How the pandemic accelerated the adoption of digital tools and digital health systems for improved health care for children
Gennie Oliva stands holding her child Kivet Marten-Oliva after receiving vaccination for the child against Measles, Mumps and Rubella (MMR) at Lower Bicutan Health Centre in Taguig City. The Philippines. 26 March 2019.
Sometimes, crisis is the creator of opportunity. Although the pandemic created vast amounts of damage and despair in countries across South-East Asia and the Pacific, it forged a path of innovation and collaboration between multiple stakeholders, particularly in the health care industry. Healthcare providers were forced to provide remote health services, including telemedicine, data collection for case tracking and monitoring and urgent immunization services. This reality varied in countries, depending on the maturity level of digital health systems.
At the beginning of the pandemic, a repeated problem emerged around access to data. “We had 200 information systems and no access to critical data during the pandemic - which held back tracking and monitoring of cases…” shared a government official from the Department of Health in the Philippines at the Asia eHealth Information Network (AeHIN) General Meeting in Jakarta on the 6-9th November 2023.
Countries that could pull data from more mature, or previously established and comprehensive data systems could respond faster to COVID-19 outbreaks through contact tracing, such as Taiwan and South Korea. Taiwan made use of its population wide digitized national health insurance system to distribute facemasks and rapid testing kits. South Korea used information technology-driven tracing strategies based on technology and an enabling environment laid out in 2015 in response to the middle east respiratory syndrome (MERS) outbreak.
Comparatively, in countries where digital systems were less advanced or interconnected, the sudden reliance on digital health technologies demonstrated healthcare and system inequities in the region. The silver-lining to this was the possibility of identifying gaps in digital systems and leveraging COVID-19 funding. Since, countries in the region have made significant investment in digital health strategy, digital tool adoption, governance, infrastructure, standards and health information exchanges.
In countries with high mobile penetration, like the Philippines, Indonesia and Cambodia, healthcare providers could leverage digital applications to pull data from healthcare facilities through mobile phones and tablets, linking community services with central government systems.
The Philippines, for example, has strengthened its digital immunization system through the development of real-time vaccine monitoring and analysis tools that can be used at community and facility levels, enabling the collection of collect vaccine related data pre, during and post-implementation enhancing decision making and vaccine coverage through mobile devices.
Further, the Department of Health’s synchronized electronic immunization repository (SEIR) and the abovementioned UNICEF developed Real-time Vaccination and Monitoring tool-kit were launched in 2023, to support a catch-up immunization campaign against measles, rubella and polio, enabling seven million children to be vaccinated within six weeks.
In addition, a mobile and web-accessible Immunization Information System (IIS) is being developed to be used at all levels for storing immunization data for easier storage and analysis and sending reminders of vaccine schedules to health workers and mothers.
“It is exciting to see that this digital transformation work is happening locally in the Philippines – this is a motivating factor for me. As a result, the work is more targeted and focused at local service delivery levels such as in health clinics. I am feeling very optimistic that these changes will benefit children” says Dr Gloria Velasco (Dr Mae), Director of Knowledge Management and Information Technology Service at the Department of Health and Director of EB-OHSSD of the Epidemiology Bureau.
Officers input data on the ASIK application during the Nationwide scale-up of Rotavirus Immunization at Pangkep District, South Sulawesi Province, Indonesia, Tuesday 15th August 2023. Photo by Dwi Prasetya/UNICEF.
In neighbouring Indonesia, UNICEF is supporting the Ministry of Health to develop and enhance digital application Aplikasi Sehat Indonesiaku or Health Indonesia Application in English (ASIK) to collect immunization data in real time or offline from all public health facilities, similarly, to enable and enhance decision making at central and district government level.
The app is part of the Ministry’s intention to transform integrated primary care solution as it integrates into the centralized and standardized data system called SatuSehat (otherwise known as One Health in English).
“With ASIK, health workers and cadres from all types of community clinics, can easily update and access immunization records. This is going to be very beneficial for catch-up programs in the field to ensure women and children receive their vaccine doses. But also, it ensures accurate data flow to all levels of government.” says Risdianto Irawan, UNICEF Indonesia Data Centre Specialist.
