Four ways in which telehealth and data innovations can increase health system resilience
The COVID 19 pandemic emphasised the need for strong and resilient health systems which can respond to emerging crises, while maintaining essential health services and quality of care. COVIDaction Resilient Health Systems (RHS), is a UK FCDO funded programme that explores the role of technology and innovation in supporting countries to build resilient health systems as they respond to the COVID-19 pandemic.
From mid 2020–21, the programme funded nine grantees who leveraged technological innovations to address health system challenges and contribute to increased resilience. These innovations focussed on two key areas — (i) telehealth (innovations that provide access to health services via digital and telecommunications technologies); and (ii) data innovations (which improve the collection, quality, availability, and use of health data, allowing for better decision-making and response to systemic shocks like COVID 19).
Findings from the RHS portfolio highlighted four ways in which these technologies can help increase overall health system resilience.
1. Improved Access and Continuity
Globally, many health systems — particularly in LMI countries — struggle to reach vulnerable and disadvantaged populations, and this was exacerbated during the pandemic. Telehealth innovations can adapt models of service delivery to overcome access barriers and ensure continuity of essential health services. RHS findings showed two ways in which this can be achieved:
Point of access: Tech innovations can shift the service delivery space away from brick-and-mortar facilities to households and communities i.e., moving services closer to beneficiaries. Some examples include remote or virtual access to care via phone or telemedicine applications, and low-cost tech and low- or no-cost innovations like toll free call centres connecting people to health providers.
Process innovation: Innovators can test and support creative process innovations — combining telehealth with processes like remote triage and emergency vehicle dispatch, to identify and provide care to those in urgent need. When partnered with facilities like hospitals, clinics, and pharmacies, this can help connect users to quality in-person care and even manage bi-directional referrals.
2. Democratisation of Healthcare
COVID-19 has further exposed that many populations — particularly in rural or remote areas — lack access to reliable health information, and are consequently unprepared to deal with health issues. Innovation can help overcome these issues, by empowering individuals with knowledge and tools that help them manage their health, thereby democratising health care. Through RHS we found 2 ways in which telehealth innovations can help to empower individuals:
Disseminating Health Information: Telehealth technologies can help disseminate timely and easily accessible information, especially via mHealth platforms that use low-tech SMS messaging and toll-free hotlines, to reach lower income or remote populations. For those with smartphones, more complex applications can empower users with health knowledge, including for instance, facility contact details, schedules, information on symptoms, etc.
Self-Management: mHealth and telehealth can provide a range of tools to enable people to successfully manage their conditions, improve health literacy and health behaviours. From platforms offering self-screening tools on basic phones, to smartphone applications that combine other digital tools like telemedicine, interactive voice response and appointment reminders, to more advanced technologies like chatbots. These tools made a critical difference for those with chronic conditions like HIV — especially during the pandemic.
3. Enhanced Health Workforce Efficiency and Capacity
COVID 19 showed how quickly health systems can be overwhelmed in acute crises, preventing healthcare workers from providing routine care or responding to other needs. Given that workers typically face the “double burden” of data collection, reporting and administrative tasks that limit their time to provide health services, telehealth and data technologies can improve their capacity and enable them to deliver quality services efficiently, even in times of crisis. The RHS portfolio shows 4 ways in which this can be done:
Improved demand management: By process innovations like virtual triage and shifting the first point of service away from facilities, innovations can help prevent overcrowded facilities and overwhelmed healthcare workers.
Task shifting: Redistributing specific tasks from highly qualified health workers at facilities, to other health system actors like pharmacists and community health workers, with shorter training and fewer qualifications, can make more efficient use of human resources. Digital tools help to support this task shifting, by better connecting these actors and integrating them with national health information systems.
Capacity development: Innovators can offer direct capacity development, via training or e-learning modules to health systems actors, helping them to deliver high quality and evidence-based telemedicine. This can also include training on soft skills like listening and empathy. In the context of task shifting, this further offloads some of the burden from healthcare providers to other actors within the community.
Time efficiency innovations: All the above have the potential to contribute to improved time efficiency of the health workforce. Innovations can streamline and digitise burdensome administrative tasks like data collection, thereby saving time for healthcare workers to focus on providing health service delivery.
4. Generation of Data and Evidence
Many countries face challenges with measuring health system performance due to a lack of, poor quality, or fragmented data. This prevents health system managers and decision-makers from obtaining a comprehensive picture of the status of their health system and makes it harder to identify spaces for improvement. Telehealth and data innovations can help with this in three ways:
Improved data collection: Innovations can help streamline and improve data collection in several ways such as guiding health workers in digital data collection methods, digitising and streamlining facility based reporting processes or collecting patient-level data via telehealth applications and creating comprehensive electronic medical records.
System interoperability: Health systems are often fragmented, with different components owned by different institutions or actors. Data and telehealth innovators can help address this by integrating into and promoting interoperability between existing health management and information systems, and their own digital platforms. For instance, innovations focussed on direct service delivery via telehealth are typically linked to national health management and information systems, to generate high quality data that supports decision making.
Targeted evidence generation: Data innovators have great potential to help governments and health systems generate targeted evidence to inform decision making and planning, especially in times of crisis, as seen during COVID 19. Innovators used mHealth platforms and innovative surveying technologies during the pandemic to generate timely evidence on issues like public trust in the health systems, vaccine confidence and uptake, and collection of covid data. When designed in collaboration with decision-makers, these efforts can be a powerful tool for responding to crises and strengthening health systems over time.
The learnings shared here on ‘4 ways in which data and telehealth innovations can improve health system resilience’ form a summary of a more detailed report, that can be found on the FCDO Frontier Technologies Hub website here. This more in-depth report shares case studies from innovators supported by COVIDaction RHS, and the different ways they worked to support more resilient health systems.
