Achieving universal health coverage through digital data driven systems

In 2005, the World Health Assembly urged member states to develop long term strategic plans to guide the development of a structure for information and communication technology for health in their context. This would enable countries to promote equitable, affordable and universal access to healthcare. Since then, over 70 member states, including developing countries, have developed such strategies and policies. 

In 2013 the World Health Assembly adopted a resolution on eHealth standardisation and interoperability which urged member states to develop policies and legislative mechanisms that are linked to the overall eHealth strategy.
In order to strengthen digital health implementation, the world health assembly adopted a resolution on digital health and consequently developed the global strategy on digital health 2020/2025. 

With a vision of achieving  “improved health for all, everywhere through accelerated development and adoption of scalable person-centered digital health solutions”, the strategy was launched in March 2019 and endorsed at the 73rd World Health Assembly.

Relatedly, the Ministry of Health also recognised eHealth as a key enabler to improve health services delivery. However, the Ugandan health sector is characterized by a fragmented landscape of ICT pilot projects and numerous data and Health Information System silos which limit effective sharing of information between healthcare participants.
 
Many health sector actors are continuing to invest in a range of digital health initiatives without any form of national plan and coordination thus posing a risk of duplication, ineffective expenditure and creation of new digital health solutions that cannot be integrated or scaled across the continuum of care.  
To establish a coordinated communication mechanism for eHealth initiatives in Uganda, the ministry of Health developed a national eHealth policy 2016 and the 2017-2021 eHealth strategy.  

Although Health information is a vital health system component for effective decision-making, a number of health information and digital health system challenges persist; posing a threat to achieving UHC. Such challenges include; limited qualified cadres in health information systems at lower-level health facilities; inadequate standard operating procedures ; limited knowledge of lower-level health facility Information system management teams on data security, data sharing, reporting.  

Uncoordinated and duplicate health information platforms yet with limited integration into the national health information systems exist. There are limited individual skills, financial resources and lack of Standard Operating Procedures for digital health resources, equipment and infrastructure maintenance. 
There is also limited use of electronic health records for clinical care, research and routine data analytics to inform policy and pragmatic decision-making. 

In May 2023, the ministry of health developed and launched the health information and digital strategic plan (2020/21 to 2024/25) to address these issues and to offer a strategic direction for the digitization of Health Information. 

Aware that Digital health and data-driven health systems play a critical role in achieving UHC, there is a need to address health data related issues: Due to its sensitivity, unprotected health data can expose individuals, groups and communities to harm including; data-driven exploitation, harassment, discrimination and surveillance.  

To achieve UHC, Uganda needs to adopt health data governance principles in the implementation of eHealth related policies. These Health Data Governance principles bring a human rights and equity lens to the use of data within and across health systems to:  protect people, individuals, groups and communities; promote health value through data sharing and innovative use of health data and; prioritize equity- by ensuring equitable benefits from health data.

Mr  Frank Ategeka- is Global Health Corps Alum, a public Health specialist and a digital health and rights advocate.