the health strategist
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Joaquim Cardoso MSc.
Chief Research and Strategy Officer (CRSO),
Chief Editor and Senior Advisor
December 14, 2023
What is the message?
The State of Digital Health Report 2023 provides a comprehensive analysis of global digital health trends, showcasing progress and challenges in the digital transformation of health systems.
The report is based on data from 67 countries participating in the Global Digital Health Monitor (GDHM) and highlights key insights to inform strategic decision-making.
One page summary
What are the key points?
Global Digital Health Trends:
The report analyzes digital health trends based on data from 67 countries across all WHO regions, demonstrating significant progress since 2019.
GDHM Expansion:
The GDHM, a multi-stakeholder platform, saw increased participation from 22 countries in 2018 to 67 in 2023, reflecting a growing global focus on digital health.
Digital Health Maturity Scale:
The GDHM indicators are mapped to a 5 Phase Maturity Scale, enabling countries to assess their digital health maturity, prioritize investments, and monitor progress year on year.
Component Analysis:
The report breaks down digital health maturity across seven components, with Leadership and Governance being the most mature and Workforce the least.
Strategies and Initiatives:
Strategies like the Global Initiative on Digital Health (GIDH) aim to strengthen alignment and cooperation, addressing gaps in the enabling environment and foundations.
What are the key strategies?
- GDHM Redesign: The GDHM underwent a review and redesign in 2022, aligning with the WHO’s global Digital Health Strategy and post-COVID-19 realities.
- Maturity Scale and Annual Survey: The Maturity Scale and annual survey help countries understand and prioritize their digital health investments.
- GIDH Launch: The Global Initiative on Digital Health (GIDH) was launched to promote cooperation, knowledge sharing, and country support in digital health transformation.
What are the key examples?
- Digital Health Components: Leadership and Governance exhibit high maturity, while Workforce lags behind, indicating a need for targeted interventions.
- COVID-19 Impact: The pandemic accelerated investments in Infrastructure and Services, fostering remote health service delivery and global standards adoption.
- GDHM Impact: The GDHM serves as a benchmarking tool, encouraging countries to participate for a more accurate representation of national and global digital health maturity.
Conclusion
The State of Digital Health 2023 underscores advancements in digital health while emphasizing the need for inclusive strategies and intentional workforce development.
The report highlights the role of systematic prioritization in leveraging digital health technologies for Universal Health Coverage and improved health outcomes.
The launch of the Global Initiative on Digital Health further signifies global efforts to address existing challenges and foster cooperation in the digital health landscape.
Infographic
DEEP DIVE
The State of Digital Health 2023
Global Digital Health Monitor
Report prepared by:
Emeka Chukwu, HealthEnabled
Patricia Mechael, HealthEnabled
Joanne Ke Edelman, Global Development Incubator
Erica Layer, HealthEnabled
Executive Summary
The State of Digital Health Report 2023 offers a comprehensive analysis of global digital health trends based on data from 67 countries across all WHO regions participating in the Global Digital Health Monitor (GDHM), complemented by secondary data from other sources. The GDHM, a multi-stakeholder, web-based platform, provides insights into the digital health maturity of countries across seven digital health enabling environment component areas. This report reflects progress since the State of Digital Health Report 2019, expanding on the GDHM’s participation from 22 countries in 2018 to 67 in 2023. It also contextualizes the analyses within a broader context of complementary trends analyses and digital health initiatives. The year 2023 witnessed tremendous activity worldwide in the digital transformation of health systems, culminating in the launch of the World Health Organization’s Global Initiative on Digital Health.
The GDHM undertook a review and redesign in 2022 and was relaunched in 2023 alongside the World Health Assembly in Geneva, Switzerland to align with WHO’s global Digital Health Strategy and meet present realities post-COVID-19. The GDHM indicators were updated to ensure consideration for emerging technology and AI, equity, gender, Universal Health Coverage, person-centered health, and population health. The indicators are mapped to a 5 Phase Maturity Scale, captured through an annual survey, to enable countries to understand where they are now and, more importantly, to prioritize where they should invest. It then enables countries to monitor their investments year on year. In 2023, the GDHM was approved as a Digital Square Content Global Good. Participating countries use the GDHM to benchmark, compare themselves globally or regionally, and monitor progress. For non-participating countries, publicly available data is used to estimate digital health maturity, encouraging these countries to participate in a more accurate representation of national and global digital health maturity.
