- As the world continues to address inequities in health, digital technologies have an immense potential to contribute;
- Five drivers of health inequity in particular may benefit from digital technologies;
- Greater leadership from all sectors can increase the use of digital technologies for good, but must also account for the potential to reinforce inequities.
Health inequity does not have a single cause; it is the amalgamation of structural and procedural dimensions that benefit some and marginalize others. It will take a concerted, collaborative effort to address these determinants of health, but in the last 10 years we have found an important tool for this work: digital technologies.
Going back 10 years, if a health worker in Tanzania needed to know how many vaccine doses she had given or how many her clinic had left, she’d have to look through seven different paper registries, cross-checking and verifying them against one another. As a result, tracking stock levels and shifts in demand could mean 8-10 hours of data management each month. With inconsistent stock levels, one in 14 children who came for a vaccine might leave the clinic without one.
Digital tools then automated the processes she used to do by hand. A tablet-based electronic immunization registry connected to a logistics management information system replaced the seven paper registries and automatically updated her inventory data every time she recorded an immunization in the clinic. A data dashboard, designed by a health worker and manager advisory group, put stock level data at her fingertips. It wasn’t perfect, but when stock data was made visible on these digital systems, incidences when stock ran out declined by roughly 70%.
The digital transformation of health systems is not about the “killer app” that will solve health inequity forever; it is about the systemic, often invisible ways that digital tools and approaches support individuals and health systems in their efforts to dismantle inequity.
Here are five factors of health inequity that digital technologies can help address:
1. Inequitable access to trusted, reliable health information
At an individual level, misinformation, disinformation and a lack of information all serve as barriers to a person’s ability to pursue health. At a systems level, a lack of high-quality, timely information can result in wasted resources, ineffective health interventions or further increasing the gap in health equity. Digital tools and approaches have an enormous role to play in addressing the need for trusted, reliable health information.
Messaging platforms, for example, democratize access to health information by connecting communities to trusted, reliable sources. This review found that text-based reminders improved HIV drug adherence across multiple studies. Another review suggests that short messaging services increased antenatal birth visits and skilled birth attendance. The Visualize No Malaria initiative demonstrates the power of data in the hands of health workers, who can respond more proactively and reactively to malaria outbreaks because they have timely data at their fingertips.
2. Inequitable access to medical expertise
An estimated 18 million additional health workers are needed to achieve Universal Health Coverage by 2030. This global shortfall in the health workforce is not shared equally amongst communities and without a sufficient health workforce, individual care suffers. Digital tools and approaches can extend the reach and skills of the existing workforce and provide new ways to address this gap.
For example, artificial intelligence (AI) enabled decision support tools can extend medical expertise into regions struggling with health worker shortages. Babyl’s AI-enabled systems have demonstrated parity in safety with direct medical doctor consultations, while ThinkMD reports high health worker satisfaction with the decision support tools it has deployed. In Myanmar and India, an AI tool called qXR supports the diagnosis of tuberculosis faster than traditional methods.
3. Inequitable access to medical commodities and other interventions:
The availability of essential medical commodities – medicines, vaccines, diagnostics, devices and more – has enormous influence on quality of care. As we’ve seen in the COVID-19 pandemic, when countries and communities do not have equitable access to something as simple as medical oxygen the implications are far-reaching. Digital tools and approaches can streamline supply chains and provide better data to anticipate and address supply shortages when they occur.
For example, electronic logistics management information systems (eLMIS) help ensure that appropriate and safe medicines are available and in stock for those who need them. In Tanzania and India, the use of an electronic logistics management information system reduced the instances when vaccines were out of stock and recent modelling efforts suggest these reductions can translate into meaningful lives saved.
4. Inequitable representation in public health systems and services
Information systems and the data they collect often do not equitably represent populations, for example, undercounting members of vulnerable communities or not collecting the right data to diagnose inequities in the health system. When data is not representative and inclusive, the analysis and use of this data will be inherently inequitable. When thoughtfully designed, digital technologies can improve representation within health system data and increase access to health services for individuals otherwise disenfranchised from care.
The USAID-funded Healthy Markets initiative at PATH, for example, reaches LGBTQI+ individuals in Vietnam through safe peer-led online forums and chatbots. Using existing platforms like Facebook, Blued and TikTok, individuals who are at-risk or otherwise marginalized can connect to up-to-date health information and essential health services such as pre-exposure prophylaxis. In this case, digital tools help the health system reach people they might not otherwise reach and connect individuals who may not have identified a way to access critical health services that felt safe and comfortable.
5. Inequitable support for catastrophic medical expenses
Each year, 950 million people spend at least 10% or more of their household budget on health care expenses and 100 million people are pushed into extreme poverty as a result. Health insurance and government financial schemes are important protections for individuals but are often unavailable in unbanked or otherwise marginalized communities. As part of the larger efforts to achieve Universal Health Coverage, digital financial services can lay the groundwork for accessible, transparent insurance schemes that prevent poverty-causing medical expenses.
Transformational change can lie in the evolution of systems and infrastructure, moving our vision of health systems from the paper-based vaccine registry to AI-enabled dashboards. Digital technologies touch all parts of health systems and we cannot neglect their potential to address inequity.
Leadership from public, private and funding organizations can contribute to this ongoing transformation. We need to continue building evidence of health impact, expanding the community of global citizens working on digital health, and protecting the promise of digital technologies from existing inequities. While not everyone has access to the internet or a mobile phone, we can work together to create a more equitable system for health and bridge the digital divide in healthcare.
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