53 Countries, 1 Digital Plan

In September 2022, WHO/Europe Member States adopted the first-ever digital health action plan for the WHO European Region. This ambitious 2023-2030 agenda defines four priorities to leverage digital transformation to improve people’s health.

What is the 12-page action plan all about? To find it out, I sat down with David Novillo Ortiz, Ph.D., Head of the Unit Data and Digital Health at the World Health Organization Regional Office for Europe (WHO/Europe).

What’s the background of the Action Plan?

In September 2020, under the leadership of our Regional Director, WHO/Europe adopted what we now refer to as the European Programme of Work (EPW), United Action for Better Health.

The EPW sets out our vision of how we can support health authorities and people in our Region to make better health choices and live healthier lives.

The strategy includes four flagship initiatives: mental health, immunization, behavioral insights and digital health. We’ve identified these flagship initiatives as especially important because they stretch across all areas of our work—from cancer prevention and treatment to mental health and rehabilitation.

Digital tools are an integral part of every functioning health system, and “digital” can be leveraged for virtually all areas of public health. One of the important traits of the initiative is that it complements actions that already exist in various countries and partner institutions by providing technical and policy guidance and expertise on the safety and efficacy of digital health solutions.

Why now? And what motivated WHO to make this step?

First, we have seen that digital solutions have really been a game-changer in response to the COVID-19 pandemic while also supporting the delivery of essential health services. Firstly, I mean how apps and listening tools enabled us to track the online “infodemic”—the spread of false, inaccurate information. Secondly, digital tools enabled patients to continue receiving care—talking with their GPs, online consultations, online prescriptions for medicines—while staying home because of lockdowns or other restrictions.  

Furthermore, in line with the WHO Global Digital Health strategy adopted in 2020, our purpose is to promote digital health systems to improve health at scale in the European Region and to support countries in leveraging and scaling up digital transformation for better health and in aligning digital technology investments with health system needs, while fully respecting the values of equity, solidarity and human rights.

Could you please summarize the four strategic priorities highlighted in the document?

The regional digital health action plan 2023-2030 identifies four strategic objectives towards the achievement of this plan. Each of them comprises several key regional focus areas, and each key regional focus area includes a number of illustrative actions, which are short-term actions that we plan to implement every two years. These strategic objectives have been identified in close coordination with our Member States and partners and based on our experience in the field.

The first one is about “setting norms, developing evidence-based technical guidance and formulating direction to support decision-making in digital health.” Our goal is to promote awareness of the importance of digital health, leading research and collecting available evidence, including guiding the development and testing of digital solutions.

If you look at other areas of work, WHO is very well known and recognized and respected for providing technical guidance and high-level advice. However, there are gaps when it comes to digital health. We are committed to ensuring that the WHO Regional Office for Europe, in close coordination with other WHO regions and headquarters, will take stock of the available evidence—of course, there are already technical documents available outside of WHO—and develop technical guidance so we can support our Member States not only with our expertise but also with the available evidence.

Our regional director, Dr. Hans Kluge, and our divisional director, Dr. Natasha Azzopardi-Muscat, are fully committed to this, and this is the reason that they decided to establish for the first time in WHO/EURO a unit on data and digital health that I have the honor to lead since January 2022.

The second strategic objective, related to “enhancing country capacities to better govern digital transformation in the health sector and advance digital health literacy,” focuses on assessing country capacities.

This also includes supporting the implementation of the technical guidance that I have mentioned in the first strategic objective. Besides, it covers supporting countries in developing or enhancing digital health policies or, at least, ensuring that a digital health component is part of an overall national health policy or strategy—digital health should be an enabler to achieving national health priorities and goals.

In addition, we are fully committed to strengthening digital literacy skills and capacity-building in the general population, with particular attention to the health workforce, for the use of digital health services and disease prevention and management.

For the third strategic objective, related to “building networks and promoting dialogue and knowledge exchange to facilitate interaction between partners, stakeholders and the wider public to steer the agenda for innovation in digital health,” we have ambitious plans.

First, to ensure that we are as much aligned as possible with our key partners—the European Commission, among others—that we can leverage the full potential and expertise of our institutions in this area of work in the European Region.

Second, to facilitate dissemination and exchange of good practices and lessons learned. As I mentioned before, this is a relatively new area of work if we compare it to areas such as communicable or non-communicable diseases. Still, we can say that we have some relatively good evidence about what works. But we still don’t know what has not worked well when implementing digital health projects. This is something we should be more open about moving forward.

And third, we plan to establish a strategic partnership council for digital health to promote the exchange of knowledge among the digital health, life science, and innovation communities and WHO, with the objectives of creating a dialogue forum to help bridge the public-private divide; helping identify the biggest implementation challenges in the Region and where WHO can support; and assisting in guiding WHO in identifying future strategic priorities for data and digital health.

Finally, moving to strategic objective four, “conducting horizon-scanning and landscape analysis to identify solutions that are patient-centered and can be scaled up at country or regional level to help shape public health and health systems in the digital era,” we will continue to monitor developments and trends in digital solutions, so you can look at WHO as a primary source of innovation to be up to date in this area of work. We expect that when you want to know what is up-and-coming in this field, you can look to WHO for that kind of advice.

To keep these actions up to date, we plan to present progress on the strategic priorities to the Member States and partners every two years. In addition, illustrative actions will be reviewed and updated as necessary.