Of the 67 participating countries,
- most countries (40%) are at Phase 3 of digital health maturity,
- followed by 33% at Phase 2 and
- 22% at Phase 4.
- No country is at Phase 1, indicating growing advancements in digital health.
Across the seven components of the digital health enabling environment as defined by the WHO/ ITU eHealth Strategy Toolkit, Leadership and Governance is the most mature, while Workforce is the least. The following is a high-level breakdown of the state of digital health across participating countries by component.
Leadership and Governance: A third of countries are either at Phase 4 or 5, making this component the highest performing component. Significant efforts are also ongoing and focused on promoting equity and gender balance in digital health programs. There is a notable rise in the adoption of emerging technologies like AI, blockchain, IoT, and VR in healthcare. However, 55% of countries show no progress in readiness for at least one of these technologies.
Strategy and Investment: Many countries have developed national digital health strategies, but only 47% are in Phase 3 or above in Strategy and Investment. Digital health funding remains insufficient in most countries, with 90% of them meeting only half of countries’ national digital health needs. A supportive environment for private sector investment is also limited and focused largely in high-income countries.
Workforce: The workforce is the lowest performing component, with over 50% of countries yet to integrate digital health in pre-service or in-service training for health professionals. In addition, over 70% of participating countries do not have a defined public sector career path for digital health.
Legislation, Policy, and Compliance: Almost half of the countries indicate Phase 4 or 5 in the Legal Framework for data protection and for privacy, consent, and confidentiality. Over half do not have any mechanism for certifying AI in health applications.
Standards and Interoperability: While most countries have adopted standards, many do not have national architectures or health information exchanges to enable individuals’ health information to move seamlessly through the health system.
Infrastructure: Infrastructure and network readiness have increased in maturity,
particularly during the COVID-19 pandemic. However, it still needs to be at the highest
levels of maturity required for full digital transformation of health.
Services and Applications: Most countries do not have digital health interventions that align with their national health priorities, but they do have the foundational building blocks to support them in the form of national registries. While many countries have digital health systems that help monitor population health, many do not have patient feedback systems to engage individuals in reflecting on the quality of the services they are receiving.
Comparisons between the State of Digital Health 2019 and 2023 highlight the effects of COVID-19 with accelerated investment in Infrastructure as well as the adoption of Services and Applications within the health system in support of remote health service delivery, including telehealth, digital self-care, remote patient monitoring, and portable personal health records. It also increased the adoption of global standards, including those related to vaccination certification, resulting in an increase in maturity of the indicator related to cross-border data sharing and use.
The State of Digital Health 2023 highlights the advancements in digital health across various components of the enabling environment. It emphasizes the need for a more inclusive and intentional approach to digital health alongside strategies and policies to harness the benefits and mitigate risks of emerging technology, such as Generative AI.
It also highlights a persistent gap in the Workforce needed to design, use, and deploy digital health interventions. Through systematic prioritization and monitoring of digital health investments, we can more effectively leverage digital health technologies to achieve Universal Health Coverage, improve health outcomes, and strengthen health systems.
THE GLOBAL INITIATIVE ON DIGITAL HEALTH (GIDH)
GIDH, or “Guide”, was launched in August 2023, as a key outcome of this year’s G20 health working group process. Given the rapidly growing demand from countries to move from a state of digital health experimentation to systematic digital health transformation, stronger alignment and cooperation across the ecosystem is needed. As noted in this report, investments in the enabling environment and foundations are lagging behind, and fragmentation in technical support and resource allocation continues to hinder effective progress across the globe.
Guide, a WHO-managed network of networks, builds on experiences gained during the COVID-19 pandemic to strengthen mechanisms for country support, and develop the tools and quality assured content and technologies that countries need to be in the driver’s seat of their own digital health transformation. Guide plans to strengthen knowledge sharing across stakeholder groups, communities of practice and technical agencies. Guide will initially work in lighthouse countries to support public sector leadership and focus development partner efforts in achieving articulated digital transformation priorities. The Monitor will serve as an important instrument for the priority setting and monitoring progress.
