More than half of the people on Earth still don’t have full coverage of essential health services and almost 100 million people fall into extreme poverty from paying for healthcare. In South-East Asia, while some positive progress has been made in achieving universal health coverage (UHC), it isn’t happening fast enough.
In the region, 62% of deaths are now due to non-communicable diseases (NCDs), which primary care systems are poorly positioned to address. Traditional service delivery and financing models often fail to adequately serve residents of remote communities. Data indicates that rural populations of South-East Asia still face persistent challenges in accessing essential health services compared with their urban peers. To overcome these challenges and reach universal health coverage in the region, players in the healthcare system must fully embrace digital health technologies to move beyond experimentation and small-scale pilots.
Digital healthcare platforms offer tremendous advantages for resource-constrained health systems in rural and remote areas of low and middle-income countries in South-East Asia striving to achieve UHC 2030 and SDG targets. Digital health allows systems to take advantage of existing resources and infrastructure, providing more services directly in communities via telemedicine approaches and task-shifting strategies.
Digital technologies are also well suited for preventative approaches, including wide-scale screening or education campaigns. India’s ambitious national goal of screening every citizen under 30 using an mHealth (mobile health) device for risk factors related to leading NCDs is a prime example. Furthermore, by integrating digital health solutions, governments and the private sector have increased access to rich, quality data to accurately inform the allocation of scarce resources – and leapfrog the challenges of many developed health systems.
We recently spent time with our community-based teams in the Philippines and Cambodia, where we’re partnering with the government, healthcare providers and the private sector to deliver affordable healthcare in remote communities. These are regions characterized by tremendous challenges in last-mile delivery of essential health services. We know from our research that the barriers are not limited to out-of-pocket payments, but that the cost of travelling long distances to seek care, along with lost wages from missed work, can be equally debilitating.
Our approach involves empowering community members (a team of women in each village who we call access managers) to create individual health profiles of residents using proprietary offline-first apps. These access managers are then able to conduct tailored public health engagement and outreach campaigns, as well as ordering and delivering medicines and health services at affordable prices directly within the communities themselves. This enables local residents to overcome many of the traditional barriers to healthcare access, all while relying on support from a local peer to navigate the system. By merging mHealth solutions with an embedded community presence and last-mile delivery, we are able to create a holistic approach that overcomes some of the common limitations of telemedicine initiatives.
Under this innovative model, we recently engaged and onboarded 42,000 individual residents in two rural and remote municipalities in Western Visayas, Philippines. The resulting community health profile indicated that access to vitamin A supplementation was a serious challenge in these areas. Vitamin A supplementation is an evidence-based practice which reduces mortality and promotes proper development in infants and children. In response, we worked with the local government and NGO partners, to facilitate a programme to address this gap, using our detailed community data to identify the specific households that would benefit. As a result of these efforts, 1,221 infants aged 6-11 months old and 7,714 children aged 12-59 months were provided no-cost access to this vital intervention – 100% coverage.
These recent visits were a time to reflect on strategies to invigorate and enable faster adoption of digital health technologies, to address the persistent subnational health inequities which prevent many citizens from accessing essential services. What’s clear is that digital health is critical to hastening UHC progress in low and middle-income countries, but stakeholders need to work together to address some surmountable challenges.
1. Driving system change vs fragmented solutions
While it’s fantastic to see digital health players address different unmet needs in healthcare systems, such as health worker training and mHealth applications, this can result in fragmented approaches which fail to create the systemic change needed to achieve UHC. Digitally enabled health systems are also dependent on telecom companies and the monopolistic nature of this industry in many markets creates an additional barrier.
Standardization is vital to scale and each sector must learn to adopt a common framework for technology development, allowing transferability across national boundaries. At Allied World Healthcare, we have adopted all global healthcare data standards, but the regulatory environment around areas such as e-prescriptions and telehealth means our solutions have added complexity. A recent review found that more than 150 countries have absolutely zero Health regulations, for example. A robust regulatory environment with global standards helps to promote, rather than inhibit innovation, fosters consumer trust and addresses legitimate concerns about data privacy and product safety.
2. Designing health apps for access anywhere
Internet penetration is now at 63% in South-East Asia, with 415 million people having internet access – up from 380 million a year ago. But rural communities are at risk of being left behind as internet access often ranges from poor to non-existent in these areas. Digital literacy amongst those with more healthcare needs, such as older people, is still lacking. In addition, accessing the internet is often expensive for those people living in rural and remote areas who might benefit most from digital health solutions.
This notion is supported by data from rural India which suggests strong links between mobile phone ownership and health care access. Among the findings, poorer rural households without mobile phones experienced more adverse health events. A more enabling and competitive market among telecom providers in rural areas would help to reduce monopolistic practices, promoting technology diffusion and reducing prices for consumers.
Our determination to connect the unconnectable means we have had to embrace offline working for novice tech users. This has led to peer-to-peer syncing of devices, simpler user interfaces and using video instead of text. For any major player in this space, designing solutions for the limitations of the last-mile is of paramount importance. The digital divide must not create new forms of health inequities.
3. Power through data-driven insight into communities’ needs
As Steve Jobs once said: “You‘ve got to start with the customer experience and work backwards to the technology.” Yet, too often digital health solutions are not fully utilized as there’s been insufficient focus on understanding the real needs of communities and healthcare professionals.
When looking at our community-level data, a village’s health needs can be vastly different from another right next door. For example, our profiling has uncovered instances where Village 1 has an extremely high prevalence of diabetes, which is broadly non-existent in Village 2 next door, where we see that kidney disease is rampant. Analysing relevant data and uncovering the right insights will drive much more targeted and effective health solutions for local communities.
Governments and other stakeholders in South-East Asia have a tremendous opportunity to embrace digital health and leapfrog the long-standing barriers to UHC that exist in previous service delivery models. Government spending on digital health produces an outsized return on investment, providing a clear incentive for investment in such solutions. The private sector is already leading the way with scalable, innovative approaches and disruptive technologies that are poised to change the way that healthcare is delivered in the region. What is now required is full support, cooperation and investment from the public sector. This will fully unlock digital health’s potential as the driving force behind the region achieving its UHC 2030 goals.