goods and health and prevent capture in some ways.

Speaker

Audience member from IT for Change

Reason

This comment draws a powerful parallel between traditional health equity issues and digital health governance, introducing critical questions about power dynamics and potential corporate capture in digital health infrastructure.

Impact

This intervention introduced a more critical and equity-focused lens to the discussion, challenging the predominantly technical and implementation-focused conversation. It raised important questions about governance, ownership, and the potential risks of DPI approaches that weren’t adequately addressed in the initial presentations.

One of the things I keep driving is, do you know your digital health champions? And they say, why? No, we just sit with documents. Yes, but without you sitting with those documents, enabling data sharing across region, you know, boundaries, we will never get there.

Speaker

Edna Somra

Reason

This comment highlights a critical gap in multi-stakeholder engagement, specifically pointing out that telecom regulators – who are essential for enabling data flows – are often disconnected from digital health initiatives.

Impact

This observation reinforced the need for cross-sectoral collaboration that had been mentioned earlier but provided a concrete example of how siloed thinking persists even within government structures. It supported the broader theme about the need for systems thinking and multi-stakeholder engagement.

Overall assessment

These key comments fundamentally shaped the discussion by elevating it from a technical presentation about digital health solutions to a more nuanced conversation about systemic transformation challenges. Hani Eskandar’s insights about data flow and mindset shifts provided the conceptual framework that influenced how subsequent speakers framed their contributions. Steven Wanyee’s observation about looking beyond health outcomes alone introduced important considerations about political economy and sustainability. The audience interventions, particularly from IT for Change and Edna Somra, brought critical perspectives on equity, governance, and cross-sectoral collaboration that weren’t adequately addressed in the initial presentations. Together, these comments transformed what could have been a straightforward technical discussion into a more comprehensive examination of the complex socio-technical challenges involved in digital health transformation, highlighting the need for fundamental changes in how stakeholders think about, invest in, and govern digital health infrastructure.

When will WHO and ITU resume their regular training meetings for countries that have been absent for the past 1-2 years?

Speaker

Ibrahim (Director of Digital Health Department, Senegal)

Explanation

This addresses a gap in capacity building support that countries have been expecting and relying on for digital health development

How can multi-stakeholder engagement be better coordinated across different government ministries and sectors for digital health implementation?

Speaker

Edna Somra (SPIDER)

Explanation

This highlights the need for systems thinking and cross-sectoral collaboration, particularly involving telecom regulators who enable data sharing across boundaries

How should bioethics principles from WHO be translated into techno-social contexts of digital health policy?

Speaker

Participant from IT for Change (India)

Explanation

This addresses the critical need to maintain right to health and universal access principles when implementing digital health governance

How can principles from intellectual property debates in pharmaceuticals be applied to prevent capture in digital public goods for health?

Speaker

Participant from IT for Change (India)

Explanation

This draws parallels between protecting populations from big pharma capture and preventing similar issues in digital health infrastructure

What specific AI governance guidelines or regulations does WHO/ITU provide for the health sector?

Speaker

Unnamed participant

Explanation

Many countries lack AI governance laws but need sectoral guidance for health-specific AI implementations

How does AI fit as an intermediate layer connecting different digital infrastructures in the DPI framework?

Speaker

Sanya (AI-based health system solutions provider)

Explanation

This addresses how AI can add value by connecting different digital infrastructures, particularly in under-resourced settings

How can countries ensure digital health strategies remain implementable rather than just existing as documents?

Speaker

Derrick Muneene (WHO)

Explanation

While 129 countries have digital health strategies, there’s still work needed to make these strategies practically implementable

How can the issue of ‘pilotitis’ and fragmentation in digital health solutions be systematically addressed in the age of AI?

Speaker

Derrick Muneene (WHO)

Explanation

The fragmentation problem identified in 2012-2013 persists in 2022, and rapid AI development may exacerbate this issue without holistic approaches