Digital and data tools are revolutionizing healthcare systems in countries around the world. In particular, their impact in Challenging Operating Environments (COEs) has transformative potential – addressing challenges that have hampered sustained access to health services for millions of vulnerable people.
Despite housing less than 14 percent of the world’s population, COEs are responsible for about a third of the global burden of disease from HIV, tuberculosis (TB) and malaria. The intertwined crises facing the world today – the COVID-19 pandemic, hunger, conflict and the climate crisis – all have enormous health implications. The World Health Organization reports that health systems are severely compromised in all regions and in countries of all income levels, with little or no improvement since 2021. These deepening crises could continue to undo hard-won gains in tackling poverty, infectious diseases and inequality. especially in COEs. But they also offer an opportunity to do things differently, using new tools and flexible approaches to deliver health services to the most vulnerable.
Digital innovations for COEs
The challenge
Timely and accurate data is the cornerstone of effective healthcare systems. But collecting data in COEs — and providing care — means, among other things, struggling with barriers to access to remote areas and hard-to-reach populations, limited institutional capacity, and a shortage of health workers that are already overwhelmed.
When data is collected by hand, the records must be transported to public health facilities in major cities for analysis. Long distances and difficult terrain can slow this process and delay healthcare for vulnerable populations.
Additionally, managing supply chains for the distribution of diagnostics, drugs, and other healthcare goods can be time-consuming when done manually — and tends to be imprecise. Inefficient supply management systems can result in drugs being out of stock, tests on the shelf expiring, or shipments being late to be hard to reach.
The solution
Access to high-quality data to make informed and timely decisions is key to supporting frontline health workers to improve the delivery of services to vulnerable people. Human-centric digital tools, when used fairly, can enable reliable, real-time surveillance of disease outbreaks, support prevention and treatment efforts, and empower local and other health workers to do their jobs more effectively and deliver health services to populations in need.
Digital tools have great potential to increase access, as seen in the adoption of the use of telemedicine and other digital health technologies in response to COVID-19.
Spotlight Stories: Digital Technology and Data Solutions in Guinea-Bissau, Chad and Afghanistan
Support real-time health monitoring in Guinea-Bissau
Prior to digitization, health records in Guinea-Bissau were collected via a paper-based system and physically sent to the National Institute of Public Health in the capital, which lies miles through flood-prone terrain.
“It took about two to three weeks from local data collection to analysis,” says health worker Herculano Bras da Silva. This made it nearly impossible to track malaria outbreaks in real time and respond in a timely manner.
In 2018, UNDP began working with partners in Guinea-Bissau to adapt the country’s District Health Information Software (DHIS) to support the collection of malaria data. To get the software into the hands of community health workers, UNDP and the Global Fund, with support from the World Bank, distributed mobile devices to record and transmit data and trained community health workers on how to use them.
This digitization of health data has strengthened the national government’s ability to map and track malaria outbreaks in real time and improve response times. Live surveillance of new malaria cases is now routine at nearly 150 health facilities in the country of 2 million people. Problems can be identified quickly: For example, if the data transmitted in real time shows that a woman visited a health facility during her pregnancy but did not receive a mosquito net or malaria prevention as expected, this could mean that the health facility is temporarily closed sold out. This can be quickly investigated and corrected by reallocating inventory from nearby facilities. That work continues – in the first six months of 2022 alone, nearly half a million people were tested for malaria and 50,000 people were treated.
Increasing efficiency and improving supply chain management in Chad
Malaria is the leading cause of death among children under five in Chad. More than 1 million children are entitled to preventive treatment, but distribution of treatment is often delayed by a health information system that requires staff to manually collect data. This system made it difficult to assess how many eligible children were living in a community, keep track of who was being treated, and determine which communities to prioritize during outbreaks.
Beginning in early 2022, UNDP supported the digitization of Chad’s malaria prevention program, helping to train more than 1,300 community health workers in 13 health districts and 184 health facilities on digital data collection in the first phase of implementation.
“The main advantage of digitization … is that we can control the data sent in real time at all levels,” explains Zachée Mbayam, malaria focal point in the health district of Kouloudia in the province of Lac. When allocating scarce resources, every treatment counts, so it is important to avoid discrepancies in records. With digitization, “everything is centralized and we can identify errors very quickly and correct them in real time.”
Over 200,000 children were reached in the first phase of the initiative. The pilot project also yielded important lessons that have been incorporated into the second phase – such as: B. Creating instant message groups to facilitate troubleshooting and sharing tips.
Building on these findings, in 2023 UNDP will expand the use of digital tools to prevent and treat malaria to improve inventory management and mass bednet distribution. This means that almost 19 million people can be reached.
Preparing healthcare workers for success in Afghanistan
Internet connection, electricity and other utilities can be scarce throughout Afghanistan. This poses additional challenges when using digital tools for health.
UNDP, together with the Global Fund, supported the digitization of the national malaria program in Afghanistan. This required working with partners to develop software that works offline and then transfers data to the central database when the internet connection is restored. All provincial malaria contact points have been trained and equipped with mobile devices, and the new surveillance system has been rolled out nationwide. Another digital solution to address the specific needs of the community is Afghanistan’s first mobile money system, HesabPay, which ensures healthcare workers are paid on time.
Digital technologies and tools are the future in COEs
To end HIV, TB and malaria as public health threats, we must reach the most vulnerable with prevention and treatment services, wherever they are. This is particularly important in COEs, where innovative and flexible solutions are required to address existing weaknesses and adapt to contexts that can change rapidly. Digital and data solutions can play a crucial role in improving the efficiency and effectiveness of health services and increasing access to health services for hard-to-reach populations.
Through its partnership with the Global Fund, governments, civil society and others, UNDP helps countries implement digital tools that respond to their unique challenges and improve the health of their citizens. In Afghanistan, UNDP is supporting the expansion of the digital surveillance and assessment program to also track tuberculosis. Guinea-Bissau is working to increase the number of community health workers using digital devices.
The UNDP-Global Fund partnership is helping countries build sustainable health systems that can withstand shocks and crises and drive progress in tackling the three diseases. The Global Fund’s seventh replenishment is an important opportunity to scale digital and data solutions for more resilient health systems.
In accordance with UNDPs Strategic Plan 2022-2025 and be HIV, Health and Development Strategy, UNDP works with the Global Fund, governments and civil society to support and strengthen multisectoral national responses to malaria by providing integrated support for policy, programs and capacity development. To date, this has saved 7.3 million lives, 1.5 million people are currently on HIV treatment; 96 million people treated for malaria; 1 million TB cases detected and people treated; over 1.1. Millions of health workers trained to support COVID-19 responses.