Introduction
Welcome to the State of Digital Health 2023 Report, a comprehensive analysis of the trends in digital health based on 67 countries that participated in the Global Digital Health Monitor (GDHM) in 2023, representing over one-third of all countries across all regions of the world.
The GDHM is a multi-stakeholder interactive web-based open data platform and global public good that provides visibility into the status and historical progression of key standard digital health performance indicators at national, regional, and global levels. It empowers health ministries, policymakers, and industry to make intelligent and informed strategic decisions about how and where to allocate resources as they strive to improve health and well-being for all through digital transformation of national health systems.
Developed through an intensive participatory process involving governments from high, middle, and low-income countries, the GDHM benchmarks countries along a five-phase maturity model against 23 standardized digital health indicators. It serves as a keystone for the World Health Organization (WHO) Global Initiative on Digital Health and uses the WHO/ITU eHealth Strategy Toolkit as the underlying framework. It was originally launched at the World Health Assembly as the Global Digital Health Index and Maturity Model in 2018 alongside the WHO Digital Health Resolution and has since undergone a comprehensive review and redesign process to better contribute to the WHO Global Strategy on Digital Health 2020-2025 with updated indicators reflecting Universal Health Coverage, pandemic preparedness, person-centered health, population health, emerging technologies, and equity/ human rights – including gender.
Governments use the GDHM to inform the development of national digital health strategies and policies at national and sub-national levels. Along with WHO, the World Bank; Africa CDC; UNICEF; The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and other international organizations are using the GDHM to prioritize funding and investments and monitor performance. In 2023, The Global Fund supported country mobilization for 55 high-impact and core countries, the majority of which are in Africa and Asia.
These and some additional countries were also mobilized to participate through global and regional networks such as the Asia eHealth Information Network (AeHIN), the International Society for Telemedicine and eHealth (ISfTeH), and Red Centroamericana de Informática en Salud (RECAINSA), that use the GDHM to identify and prioritize joint learning opportunities that can benefit multiple countries. It facilitates learning and sharing of resources from and by countries that are further ahead in specific areas.
The GDHM serves as a vital digital resource with the aim to empower stakeholders, evaluate national digital health maturity, and motivate strategic action toward digitally transformed health systems and improved health outcomes.
The purpose of this report is to present a detailed analysis of the current state of digital health in 2023, utilizing the data and insights gathered mainly through the GDHM. This report reflects progress made since The State of Digital Health Report 2019 and the expansion of GDHM participation from 22 countries at inception in 2018 to 67 countries post-redesign in 2023. The report seeks to illuminate the advancements, trends, and challenges in scaling and sustaining digital health interventions and enablers, providing key stakeholders with insights to guide future initiatives both at the country and global levels.
Year in Digital Health 2023
The year 2023 witnessed unprecedented milestones in digital health, all geared towards attaining the strategic objectives set out for member states and other stakeholders in the WHO Digital Health Strategy 2020- 2025. In August 2023, at the G20 Summit in India, the WHO launched the Global Initiative on Digital Health to accelerate the use of digital technologies in achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDG) as important contributions to the achievement of the Digital Health Strategy. The GDHM’s revised set of 23 indicators were updated to align with the strategic objectives of the WHO Strategy, paving the way for a standardized mechanism for implementation progress monitoring as a foundational resource within the Global Initiative on Digital Health. Other noteworthy milestones include the update of the WHO Classification of Digital Health Interventions, the WHO’s landmark digital
health partnership with the European Union (EU), and the joint partnership of the Pan- America Health Organization (PAHO) with the Inter-American Development Bank (IADB) to facilitate digital transformation in the Americas with greater focus on telehealth, artificial intelligence, digital literacy, digital public goods, governance, and adaptation of international guidelines and standards including the WHO SMART guidelines and Fast Healthcare Interoperability Resources (FHIR).
