As we approach the end of the twenty-first century’s second decade, there’s a growing sense of urgency thanks to the United Nations’ Sustainable Development Goals, which seek to achieve significant progress against health and related global challenges by 2030.
The UN recently called for much more work in this area, arguing that it is “critical to assess how technology can be mobilized to provide solutions to our greatest challenges”. If we are to extend universal healthcare to almost nine billion people – the anticipated population of the world in 2030 – in just over a decade, it is clear that business as usual and reliance on existing solutions won’t get us there.
Put simply, the Sustainable Development Goals will not be reached without digital technology and innovation playing a significant role. As the Global Health Council has found, digital solutions have enhanced health progress in low- and middle-income countries, by expanding reach, growing coverage and accelerating the speed of services. Many of these innovations are being used to reduce inefficiencies, improve access, reduce costs, increase quality and personalize care. Well-established examples include:
- mobile phone-based health applications for issues ranging from disease surveillance to stock control and management
- telemedicine for providing medical services virtually to patients
- wearable devices and drones being used in a variety of applications from surgery to drug delivery.
Complexity and fragmentation
However, there are three challenges that we need to contend with if we are to realize the benefits of the digital revolution for sustainable health. The first is that a focus on digital technologies risks putting the technology cart before the health horse. After all, technologically driven approaches in developing countries have had, at best, an uneven history. Well-known – and justified – critiques have focused on technological over-optimism and ‘technology transfer’ that consists of little more than development organizations trying to copy and paste tech solutions into developing countries with little attention to context or complexity.
There are also numerous instances where technological development has occurred despite the development sector, which is then left sprinting to catch up. The technology hype cycle is prevalent and damaging for development prospects and ambitions. This seems to be especially the case with digital technologies because the cost of developing apps in the twenty-first century is far less than, say, a tractor or a piece of plant machinery in previous decades.
The second issue is that without due care, digital technologies can and will enhance and exacerbate inequalities rather than address and overcome them. A mobile phone-based system for healthcare delivery will by its very nature exclude the most impoverished and vulnerable – at last count, according to the World Bank, the two billion poorest people in the world have no access to a mobile phone and four billion have no access to the internet. This leaves the majority of the most vulnerable well beyond the scope of digital health innovations.
One could even argue that it will become ever harder to ‘leave no one behind’ if digital technologies become the mainstay of global health efforts. Moreover, the exclusive nature of technological development more generally in health – witness the battles over drug patents that continue to rage – threaten to emerge as a major issue in digital health, with ever greater emphasis on proprietary technologies and monopolistic platforms.
The third challenge concerns the context in many developing countries. The potential of digital health can be far from fully realized because of fragmented and imperfect markets in which many not-for-profit, public and private players work in silos. There’s often a huge amount of duplication, overlap and waste. In such settings, again according to the Global Health Council, “scaling of promising digital health solutions is… impeded by a lack of coordinated funding that aligns with government priorities, limited leadership and peer support, and a lack of support and availability of technologies that could be reused or adapted”.
A system that works for end users
How to navigate this set of quandaries? Landmark work on frontier technologies in development has shown that the more technological development efforts are grounded in specific, tangible health challenges, the more sensitive they will be to national and local political and cultural contexts. Furthermore, if they can include local communities, organizations and governments as active creators and owners and not just as targets or end-users, they’re far more likely to be successful.
In order to capitalize on all this, we need to put in place a new kind of innovation system. This must be more evidence-based and systematic, more anticipatory and dynamic, and more open to new ideas and approaches, wherever and from whomever they originate. Ultimately, the system needs to be more geared to the needs and opportunities faced by poor and vulnerable people.
With this in mind, I would put forward three sets of recommendations for the international development community, drawing on the work of myself and colleagues at the Institute of Development Studies (IDS):
- Enhance the development, testing and diffusion of novel digital technologies with a firm focus on ensuring these technologies are implemented with attention to the evidence base for their effectiveness
- Ensure better management of quality and risk throughout the digital technology development process, with particular attention paid to the risks faced in developing country contexts, and by those intended beneficiaries of the innovations in question
- Focus efforts on achieving outcomes for the poorest, working in adaptive and astute ways to simultaneously solve technical, economic political barriers to advancing health goals.
I would like to give the final word to Sir Tim Berners-Lee, inventor of the World Wide Web, who wrote the following in his foreword to my team’s 2016 report on frontier technologies for international development report. I believe that those eager to see digital technologies in the twenty-first century contribute to health gains equivalent to the remarkable innovations of previous centuries would do well to adopt the ideas below as a fundamental guiding philosophy.
Without due care and attention… new technologies will become uneven playing fields, with a select few winners and many more losers…
“to ensure these exciting technologies realize their potential to contribute to economic growth and social progress, people in developing countries will need sustained and thoughtful engagement. Along with patient investment in novel approaches, there will need to be adaptive and intelligent approaches to anticipate and head off risks and protect users’ rights, as well as creative ideas for building these technologies on open standards and applying them in ways that meet the needs of those in developing countries.”