Alain Labrique delivered the closing keynote at the 2024 Global Digital Health Forum in Nairobi, reflecting on the pressing need to transform global health through collaboration, science, and digital public infrastructure (DPI). Most importantly, through passionate insistence on countries and people at the center of digital health.
The event marked a pivotal moment in digital health transformation. As participants gathered in the cradle of humanity, it became clear that Africa isn’t just where our species began – it’s helping shape where we’re headed through innovative digital solutions like M-PESA, which revolutionized financial inclusion across the continent.
Yet amid the excitement of digital possibilities, we must confront sobering realities. Today, 1.2 billion people lack access to electricity, 2.2 billion don’t have clean water, and 2.6 billion remain disconnected from the digital world.
Perhaps most devastating, 800 women die daily from preventable causes related to pregnancy and childbirth. These statistics serve as a crucial reminder that digital transformation isn’t about technology for technology’s sake – it’s about addressing fundamental inequities in health access and outcomes.
The COVID-19 pandemic exposed significant gaps in our digital health infrastructure. Studies revealed that digital failures were as much human as technical – from restrictive laws and proprietary systems to trust issues and inadequate local infrastructure. These challenges prevented digital solutions from effectively pivoting to serve urgent needs during the crisis.
Digital Health is Nation Building
We need to understand that digital health is nation-building. It’s not just about apps – it’s about building foundational infrastructure that enables scalable, interoperable, and equitable health systems. We need governance, not more fragmented pilots. Countries need cohesive national strategies, governance frameworks, and investments in core digital public infrastructure.
Three key shifts are creating unprecedented opportunities for meaningful digital transformation:
1. Demand
Communities across sectors have experienced digital transformation in banking, transportation, and commerce. They now expect similar innovations in healthcare delivery. However, there is a $12.5 billion investment gap for DPIs in 78 LMICs. They will require innovative financing models, including public-private partnerships and global coordination. We can’t expect digital transformation with small budgets for “experiments”.
2. Political Will
129 countries have established digital health strategies, with supporting policies and legislation. The Global Digital Health Compact, ratified by 194 countries, represents the first international agreement on digital transformation, emphasizing interoperability, open-source solutions, and good governance.
3. Standards and Building Blocks
We now have robust, open standards and agile building blocks that governments can employ to create affordable, person-centered digital ecosystems. We must collaborate across governments, international agencies, and the private sector, ensuring technology solutions are built with – not just for – countries.
Path Forward for Digital Health Transformation
The path forward requires a fundamental shift in approach. As Smisha Agarwal from Johns Hopkins University emphasized, “Health has to be at the center of what we do – digital is a means to strengthen how we deliver health for all.” This means we must:
1. Prioritize Digital Public Infrastructure
Countries like Ethiopia, Indonesia, and Kenya are leading the way by investing in governance, policy, and legislation to reduce fragmentation. DPIs are becoming the essential highways of global digital health, creating environments where interoperability isn’t just aspirational but practical.
2. Learn Across Sectors
We must break down silos and engage with broader health systems, financing, and policy experts. The success of initiatives like M-PESA offers valuable lessons for health sector transformation.
3. Build Local Capacity
The recent Open Digital Health Summit in Nairobi focused on building local capacity across 50 countries in interoperability standards and architecture. As Africa CDC’s Chief Digital Health Adviser noted, we need to “move from thinking in silos to action by architecture.”
For development practitioners, this means:
- Development Partners: Align funding with country priorities and invest in governance and architecture. Theory must be backed by concrete financial commitments.
- Implementers: Share your work but commit to using standards when building new solutions. The era of siloed systems must give way to digital commons maintained by government agencies.
- Researchers: Focus on better measurement and impact evaluation. Demonstrating what works through solid evidence is crucial for convincing ministries of finance and policymakers to invest in digital transformation.
Digital Transformation Can Democratize Health Access
We stand at an inflection point where technology can either democratize access to health services and data or widen existing inequities. The World Bank’s recently released blueprint for costing and budgeting digital transformation, combined with the new Digital Health Atlas, provides practical tools for navigating this transformation.
Success requires resisting the urge for unbridled enthusiasm and instead focusing on evidence-based implementation. As one Kenyan official noted, “the proof is in the pudding” – we must deliver on our promises to build trust and demonstrate impact.
The future of global health lies in our collective ability to harness digital solutions thoughtfully and equitably. By building strong foundations, fostering local innovation, and maintaining a relentless focus on health outcomes, we can create digital systems that truly serve those who need them most – including the 800 women who die each day from preventable causes related to pregnancy and childbirth.
The technology exists; now we must ensure it reaches and serves everyone.
This is a synopsis of Alain’s recorded remarks and post-event musings.