This year, there has been a paradigm shift to focus more on the capabilities of digital technology to facilitate improved access to and delivery of health services with a focus on equity, as captured in the World Bank’s “Digital-in-Health: Unlocking the Value for Everyone” report. Digital health is known to both facilitate improved access to and delivery of health services, but the historical focus on its ability to generate data and information has been outsized. Evidence is showing that countries use less than 5% of health data in health-related decision-making, and that appropriate digital health investments can help governments save 15% of health costs when applied strategically in the service of health system outcomes and targeted health outcomes. Three essential areas were highlighted as governments invest in digital in health, namely 1) be service- driven, 2) start with intractable challenges, and 3) ensure equitability and scalability with enablers identified, supported, and monitored using the GDHM.
Advances in emerging technologies in health, particularly Generative Artificial Intelligence (GenAI) for healthcare, has dominated the field in its known and unknown potential to increase equity in health and/or to exacerbate gender and racial biases already present in the technology sector and underlying data sources. The launch of ChatGPT re-energized the conversation about artificial intelligence (AI) and Large Language Models (LLM), their responsible use, regulations and has catalyzed unprecedented financial investments. The Broadband Commission for Sustainable Development Working group on Digital and AI in Health projects that global healthcare spending will reach $20 trillion by 2040. The report identified the following areas for AI in health maturity: People & Workforce, Data & Technology, Governance & Regulation, Design & Processes, Partnership & Stakeholders, and Business models.
Many of these enablers are captured within the GDHM as they are necessary for both the technology and data needed to harness the benefits while mitigating the risk of GenAI.
An important challenge in the accelerated adoption and use of digital health and AI is the widening gender digital divide and the need to move beyond digital literacy among a predominantly female health workforce towards digital fluency and greater representation and participation. Gender-intentional digital health promotes an intersectional approach that includes race, age, disability, and other characteristics that may hinder active participation in a way that strives to ensure that technology and data reflect the needs, wants, and characteristics of the people it is intended to serve.
This is reflected in new indicators focused on equity, human rights, and gender in the GDHM and supported by the Gender-Intentional Digital Health Intervention & Enablers: Rapid Guide for Analysis, Planning, and Monitoring toolkit, which provides a clear framework for analysis, design, and implementation of gender and broader inclusiveness in digital health.
2023 has been a pivotal year for digital transformation of health with more sub-national, country, regional, and global initiatives than ever. The GDHM powers and complements other initiatives to monitor and track digital health progress, including the forthcoming Africa Digital Health Index, which uses the GDHM data to set a baseline and monitor progress for the Africa CDC Regional Digital Health Strategy, and the 2023 Digital Health Barometer covering 10 countries including the United Kingdom and the United States of America.
This State of Digital Health Report 2023 provides the most geographically diverse set of participating countries to garner insights and shed light on where we are now and where we ought to be going towards digital transformation to achieve the WHO definition of health, “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity,” for all people everywhere.
Conclusion
The State of Digital Health 2023 reflects stability and sustained progress in key components of the digital health enabling environment through a systematic analysis of countries participating in the GDHM in 2023. These enablers form the foundation for the successful implementation and sustained use of digital health interventions leading to improved health outcomes and strengthened health systems worldwide. An important achievement is the scaled investment in digital health Services and Applications that align with national health priorities. Based on the findings and recommendations of the State of Digital Health Report 2023, we propose the following call to action:
1. Equity and Inclusion: Efforts should be made to ensure equitable engagement in the design processes and access to digital health interventions, particularly for marginalized and underserved populations. Strategies should be developed to overcome known biases such as gender and race and to address barriers such as language, cultural sensitivities, and low digital literacy, to ensure that no one is left behind in the digital transformation of health.
2. Workforce: Health professionals need to be equipped with the necessary digital skills and knowledge to effectively utilize digital health interventions. Pre-service and in-service training should be implemented to ensure health providers are prepared to leverage the benefits of digital health and other emerging technology innovations like GenAI.
3. Standards and Interoperability: Governments should prioritize the development and implementation of architectures and standards that promote interoperability between digital health interventions to support the continuum of care.
4. Infrastructure: Adequate investment in digital infrastructure, including broadband connectivity, telecommunication networks, and health information systems, is crucial to enable the widespread adoption and effective use of digital health interventions.
5. Strategy and Investment: While ambitions for digital transformation are high, the financing needed is not sufficient to meet the needs of most countries. Greater investment should be made by the public sector and the conditions established to promote private sector engagement.