The strategy has been accepted by WHO Europe 53 Member States during the WHO 72nd Regional Committee for Europe. So what is the next step from declaration to action?

The action plan now gives us a roadmap to move forward together on digital health. And, as you have rightly said, it’s time to move from words to action.

Apart from the longstanding tradition that WHO has in supporting countries to work on digital health at the local, regional and global level, these intense months of working with and learning from our Member States and partners in the development of this action plan have helped us identify the real priorities for the European Region.

From the 18 focus key regional areas presented in the plan, countries have been asked to prioritize the following: strengthen digital literacy skills and capacity-building in the general population, with particular attention to the health workforce; strengthen HIS and health data governance and use; foster innovation on predictive analytics for better health, through big data and artificial intelligence; promote and facilitate the dissemination and exchange of good practices and lessons learned in digital health among the Member States, and to ensure that a people-centered approach is considered so as to build trust and facilitate adoption.

For all these areas, we are currently working on developing technical guidance and capacity building. In addition, I am pleased to share with you that we are finalizing the data collection process of a regional digital health survey that we have used to develop this action plan and that we expect to publish as a report in the first quarter of 2023, so we can learn more about the current status of digital health in the European Region.

What instruments and tools will be used to implement the assumptions of the plan?

For this question, I would like to refer to the adopted resolution “Leveraging digital transformation for better health in Europe,” which highlights the commitments made by the Member States and WHO from 2023 to 2030.

In the case of the countries, among other commitments, they have been urged to better leverage digital transformation in health to promote health and well-being by:

• adapting to the current environment and health situation and trends;
• ensuring that decisions on and investments in digital health are based on evidence and driven by real needs;
• implementing the necessary changes to the financial, infrastructural, human, organizational and cultural resources of the digital ecosystem, respectful of national context;
• measuring the digital health literacy of health workers and citizens and enhancing their skills through digital training programmes;
• promoting health equity, gender equality and human rights as core values;
• establishing an integrated system to monitor, evaluate and ensure accountability for policies, plans, programmes and interventions.

We are convinced that these commitments, along with strong networks and partnerships, will help us to deliver the assumptions of this action plan.

How will WHO cooperate with WHO Europe Member States and European Commission to “support countries in leveraging and scaling up digital transformation”?

We have been working and cooperating with the WHO European Member States and the European Commission in this area of work for many years now, and they have been critical in developing and shaping this action plan and resolution.

In particular, all countries were contacted and involved in developing these strategic documents; and the European Commission, which leadership role is clearly acknowledged in the action plan and resolution, provided critical feedback, particularly in the development of the resolution. We are extremely grateful to our member states, the EC, our UN partners, and all relevant international partners that have contributed to and embarked on this adventure.

The European Region has been heavily impacted by the COVID-19 pandemic, and we have the opportunity of our lives in front of us to show that people-centered digital solutions, if widely adopted, have the potential to help overcome the challenges observed during this pandemic.

WHO has received the mandate from its member states to leverage and scale up digital transformation for better health. However, we know that we will be successful only by working together and placing the individual at the center of trustworthy care delivered digitally. That’s the reason why one of the strategic objectives is related to building networks and promoting dialogue and knowledge exchange. Translating these words into action, networks and partnerships were and will continue to be established so we can coordinate our efforts and deliver better results.

What’s the most significant benefit we can expect from the document?

I think the five most relevant benefits for the next two years, from my point of view, are:

• guidance on priority digital health areas is developed and provided to the Member States, and capacity is increased in these areas;
• a standardized approach is proposed for measuring digital health literacy skills in the population at the national and regional levels;
• international coordination and cooperation are enhanced for the benefit of Member States;
• a standardized approach to monitoring digital health at the national and regional levels is proposed;
• approaches are identified to empower end users and beneficiary populations using digital health services.

Let me be clear. Progress will come only if, first of all, we place the individual at the center; secondly, we understand health system challenges, including health needs and trends; thirdly, we recognize the need for policy decision-making based on data, evidence and lessons learned; and fourthly, we acknowledge that institutionalization of digital health requires a long-term commitment and an integrated care approach.

Apart from following these guiding principles, it’s important to remember that this is a team effort, and if we don’t work together in the same direction, we will fail. So it’s time for joint action.

—Off the record —

Let me conclude by thanking you for the opportunity to present our work to you and your readers and by acknowledging and thanking the 53 governments that have made this action plan a reality and the international partners that have contributed to shaping the action plan (in alphabetical order): the Asian Development Bank (ADB), the U.S. Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), the European Commission, the International Telecommunication Union (ITU), the Organisation for Economic Co-operation and Development (OECD), the United Nations Conference on Trade and Development (UNCTAD), the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), the United States Agency for International Development (USAID), and the World Bank.

Relevant links:

Action plan – Regional Committee for Europe, 72nd session. (‎2022)‎. Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: Regional digital health action plan for the WHO European Region 2023–2030. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/360950

Resolution – Regional Committee for Europe, 72nd session. (‎2022)‎. Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: resolution: leveraging digital transformation for better health in Europe: Regional digital health action plan for the WHO European Region 2023–2030. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/362959

Digital health at WHO/EUROPE – https://www.who.int/europe/health-topics/digital-health#tab=tab_1

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