22 October 2020

COVID-19 should be the accelerator for e-health in the least developed countries

by Désirée van Gorp and Girish Ramachandran / in Op-ed

On transforming healthcare where it’s needed most

Healthcare is being transformed the world over, instigated by the fourth industrial revolution and hastened by a common, invisible and deadly enemy – COVID-19. The entire healthcare industry and related businesses are being reshaped, with a new generation of smaller, more agile companies competing with larger enterprises on a more equal footing. Emerging technology breakthroughs and e-health concepts are driving the confluence of the physical, digital and biological worlds.

This reform of healthcare has promise, especially for LDCs that are often low in resources due to lack of sufficient infrastructure, capital, medicine, water, electricity and healthcare professionals, while also suffering from prohibitive costs. All this combined is preventing health services from being readily available, and the current pandemic makes the urgency of reforming healthcare for LDCs even more apparent. With an average of only 113 hospital beds per 100,000 inhabitants, which is less than half the number in developing countries and around 80% below the hospital beds in developed countries, it is not hard to imagine the impact on vulnerable LDCs, like Sudan for example, if COVID-19 spreads further among the population. Sudan, a country with 7.8 million people facing critical problems related to mental and physical wellbeing before the pandemic, will suffer greatly in an additional humanitarian crisis.

A shift to e-health and digital systems may well not be the answer to everything, but can be an important tool to reform vulnerable health systems. As such, these systems can help to increase the availability of health services in remote areas, for example due to lower costs, and via public and private partnerships, less dependence on physical infrastructure and by increasing trade in health services.

Moreover, this shift to digital systems is enabling healthcare providers to identify diseases earlier and proactively intervene with low-touch care. This is being accompanied by a change in focus: from traditional medical care to more broadly defined health and wellness, with empowered consumers and private business playing an active role in providing health services.1

This is in line with the General Agreement on Trade in Services (GATS), which aims to expand the involvement of private enterprise in the service sector. It can create opportunities for LDCs to be part of health ecosystems; to expand their involvement in international trade of health services; to access technology, both in terms of physical technology and devices as well as education; to ensure populations are digitally savvy; and to ensure all citizens have access to tele-healthcare (education).

E-health can bring innovation to the healthcare sectors of LDCs, which are mostly low-resource environments with inadequate healthcare infrastructure and services, as well as poor access to information. Especially in these environments, there is potential to use mobile phones, teleconferencing and other technologies for educational purposes to improve the knowledge and skills of public-sector health professionals2 and to increase the quality, efficiency and effectiveness of health services.

In order to exploit this potential, it is essential to build the foundation for e-health-ready environments in LDCs. COVID-19 can be the accelerator to do so.

The current pandemic has proven that essential healthcare services can be digitalised to help reduce the burden on the healthcare system and halt the spread of infections. One nation that has had success with a digital approach to rebuilding its healthcare system is India. A shift from traditional to digital channels has eased the burden of its already troubled public healthcare systems while lowering costs.

Building the foundation for e-health

The way forward is anchored in a digital foundation driven by governments to level the playing field by ensuring uniform access to technologies.

Governments play a key role in instigating systemwide digital health projects and should be given a clear mandate to build a digital spine, leveraging internet, cloud and mobile technologies, big data analytics, artificial intelligence and other innovations for connectivity and collaboration, backed by strong cyber security. By further sharing IT infrastructure with other public services, such as citizen-ID and consent-management systems, governments can accelerate the healthcare industry’s transformation to data-driven organisations, allowing for processes that are digitally enabled and decisions that are based on the patterns emerging from them.

In a connected ecosystem, public and private stakeholders, including governments, can proactively share information and cooperate, especially with the adoption of innovation accelerators like 3D printing, the Internet of Things (IoT), blockchain and augmented and virtual reality technologies. The sharing of information can enhance evidence-based healthcare for vulnerable communities in LDCs where traditional healthcare infrastructure and health care services are inadequate, and mobile technologies can play an important role in the provision of healthcare services at the regional, community and individual levels.3 The initiative E-Health Africa is a good example of this innovation in healthcare in developing countries. It all starts with assessing whether a location has a certain level of e-health readiness and engaging different partners in national and especially local health ecosystems in order to have a good digital health team on the ground.

The importance of a sound health ecosystem

Although governments are important stakeholders, non-governmental health system actors are crucial for a sound health ecosystem. This is important because governance failure at one level of the health ecosystem can be compensated for by other players. E-health can help to build such a framework and can contribute to the decentralisation of the health sector in LDCs. Decentralisation helps ensure participation of key players in the public and private sector better respond to local healthcare needs and enhances data-driven decision making in healthcare. This is crucial for LDCs with limited data sharing.

As an example, India deployed a digital nerve centre (DiNC) to leverage technology, people and processes in a holistic way to improve healthcare access for the underprivileged. The DiNC technology platform combines structured and unstructured data to build one cohesive picture, and connect patients with primary, secondary and tertiary healthcare providers over the phone. It allows appointment booking and maintains digitised health records for patients, includes care coordinators who handle non-medical queries, and lets hospitals and treatment centres collaborate and share knowledge. This platform can serve as an example for LDCs with limited resources.

However, simply digitising healthcare is not enough. Digital equity is also required. Governments together with other stakeholders in the health ecosystem will need to reinforce digital inclusion to ensure that all citizens have the skills, tools and access to participate in digital healthcare. The pandemic has not only highlighted that people and organisations can rapidly change their behaviour when required, but also showed that a healthy society is not possible if some people or communities are left behind. Hence, there is a need for sound health system governance that government can’t develop alone, and should be done with joined forces of private and public stakeholders with local communities as a point of departure.

COVID-19 can be the accelerator to bring in the basic essential requirements for building such ecosystems and to bring different stakeholders together, and this is paramount for bridging the digital divide in different parts of the world. Part of this effort should be increased trade in health services focusing on ensuring access of the vulnerable populations in LDCs to effective medication against COVID-19. The current health crisis should be used to bring about innovation in healthcare for those who need it most.


Désirée van Gorp is Professor of International Business and Girish Ramachandran, President, TCS Asia Pacific.


1 Parts of this article has been published in: https://health.economictimes.indiatimes.com/amp/news/industry/the-future-of-healthcare-personal-wellness-advisors/77925226

2 An example of e-learning to educate medical professionals addressing challenges in complex emergencies and fragile states:  https://www.kit.nl/study/course/rebuilding-disrupted-health-systems-developing-context-specific-strategies-health-care-policies-implementation-governance-e-learning-rdhs-e/

3 Chib, A.;van Velthoven, M.; and Josip, C. (January, 2015). Mhealth adopton in low resource environments: A review of the use of mobile healthcare in developing countries. Journal of health communication, 20(1): 4-34

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