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Marelize Gorgens—Lead of the Digital Health Flagship Program at the World Bank—explains why we’ve been too siloed in our thinking on health digital transformation.
Why is digitalization in healthcare in the spotlight of the World Bank?
Our focus on digital healthcare is a response to what countries are struggling with, whether developing electronic medical records, enterprise architecture, or capacity building. It also supports our mission to work with countries on resilient health systems.
Governments and ministries of health we work with are placing increasing importance on digitalization. They face growing demands from consumers who view healthcare like other commodities and services they can interact and transact digitally. The ability to make appointments online for various services is commonplace, yet this convenience is lacking in the healthcare sectors of many countries we operate in.
Recently, the World Bank published a report, “Digital-in-health: Unlocking the Value for Everyone.” Could you please summarize the key findings?
We’ve been observing the global momentum towards digitalization and the growing evidence of the value of digital technology and data. Thus, we found it valuable to retrospectively examine the investments made by countries and other development partners in digital health over the past decade.
What we found is that the establishment of foundational infrastructure and the development of health information systems led to substantial improvements in health outcomes and the delivery of health services in countries.
However, as we look ahead, we acknowledge existing challenges: Investments in digital technology, data, and related fields are often isolated and fragmented. One example is disconnected health information systems and mobile apps with data that are not integrated into the national infrastructure. This fragmented environment leads to challenges, such as patients being double-counted and missed as they move from one health facility to the next.
“Digitial-in-Health means a future where digital technology and data are embedded in every facet of healthcare delivery.“
In the report, we propose a new mindset called “digital-in-health.” This approach advocates for a comprehensive and seamless strategy that integrates digital aspects in service delivery, health financing, nutrition, emergency preparedness and response, medical education, and drug discovery. In countries where this approach has been successful, digital technology seamlessly blends into healthcare, becoming an integral and almost invisible component.
Contrary to the past terminology of “digital health,” we envision a future where digital technology and data are embedded in every facet of healthcare delivery. The responsibility lies in intentionally integrating digitalization in healthcare delivery, health systems management, and public health to unlock the value of using technology in health for everyone.
The report emphasizes three core areas for countries to focus on connecting and filling in health information gaps, prioritizing equity, problem-solving for the underserved, and scaling to unlock value for everyone. It underscores the need to address gaps in health information systems through effective country leadership, scale efforts through good governance, and incorporate digital skills, collaborating innovatively with and among private sector stakeholders.
Recognizing the challenges healthcare workers face, including excessive paperwork and the simultaneous use of paper and digital records, we emphasize the importance, from their perspective, of providing digital technology and data solutions. The focus should be on easing their workload, increasing efficiency, and simplifying service delivery.
Lastly, the report acknowledges the widening digital gap between regions and within countries based on income levels and digital skills. It underscores the importance of addressing these disparities through strategic governance, collaboration, intentional design to reduce the digital divide and skill development initiatives.
We already see the rising digital gap between different regions and within countries driven by income level or digital skills. Will we manage to reduce this societal accessibility gap?
Reducing the digital gap and improving equity in health are interconnected. We cannot enhance health equity without addressing the digital divide. Due to the rapid adoption of technology, especially with the rise of generative AI, technology adoption in the health sector is accelerating in high-income countries. Even if low and middle-income countries or vulnerable populations within those countries maintain their current level of digital adoption, the divide will widen due to the faster pace of adoption in wealthier contexts.
It would be naive to assume that making a few investments will solve the issue, but governments can be intentional about it and enable meaningful change. When facing resource constraints, governments must operate within specific budgets, choosing what to finance and invest in.
“Reducing the digital divide is a multisectoral issue and involves all aspects of human capital.“
Consider this example: if a government had to choose between upgrading to a new electronic health record system versus rolling out a basic telemedicine service that reaches rural areas and underserved patients, I would argue that prioritizing the telemedicine service is a higher priority. The only way to address the digital divide is through intentional investment decisions.
This “small is big” approach is crucial. Sometimes, small, incremental progress—measured along the way—leads to the most significant and sustainable transformations. But we must also ensure that every dollar invested in digital technology and data is well-spent.
