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Using data and digital for health in challenging operating environments - the world

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Digital tools and data are revolutionizing health systems in countries around the world. Their impact in challenging work environments (COEs), in particular, has transformative potential—overcoming challenges that have impeded continued access to health services for millions of vulnerable people.

Despite being home to less than 14 percent of the world’s population, home-owned equipment is responsible for about a third of the global disease burden caused by HIV, tuberculosis and malaria. The intertwined crises facing the world today – the COVID-19 pandemic, hunger, conflict and the climate crisis – all have enormous implications for health. The World Health Organization reports that health systems in all regions and countries at all income levels have been severely affected, with little or no improvement since 2021. These deepening crises could continue to reverse hard-earned gains in tackling poverty, infectious disease and inequality, especially in contingent-owned units. But it also presents an opportunity to do things differently, using new tools and flexible methods to deliver health services to the most vulnerable.

Digital Innovations for Unit Owned Enterprises

the challenge

Accurate, timely data is the cornerstone of effective health systems. However, collecting data in centers of excellence – and delivering care – means confronting barriers to accessing remote and difficult populations, limited institutional capacity, and a shortage of already overburdened health workers, among other factors.

Where data is collected manually, records must be taken to public health institutions in major cities for analysis. Long distances and difficult terrain can slow this process, delaying health services for vulnerable populations.

In addition, managing the supply chains for distributing diagnostics, drugs, and other health goods can be time consuming when done manually — and likely to be inaccurate. Ineffective supply management systems can lead to drug shortages, shelf tests expiring, or shipments arriving too late to reach.

The solution

Access to high-quality data to make informed and timely decisions is key to helping frontline health workers improve service delivery for vulnerable people. People-centred digital tools, when implemented equitably, can enable reliable, real-time monitoring of disease outbreaks, support prevention and treatment efforts, and enable the community and other health workers to do their jobs more effectively and provide health services to populations in need.

Digital tools have great potential to increase access, as noted with the uptake 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 data in Guinea-Bissau was collected via a paper-based system and physically shipped to the National Institute of Public Health in the capital, kilometers across flood-prone terrain.

“It took about two to three weeks between collecting and analyzing local data,” says health worker Herculano Bras da Silva. This has made it nearly impossible to track malaria outbreaks in real time and respond to them in a timely manner.

In 2018, UNDP began working with partners in Guinea-Bissau to adapt the country’s District Health Information Program (DHIS) to support malaria data collection. To get the program into the hands of community health workers, UNDP and the Global Fund, with support from the World Bank, distributed portable devices for data recording and transmission, and trained CHWs in their use.

The digitization of health data has enhanced the national government’s ability to map and track malaria outbreaks in real time, resulting in improved response times. Live monitoring of new malaria cases is now routine in nearly 150 health facilities across the country of two million people. Problems can be detected quickly: for example, if real-time transmitted data shows that a woman visited a health facility during her pregnancy but did not receive a bed net or preventative malaria treatment as expected, it could mean that the health facility is temporarily out of stock. This can be quickly investigated and rectified by reallocating inventory from nearby facilities. This work is ongoing – in the first six months of 2022 alone, nearly half a million people have been tested for malaria, and 50,000 people have received treatment.

Increase efficiencies and improve supply chain management in Chad

Malaria is the leading cause of death for children under five years of age in Chad. Over a million children are eligible to receive preventive treatment, but treatment distribution is often delayed due to a health information system that requires workers to manually record data. This system made it difficult to assess the number of eligible children living in a community, keep track of who received treatment and decide which communities to prioritize when outbreaks occur.

Starting in early 2022, UNDP supported the digitization of the malaria prevention program in Chad, helping to train more than 1,300 community health workers in 13 health districts and 184 health facilities to collect digital data in the first phase of implementation.

“The main advantage of digitization… is that it allows us to control the data transmitted in real time at all levels,” explains Zaché Mpiam, Malaria Coordination Center in Kolodia Health District in Lac County. When distributing scarce resources, every remedy is important, so it is necessary to avoid discrepancies in the records. With digitization, “everything is centralized, we spot errors very quickly and can correct them in real time.”

In the first phase of the initiative, more than 200,000 children were reached. The beta also spawned important lessons that were incorporated into the second phase – such as creating IM groups for easier troubleshooting and sharing tips.

Building on these lessons, UNDP will expand the use of digital tools to prevent and treat malaria in 2023 to improve inventory management and distribution of bed nets. This could reach nearly 19 million people.

Preparing health care workers for success in Afghanistan

Internet connectivity, electricity and other utilities may be scarce across Afghanistan. This presents additional challenges when using digital health tools.

The United Nations Development Program, along with the Global Fund, supported the digitization of the National Malaria Control Program in Afghanistan. This requires working with partners to design software that works offline and then transfers data to a central database when the internet is resumed. All district malaria focal points have been trained and equipped with mobile devices, and the new monitoring system has been deployed nationwide. Another digital solution to respond to the specific needs of society is Afghanistan’s first mobile cash system, HesabPay, ensuring timely payment for healthcare workers.

Digital technologies and tools are the future in unit-owned entities

To end HIV, tuberculosis and malaria as public health threats, we need to reach the most vulnerable with prevention and treatment services, wherever they are. This is particularly important in contingent-owned equipment, where innovative and flexible solutions are required to address existing vulnerabilities and adapt to rapidly changing contexts. Digital and data solutions can play a critical 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 supports countries to 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 monitoring and evaluation program to track tuberculosis as well. In Guinea-Bissau, work is underway to increase the number of CHWs using digital devices.

The partnership between the United Nations Development Program and the Global Fund supports countries to build sustainable health systems that can withstand shocks and crises and drive progress against the three diseases. The Seventh Replenishment of the Global Fund represents an important opportunity to scale up digital and data solutions for more resilient health systems.

In line with the United Nations Development Program Strategic Plan 2022-2025 and his HIV strategy, health and development, UNDP partners with the Global Fund, governments and civil society to support and strengthen multisectoral national responses to malaria, by providing integrated policy, program and capacity development support. This has so far saved 7.3 million lives, and 1.5 million people are currently receiving treatment for HIV; 96 million people have been treated for malaria; detecting 1 million cases of tuberculosis and treating people; More than 1.1. One million health workers have been trained to support the response to COVID-19.