Using data and digital for health in challenging operating environments
Digital and data tools are revolutionizing systems for health in countries across the world. Their impact in challenging operating environments (COEs), in particular, has transformative potential — overcoming challenges that have stymied consistent access to health services for millions of vulnerable people.
Despite being home to less than 14 percent of the world’s population, COEs account for approximately one third of the global disease burden for HIV, tuberculosis (TB) and malaria. The intertwining crises facing the world today — the COVID-19 pandemic, hunger, conflict and the climate crisis — all have enormous impacts on health. The World Health Organization reports that health systems in all regions and in countries of all income levels are severely impacted, with little to no improvement since 2021. These compounding crises could continue to reverse hard-won gains in addressing poverty, infectious diseases and inequality, particularly in COEs. But they also present an opportunity to do things differently, using new tools and flexible approaches to deliver health services to the most vulnerable.
Digital innovations for COEs
Timely and accurate data is the cornerstone of effective systems for health. However, collecting data in COEs — and delivering care — means contending with barriers to accessing remote areas and hard to reach populations, limited institutional capacity, and a shortage of health workers who are already overstretched, among other factors.
Where data is collected by hand, records must be transported to public health institutions in major cities for analysis. Long distances and difficult terrain can slow this process down, delaying health services for vulnerable populations.
Additionally, managing supply chains for the distribution of diagnostics, medicines, and other health commodities can be time consuming when done by hand — and is more likely to be inaccurate. Inefficient supply management systems can result in stock shortages of medicines, tests expiring on the shelf, or shipments arriving too late for the hard to reach.
Access to quality data to make informed, timely decisions is key to helping frontline health workers improve delivery of services 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 empower 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 was seen with the uptake in use 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
Supporting real-time health monitoring in Guinea-Bissau
Before 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, kilometres away through flood-prone terrain.
“It took around two to three weeks between local data collection and analysis,” says health worker Herculano Bras da Silva. This made it nearly impossible to track malaria outbreaks in real-time and respond in a timely manner.
In 2018, UNDP began working with partners in Guinea-Bissau to adapt the country’s District Health Information Software (DHIS) to support the collection of malaria data. To get the software into the hands of community health workers, UNDP and the Global Fund, with support from the World Bank, distributed mobile devices to record and transmit data, and trained community health workers on their use.
This digitization of health data has strengthened the national government’s capacity to map and track malaria outbreaks in real time, improving response times. Live monitoring of new cases of malaria is now routine in almost 150 health facilities across the country of 2 million people. Problems can be swiftly detected: for instance, if the data transmitted in real time shows that a woman visited a health facility during her pregnancy but did not receive a bed net or preventive malaria treatment as expected, it could mean the health facility has temporarily run out of stock. This can be quickly investigated and corrected by reallocating stock from nearby facilities. This work is ongoing — in the first six months of 2022 alone, nearly half a million people were tested for malaria, and 50,000 people received treatments.
Increasing efficiencies and improving supply chain management in Chad
Malaria is the leading cause of death in children under five in Chad. More than 1 million children are eligible to receive preventive treatment, but distribution of treatment is often delayed by a health information system that requires workers to manually record data. This system made it difficult to assess how many eligible children lived in a community, track who had been given treatments and determine which communities to prioritize when outbreaks occurred.
Beginning in early 2022, UNDP supported the digitization of Chad’s malaria prevention programme, helping train more than 1,300 community health workers across 13 health districts and 184 health facilities on digital data collection in the first phase of implementation.
“The main advantage of digitalization … is that it allows us to control the data sent in real time at all levels,” explains Zachée Mbayam, Malaria Focal Point for the Kouloudia health district in the Lac Province. When distributing scarce resources, every treatment matters, so it is critical to avoid discrepancies in records. With digitization, “everything is centralized, and we detect errors very quickly and we can correct them in real time.”
In the first phase of the initiative, over 200,000 children were reached. The pilot also yielded important lessons that were incorporated into the second phase — such as creating instant message groups to facilitate troubleshooting and sharing of tips.
Building on these lessons, UNDP will scale up the use of digital tools for malaria prevention and treatment in 2023 to improve stock management and mass bed net distribution. This has the potential to reach nearly 19 million people.
Setting health care workers up for success in Afghanistan
Internet connectivity, electricity and other utilities can be scarce across Afghanistan. This presents additional challenges when using digital tools for health.
UNDP, along with the Global Fund, supported digitization of the national malaria programme in Afghanistan. This required working with partners to design software that functions offline and then transmits data to the central database when internet connectivity resumes. All provincial malaria focal points were trained and provided with mobile devices, and the new monitoring system was rolled out nationwide. Another digital solution to respond to the specific needs of the community is Afghanistan’s first mobile money system, HesabPay, ensuring timely payment of health care workers.
Digital technologies and tools are the future in COEs
To end HIV, TB and malaria as public health threats, we need to reach the most vulnerable people with prevention and treatment services, wherever they are. This is particularly important in COEs, where innovative and flexible solutions are required to address existing weaknesses and adapt to contexts that can change rapidly. Digital and data solutions can play a critical role in improving the efficiency and effectiveness of health services and increase 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 are responsive to their unique challenges and improve the health of their citizens. In Afghanistan, UNDP is supporting the extension of the digital monitoring and evaluation programme to also track tuberculosis. In Guinea-Bissau, work is underway to scale up the number of community health workers using digital devices.
The UNDP-Global Fund partnership supports countries to build sustainable systems for health that can withstand shocks and crises and drive progress against the three diseases. The Seventh Replenishment of the Global Fund is an important opportunity to scale digital and data solutions for more resilient systems for health.
In line with UNDP’s Strategic Plan 2022–2025 and its HIV, Health and Development Strategy, UNDP partners with the Global Fund, governments and civil society to support and strengthen multi-sectoral national responses to HIV, TB and malaria by providing integrated policy, programme and capacity development support. To date this has resulted in 7.3 million lives saved, 1.5 million people currently receiving HIV treatment; 96 million people treated for malaria; 1 million cases of TB detected, and people put on treatment; over 1.1. million health workers trained to support COVID-19 responses.