Reducing the digital divide is a multisectoral issue and involves all aspects of human capital—our report demonstrates that almost half of the World Bank’s investments benefiting digital health originate from sectors like e-government, digital ID, social protection, and education for digital skills.
In recent years, big tech has entered healthcare with new business models. Is this a positive or negative trend?
The more people and institutions we have at the table—aiming to address challenging healthcare issues globally—the better. Whether they are major players, smaller entities, or locally grown initiatives, each has a valuable role in the digital health space.
Governments should consider certain key questions when contemplating private sector involvement in digital health. A crucial aspect is establishing clear rules. Just as we drive on a particular roadside and adhere to stop signs and traffic lights, a digital health ecosystem requires standardized rules for seamless operation.
Insights gathered during interviews we conducted while researching for the report suggest that private sector stakeholders face the same challenges as governments—challenges that occur because of uncertainty about regulation and fragmented, siloed solutions. Private sector entities want to contribute to the sector’s growth, benefit the economy, and enhance people’s health and well-being. However, their success hinges on governments having well-defined standards, regulations, and certification processes. This ensures that all players understand interoperability rules, data standards, data exchange protocols, health data protection measures, and cybersecurity rules.
The private sector has and will continue to play a pivotal role in digital transformation. Governments must establish regulations to foster innovation without stifling it through overregulation. Striking the right balance is crucial.
2023 was the year of generative AI. Are you waiting with concern or optimism for the AI developments in healthcare?
There are immense opportunities for AI to reduce the digital divide. One significant barrier is that many countries possess outdated information systems or they are still using paper records. The potential of AI to summarize and integrate this legacy medical and health information is unparalleled. It opens up opportunities to consolidate a person’s health data in one place and allows clinicians or health workers to easily access all relevant information. Areas like AI-based radiology, where over 75% of FDA approvals for AI-enabled medical devices are granted, showcase its potential.
However, there are also risks. The rapid pace of technology adoption in high-income countries may widen the digital divide. Concerns about ethics, privacy, and technical risks are arising. Healthcare decisions are not always reversible, demanding a conservative and careful approach. Recent developments include the establishment of regulations for AI, such as the Belgrade Declaration on AI safety, agreed upon by 28 countries.
Low and lower-middle-income countries face the challenge of navigating AI’s potential without getting distracted or missing out on its benefits. Identifying low-hanging fruit in AI investments is crucial. Our report provides specific recommendations, recognizing that the rapidly evolving nature of AI may alter observations and recommendations in the coming months. These countries need to stay abreast of AI advancements and strategically invest in areas where the technology can bring immediate benefits.
What have you learned during your 17-year World Bank career that is driving your approach to digital health?
My first lesson is that we must embark on digital transformation together. Many of our investments these days are multisectoral. For example, when considering digital health, we must include investments in ICT by the Ministry of Communications and also investments by the Ministry of Education. There’s genuine wisdom in the saying, “If you want to go far, go together.”
The more countries take the driver’s seat and make decisions, the more their capacity grows as they share experiences within the country and with others—this is the second lesson I’ve learned, drawing on my experience in advising the Indian government on their HIV and nutrition programs.
This brings me to the third point: sometimes, the most significant changes we can make are not necessarily the largest ones. While substantial, system-wide shifts are necessary, not every change must be extensive. Minor adjustments build on each other, and their cumulative effect can be transformative.
As someone with an engineering background, I value data and analytics. We need to demonstrate the value of data and technology, whether in HIV or health emergency preparedness. We must show countries the practical value of digitalization, making it clear how data and technology can address health sector challenges.
Can you give one piece of advice about investing in digital health?
Instead of operating in silos, the development community should adopt a more horizontal approach, moving away from vertical programs with isolated information systems, like, for example, a malaria information system or a TB information system. It’s crucial to connect these disparate data points universally, by the patient and by the health facility, regardless of when or the kind of health service provided. Breaking out of silos, establishing open standards, open content, and ensuring open access to data in a secure and well-governed environment can allow us to connect these data dots effectively and bring more value.
Click here to read the report DIGITAL-IN-HEALTH: Unlocking the Value for Everyone.
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