Digital Inclusion in Healthcare
- A Double Edged Sword?
The closing of borders and lock-downs due to the COVID-19 pandemic have undoubtedly narrowed the geographic focus and range of news topics. Thus an email from the British DFID's Frontier Technology programme drew my attention. It was seeking funding applications for the provision of “data sources, tools, and analysis solutions to allow the development sector to respond more effectively” to COVID 19.
This reminded me of an article by Andrew Jack in the September 2018 issue of FT's “Impact Investing” publication about potential pitfalls of funding and employing digital solutions in health services. Rather than examining ramifications, several earlier posts in this blog reviewed conditions in developing countries that hamper digital inclusion from realising its potential for lifting living standards. Andrew's perspective is truly eye-opening and should not be lightly ignored in the frantic push for solutions.
Against a background of enthusiasm over the advances digital solutions have already made in the areas of prediction, prevention, remote detection, diagnosis and treatments, Andrew raises a few concerns. In his well-balanced article, Andrew includes some case studies to illustrate some of their benefits. While such technology can potentially reach and improve the health and lives of the world's poorest in the remotest parts, it also promises greater impact. Subsequently, this also attracts impact investors foreseeing that such new approaches may lead to the generation of “sustainable financial and social returns at a time of squeezed public sector budgets, donor retrenchment and the need for greater efficiency.”
He argues that this may be accompanied by several caveats. In general, technology biased impact investors could find other solutions promising a greater impact less attractive. Such cases could be the scaling up of existing approaches, the improvement of training, and lower-cost drug-supplies. Further, it may undergird already existing disparities between those with digital access and those without. There is also a caution that digital health-care solutions funded by impact investors encourage “cherry-picking patients” offset by only moderate returns. In such a broader, more inclusive perspective, it may even lead to “brain-drain” in government health services with a detrimental effect on the wider public.
The road of hell is paved with good intentions
Quite literally, impact investors might fail to realise the desired outcome when digital solutions are only affordable to those who can pay for them or those with health insurance policies. In some cases, beneficiaries' living standards are comparable to those investing in technologies affordable to them!
Potential for exploitation
Accuracy, access and speed of data availability are major advantages of digital solutions over other recording and communication methods. The lack of adequate quality of patients' records can have severe consequences at an individual and national level. Digital solutions easing administrative work and aiding the management of patients are in demand. However, there are two more concerns voiced in this article about the use of data. Essentially, the privacy and safety of personal and medical data need to be weighed against any potential benefits. This applies specifically to politically unstable countries.
Interoperability is another critical factor when deciding to partner with a digital solution vendor in projects intended for large-scale roll-outs. Often they are pioneering solutions and therefore lack competition. Their potential savings or benefits appear to compensate for the risks of establishing vendor over-reliance. When the vendor goes out of business, systems may no longer be maintainable. The lack of interoperability could also prevent wider or better use of the data because of incompatibility with other systems, as suggested in Andrew's article. Without competition, public procurement processes designed to ensure accountability are not enforceable. As a result, services such as updates, customisation, the introduction of new features, user training, etc., may incur higher operational costs and their availability may be limited.
Andrew Jack's article implores impact investors to consider the wider implications of digital solutions intended to address lack and inefficiencies in developing countries' health-care systems. Even though digital solutions often target specific areas, comprehensive consideration of all interests is advisable to serve the common good in the long term. This also cautions against any hasty decisions in a crisis such as this pandemic to avoid unintended consequences.
Frontiers Technology- COVIDaction Data Challenge: https://bit.ly/COVIDaction-Data
Andrew Jack: “Treat with caution” in Financial Times Impact Investing, September 2018, pp.30-31