Child health and universal health coverage have improved dramatically over the past 30 years, with a 59% decline in child mortality. Improvements in access to primary health care, nutrition, economic development, and access to targeted public health interventions to reduce infectious diseases like malaria, diarrhea, and pneumonia, have all contributed to this success. However, large equity gaps remain in child and maternal health indicators, contributing to preventable deaths and perpetuating poverty. Addressing inequities is essential to achieving universal health coverage and improving the health of all children and mothers.
While addressing health inequities needs a multi-pronged approach, there is untapped potential to use technology to reach more mothers and children with essential information and services. Digital technologies are quickly becoming the backbone of health care delivery, providing essential interventions, and strengthening health systems. In low-resource and emergency settings, they are an essential tool for delivering care at scale, from non-communicable disease screening to disease surveillance and antenatal care.
India is playing a leading role in promoting digital health for universal health coverage (UHC). The proposed WHO-led Global Initiative on Digital Health (GIDH) is a welcome step that will help align country priorities and needs with coordinated support available and ensure that all countries have access to the tools and skills they need to develop and implement sustainable and safe digital health solutions.
The GIDH resonates with the message of “One Earth – One Family – One Future,” which was the theme of India’s G20 presidency. The initiative is proposed to consolidate and amplify recent and past gains in global digital health while strengthening mutual accountability to enhance the impact of future investments by addressing challenges such as duplication of efforts, lack of standards and “products-focused” digital health transformation.
The COVID-19 pandemic has shown that digital technologies can be essential for delivering healthcare. However, deploying these solutions during a crisis can be challenging. It requires coordination and collaboration between different stakeholders, access to substantial amounts of data, security, and compliance with regulations. Many countries were not prepared with even the most basic digital health infrastructure when COVID-19 hit. This was compounded by weak enabling environments, with countries often trying to implement complex initiatives, often without the necessary foundations in place. Solutions that were implemented were often short-lived, vertical, duplicative, and not able to exchange data with existing health information systems.
Now is the time to reflect on how to improve collaboration and coordination to optimize resources and maximize the benefits of digital transformation of health systems. Convergence and collaboration are essential for the future of digital health. By bringing together stakeholders from different sectors, we can identify and prioritize digital health challenges and opportunities. This will help us focus resources and efforts on the most pressing issues, share resources and expertise, and develop joint action plans. By fostering convergence using interoperable standards-based solutions, we can mitigate the harms of cyber threats and fragmented data silos.
Scaling up access to healthcare with digitization
UNICEF has seen first-hand the power of digital platforms to advance the reach of health services in India, not just for COVID-19 but also for maternal and child health. The government has pioneered a national digital health ecosystem that digitizes all public health information and ensures a confluence of digital tools to combine and maximize impact.
The National Digital Health Mission, or the Ayushman Bharat Digital Mission (ABDM) as it was later named, was announced by Prime Minister Narendra Modi on India’s 74th Independence Day in 2020. The ABDM aligns with the goals and objectives of the National Health Policy and the National Digital Health Blueprint to create a national digital health infrastructure for providing universal health coverage to all citizens in the country. Under the mission, every Indian will be issued a health ID that will store their medical records. The ABDM is a bold and ambitious initiative that has the potential to transform the health system in India by improving the quality, efficiency, and accessibility of health services. The ABDM is still in its initial stages, but it may be one of the most important investments that the Government of India has made for the digital transformation of health in the country. Using a standards and architecture-driven blueprint, along with digital public infrastructure such as the unique ID, an environment has been created where other initiatives, such as the Reproductive and Child Health Portal to support women and children’s health needs, can be built on top.
India’s CoWIN: A Model of Coordination and collaboration
India’s COVID-19 vaccination drive is the world’s largest, with over 2.2 billion doses administered. The agility and speed of the Indian government’s response was enabled by the CoWIN platform, which served as the program’s digital backbone. Within a matter of weeks, the government of India delivered a platform that housed end-to-end workflows from the manufacturer through each step of the vaccination process. This required consensus building and coordination with a multitude of stakeholders, while employees also adapted to a new reality of physical distancing and working remotely.