Ms Khen Pich, 67, received a Johnson & Johnson booster shot at Bavel Referral Hospital in Bavel Commune, Battambang Province, Cambodia. She proudly holds up her vaccination card.
Investment in strengthened immunization systems through digital technologies will support governments to close the gap on the 2.5 million children that are under-vaccinated in the region. Improved clarity on immediate coverage is one benefit, but understanding inequities will make the difference. This creates a picture of which vulnerable groups, women and children are left behind and why.
One country that is at an earlier stage in digital health transformation – despite high tech indicators in other areas such as internet use by young people at almost 90% - is Cambodia. This is why it is investing in a Digital Immunization Roadmap to strengthen systems for improved immunization outcomes for all.
“The burden of keeping track of vaccinations is placed on health service providers and the population. Up to 30% of children in the population lose their vaccination cards. Many of these are children of mobile or migrant populations. This is why UNICEF supports the Health of Ministry by strengthening digital immunization strategy and systems.” – Rathmony Hong, Health Specialist UNICEF Cambodia.”
UNICEF Mongolia handed over infrared thermometers to all public schools and kindergartens of Bayanzurkh district, as part of its COVID-19 prevention interventions. Also, UNICEF Mongolia will provide infrared thermometers to all schools and kindergartens of Bayankhongor, Gobi-Altai and Zavkhan provinces, which are UNICEF Mongolia Country Program focus areas.
With the accelerated digital transformation of health systems during the pandemic, what we have also learned is that countries must work on building the appropriate roadmaps and enabling environments, including human resources and financing, to achieve sustainable progress and outcomes.
For example, lessons learned from countries in the African regions showed that “approximately 2/3 of countries that implemented patient-level, digitalized case management systems for COVID-19 without a sufficiently strong enabling environment actually reverted back to paper-based systems – this is why a clear and realistic national blueprint based on the digital readiness of a country, as well as strong governance, human resources and standards, is key when planning” explained Sean Blaschke from UNICEF HQ at the AeHIN conference.
Mongolia, a country with three million people has advanced significantly in its digital transformation journey. The government implemented e-tools since 2015, meaning that its public health data has been digitized for some time. However, sectors are still operating in siloes, and the government aims to consolidate its digital health strategy and vision in 2024 building on existing digital health tools and systems to support its ambitions of becoming a Digital Nation aligning with Vision 2050.
Dr Mae shares her reflections on the need for convergence in a planning session for the convergence workshop that will be presented to the Department of Health. She is joined by government officials from the Department of Health and partners including UNICEF, the World Bank, PATH and AeHIN facilitators. Photo by Anna Lisa Robertson/UNICEF.
The annual AeHIN conference confirmed that countries in the region are very committed to the development of their digital health space. The meeting, co-funded by UNICEF, provides a crucial opportunity for health workers from the Global South to learn from each-other's experiences when it comes to pursuing digital transformation in the sector. Finally, the event welcomed the pre-launch of the Digital Health Convergence toolkit (supported by UNICEF and in collaboration with PATH) and the official launch of the Digital Health GAPS White Paper based on the AeHIN GAPS Framework. With renewed actions, targets and roadmaps, and the support of development partners, impressive progress is sure to come in 2024.
“The value of a convergence is the opportunity to have partners provide different options or solutions, and our priority is to make sure that resources are well invested by partners. This is why a convergence workshop is useful. We have more partner support than ever before right now, which is very positive. All workplans need to be thought of in a service delivery framework – no standalone system, solution or initiatives allowed” reflects Dr Mae in a convergence planning workshop at the AeHIN conference in Jakarta.
UNICEF East Asia and Pacific Islands (EAPRO) supports countries in strengthening and implementing robust digital health strategies through regional advisory and technical assistance, in collaboration with UNICEF’s HQ Digital Health & Information System Unit. These investments are anchored in the Global Initiative on Digital Health (GIDH), with key partners including WHO, Gavi, the Global Fund, USAID and the World Bank.