Through prioritized investments and systematic monitoring, countries can accelerate the adoption and impact of digital health, ultimately leading to improved health outcomes, enhanced access to and delivery of health services, and more equitable and resilient health systems. This foundational contribution to the Global Initiative on Digital Health strives to inspire collective action towards greater maturity in digital health through sharing and learning between countries at higher maturity and those on the path towards higher maturity.
The GDHM invites countries who participated in 2023 to participate again in 2024 to measure their progress, and invites new countries to set a baseline in 2024 and use the platform to prioritize their digital health investments into the future. Year on year, it is our hope that we will see an overall movement towards Phase 5 in all components in all countries in a way that contributes to the achievement of UHC and leads to health and well-being of all people, everywhere, so that no one is left behind.
GDHM Methodology
In early 2016, the GDHM Secretariat together with representatives from 20+ countries and 50+ international agencies and organizations, designed version 1.0 of the Global Digital Health Index (GDHI). In 2022, the resource underwent a year-long indicator and platform review and redesign process to align the indicators with the WHO Global Digital Health Strategy to complement the WHO Digital Health Atlas and to include a greater focus on AI, equity, gender, and Universal Health Coverage. In addition, the name was changed to the Global Digital Health Monitor (GDHM) to articulate the tool’s value in providing a platform to monitor digital health progress at a country,
regional, and global level. The updated GDHM includes year on year performance monitoring country visualizations, regional visualizations, and country-to- regional/country-to-global comparisons.
Source: https://monitor.digitalhealthmonitor.org/
Under the guidance of a global Technical Committee and through consultations with early adopter countries, the GDHM team undertook the following process to develop the twenty-three (23) indicators.
- A systematic review of existing prioritization tools covering digital health, health information systems, digital development, AI, and mHealth.
- A landscape review of relevant publicly available data collected and made available by multilateral organizations.
- A review of existing frameworks and tools developed by experts to help practitioners and countries understand the strength and maturity of the enabling environment relevant to digital health.
- Virtual regional workshops with early and new countries to document their experiences and assess interests and needs in relation to both indicators and functionality.
- Countries strongly recommended removing some sub-indicators and minimizing the overall increase in indicators. This led to a final net increase of one indicator.
DATA COLLECTION AND VERIFICATION
The GDHM team works with Ministry of Health representatives and country partners who are leading digital health efforts in their respective countries to convene multi- stakeholder consultations to collect data for each country. These country partners submit their country’s data through a unique country link to an annual GDHM survey and select the appropriate phase for each indicator as well as rationale and evidence to support these phases. Broader national population health indicators from the World Bank Development Indicators 2019 have been included to contextualize digital health maturity.
Approval to publish results is provided by the national government’s digital health focal people. Where there are no clearly recognized government focal points, other recognized digital health experts are contacted, who then work in a group of three or more persons (preferably including health and IT stakeholders). Information entered is then reviewed, approved, and published as “Pending Government Approval.” Data from countries with completed surveys included in the GDHM (67 countries) have been analyzed and form the basis of this report.
CALCULATIONS AND BENCHMARKING
The GDHM uses the main indicator in each category to calculate the overall country average. While sub-indicators are included to add greater specificity to specific GDHM indicators, they are not used in calculating the Component Phase or the Country or Global Averages. The GDHM enables countries to benchmark themselves against the Global Average or a Regional Average.
PRE-POPULATED DATA FROM PUBLICLY AVAILABLE SOURCES
For countries that have not completed a survey in the Global Digital Health Monitor, data was extracted from publicly available information to pre-populate the indicators below to give a general sense of broader digital ecosystem maturity in alignment with relevant indicators.
While this data serves as a proxy for these digital health indicators for countries, data completed by government officials provide a more accurate and robust picture of the digital health progress in each country. The Data sources in the GDHM included the GovTech Maturity Indicator (GTMI), the Network Readiness Index, and the GSMA Mobile Connectivity Index. Indicators populated include 2a, 4, 6a, 7, 8, 9, 17, and 18.
This means that many high-income countries that did not participate have their data extracted from published sources to extrapolate Leadership and Governance, Policy and Legislation, and Infrastructure data components.
To read the original publication, click here.