The Indian government’s coordination in designing and deploying the CoWIN platform during the COVID-19 vaccine rollout was exemplary and has impressed the global digital health community. CoWIN has been instrumental in the success of India’s vaccination drive and has the potential to be a valuable digital public good for India and the world.
Some of the key factors that helped make CoWIN a success include strong leadership, collaboration, preparedness, interoperability, and agility. The Indian government provided strong political will and leadership by creating the National Expert Group on Vaccine Administration for COVID-19, which guided all aspects of vaccine introduction in India. The group effectively established high-level coordination with 19 ministries at the national level, 23 departments at the state and district level, and numerous developmental partners. This laid the foundation for a cohesive and coordinated effort.
The Indian government’s successful coordination in designing and deploying CoWIN is a model for other countries. It shows that it is possible to develop and deploy a complex digital platform in a short period of time, and it shows that it is possible to coordinate effectively with a wide range of stakeholders, including private stakeholders such as IT (Information Technology) companies and telecom providers. It is a model for other countries that are looking to scale up their vaccination programs.
CoWIN’s success was built on pre-existing capabilities of the Indian government to perform disease surveillance and monitoring and to manage technology, people, and processes across the vaccine supply chain. Thanks to the pre-existing Digital Health Blueprint and the digital public infrastructure, the government could leverage existing open-source technologies to develop CoWIN quickly. These included the Electronic Vaccine Intelligence Network (eVIN), the Digital Infrastructure for Vaccination Open Credentialing (DIVOC), DigiLocker, and Surveillance and Action for Events Following Vaccination (SAFE-VAC). As a result, the CoWIN is an open-source, modular, and interoperable multilingual application ecosystem that serves as a one-stop shop for vaccination registration, appointment scheduling, identity verification, vaccination, and certification. It is a critical tool for achieving universal vaccination coverage.
The CoWIN platform is a unique example of the agility of the Indian government. The speedy deployment was made possible by running parallel processes for developing the platform and preparing for its implementation. They created databases of healthcare workers and frontline workers, outfitted vaccination centers with cold storage facilities and digital tracking devices, and trained staff on how to use the platform. The CoWIN platform was designed to be adaptable, so the government was able to quickly address any technical issues that arose. They also invited third-party application developers to integrate their APIs (Application Programming Interfaces) with the platform, which has enabled these applications to provide a variety of value-added services, such as booking appointments.
The Global Initiative on Digital Health to Amplify India’s Digital Health Efforts
India leading the way in accelerating the transition to convergence and equity in digital health. The investment in the ABDM and the country’s CoWIN deployment are prime examples of how strong leadership, collaboration, and ambition can build a strong digital ecosystem for healthcare. Through the broader platform agnostic investments made, the Government can now expand CoWIN to include the Universal Immunization Programme and connect it with the building blocks of ABDM, which intends to combine all health-related digital interventions under one digital umbrella. The recently launched Global Initiative on Digital Health (GIDH) will further amplify these efforts by promoting the transfer of open-source digital public goods, encouraging countries to adopt interoperable standards, and building a resilient ecosystem capable of addressing healthcare emergencies.
UNICEF believes that every donor and partner must join hands and collaborate to support countries to transform their health landscape and enable equity of access. Let us learn from both the successes and the challenges we have observed in India and come together behind the global digital health investment principles to improve access to healthcare, reduce costs, and enhance the quality of care on a global scale. Let us integrate our innovative digital healthcare solutions to build a healthier future for all.
[Photo by Prime Minister’s Office, India, via Wikimedia Commons]
The views and opinions expressed in this article are those of the author.
The writer is a global health leader – Digital Health & Information Systems, UNICEF.
