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The views expressed are those of the author and do not necessarily reflect the position of FORESIGHT Global Health.
Well-designed digital health solutions— those that provide quality care that is truly accessible and available for all, including the poorest and most vulnerable communities—require investment and the right regulatory framework. Where both requirements are present, digital solutions show great promise for health care and health equity, across and within countries. The development of health tech combined with ready and equal access to health services is particularly important in times of a rising epidemic of non-communicable diseases (NCDs) alongside the covid-19 pandemic. It is also especially important given that the greatest NCD burden falls on LMICs.
While the priority during the coronavirus pandemic has been preventing infection, minimising the spread, and providing adequate care and treatment to those with covid-19, NCDs, which include diabetes, cancer, cardiovascular diseases and conditions such as obesity and hypertension, continue to pose the greatest health burden worldwide. The diversion of limited health resources to the pandemic response has had an especially profound negative impact on continuity of care for people with NCDs.
A recent rapid risk assessment survey on health service disruptions during the pandemic from the World Health Organization (WHO) showed that out of a total of 155 countries responding to the survey, 53% reported partially or completely disrupted services for hypertension treatment; 49% for treatment for diabetes and diabetes-related complications; 42% for cancer treatment; and 31% for cardiovascular emergencies. These disruptions are happening even though NCDs continue to be the world’s biggest killer, responsible for the premature deaths of 15 million people aged 30-69 each year; and the numbers are rising, most of all in LMICs.
The covid-19 pandemic has highlighted that reliable NCD management and care must be a part of every health system, everywhere—also during times of emergency. Digital health solutions and innovations can play a key role in abating NCDs. Many countries have already begun to integrate them into health services. Use of digital tools, however, implies a drastic shift in the way care is delivered, as has become evident through the covid-19 response. Mitigation strategies including lockdowns preventing travel to health services, plus people giving health centres a wide berth for fear of covid-19 contagion, have catapulted us into the digital health age.
According to WHO, 58% of countries are reporting using telemedicine during the pandemic to replace in-person consultations whenever possible. In some cases, the use of telemedicine has skyrocketed. Virtual urgent care visits at one US health centre grew by nearly seven-fold and non-urgent virtual care visits grew by an unprecedented 40 times. China implemented a wide range of digital solutions throughout different stages of the outbreak. South Africa is developing a complete digital health framework, laying out international standards to ensure interoperability and replicability. Such new digital services do not need to disappear once the pandemic is brought under control. To the contrary, they need to be further refined and developed for permanent integration and more specifically for NCD prevention, treatment and care.
Within the context of NCD care, digital solutions can improve efficiency, affordability and reach by ensuring that human resources are focused primarily on tasks in which human contact cannot be replaced. The options for digital tools span much further than just virtual and telephone consultations. Software and digital platforms can offer diverse solutions to make NCD management and care more autonomous. Empowering people living with NCDs who require day-to-day care to manage their conditions, on their own and from their homes, gives them greater freedom from their conditions. Digital tools can work similarly for health workers. Even simple text messages can help health workers in their decision making, allow them to track their patients’ records, follow up with them more easily and communicate more effectively with their teams.
Beyond treatment and care, digital training tools like the new NCD Academy represent innovative health learning solutions that can be used and adapted in diverse settings, including LMICs. The academy is an online learning platform developed to equip frontline health workers like clinicians, nurses and community health workers with professional knowledge and skills on NCD care. Digital training can cover a diverse range of competencies in medical knowledge, specialisations, and clinical practice; and it provides a cost-effective, flexible and much-needed solution to health workforce capacity building.
Despite the potential benefits of digital solutions, their uptake has remained slow and there are challenges to be overcome before health systems can make use of their full potential. Public awareness and trust in the storing and use of data needs to be raised; information communications technology infrastructure needs to be improved in many countries; data protection and privacy need to be ensured for patients; and innovative digital health policies must be implemented.
Digital solutions are also challenging for some demographics, particularly older populations. Moreover, they remain out of reach for many people living in low-resource settings where access to the internet and mobiles phones can be absent or limited. For people living with dementia who rely on regular in-person care and support, the shift to telephone and web-based support during the pandemic has been challenging, increasing stress, anxiety and loneliness. For all these reasons it remains critical that digital strategies and solutions are designed and planned to be accessible and available for all, including the most vulnerable and poorest communities.
Provided the barriers to digital health are recognised and dismantled, the promise of digital tools for all countries is great. They can increase the reach and capacity of the health workforce, improve NCD care, achieve greater health equity and contribute to the attainment of universal health coverage. The time is overdue for governments to support the development of digital health tools and services, including establishing a regulatory framework. Good governance helps protect and improve health for people living with NCDs and for people everywhere, both during a pandemic and beyond. The message is clear: We have no time to lose in seeking solutions to our global health crisis—in all its dimensions. •
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