Better Health For All

The end of 2018 marked the 70th anniversary of the Universal Declaration of Human Rights, the 40th anniversary of the Alma Ata Declaration on primary health care for all, the 23rd anniversary of the Beijing conference on gender and human rights, and the 45th anniversary of the first mobile phone call ever made. The common thread connecting these historical milestones becomes evident against the backdrop of the digital health technologies increasingly being used to strengthen the right to better quality primary health care, especially for women and girls.

Arguably, digital networks and mobile technology have permeated nearly every aspect of people’s lives across the globe. And many digital innovations have been introduced to improve how health services are planned, delivered and received, and even save lives.  

A recently published supplement, Advancing health equity and gender equality: Digital health in the Global South, documents evidence from seven countries from the Global South about what has worked and what hasn’t in terms of the use of digital technology to reduce health and gender inequalities. The authors from Bangladesh, Burkina Faso, Ethiopia, Kenya, Lebanon, Peru and Vietnam used results from five years of research funded by the International Development Research Centre (IDRC) to explore these important questions. The projects focused on access to health services by historically neglected communities who are served by an over-extended and under-resourced health workforce. The answers are, therefore, very helpful to support efforts by the global health community to reach the Sustainable Development Goals (SDGs) by leaving no one behind.  

In Vietnam, for example, a customized Health intervention for ethnic minority women in a mountainous region witnessed improvements in antenatal and postnatal behaviours. The customized text messages and personal follow-up increased women’s confidence to ask questions about their health. The intervention showed that changes in health behaviours and gender norms can help address decades of social exclusion that have been leading to lower health outcomes. Researchers in Peru, for their part, found that providing pregnant indigenous women with access to their health records strengthened their power, ownership and agency. And in Ethiopia, careful analysis allowed researchers to identify the potential negative impacts of a Health intervention on an already overstretched cadre of all female healthcare workers working in rural areas.  

The cohort of seven projects included some cross-cutting analyses that were integrated from the outset. Areas such as health equity, gender analysis, research quality, knowledge translation and cross-grant learning were monitored and supported to improve the potential impact of the results in different communities.  

The overall messages from the supplement are that digital health interventions at primary and secondary health care levels can positively influence health equity, help tackle existing gender inequalities, and create opportunities for new forms of positive power dynamics. But for that to happen, interventions need—at the outset—to be thoughtfully designed and implemented. Questions about inclusion, equity, rights, identity, access, agency and citizenship need to be integrated in the research questions and methodology in order to generate a solid knowledge base about how this could work in different geographic contexts, different populations and for different health challenges.  

The research also showed that digital health should not be based on a top down design. Findings from Burkina Faso and Lebanon pointed out that the chances of success and positive outcomes are commensurate when digital health interventions are based on community engagement, and user-centred models.  

The onus of building the evidence of what works, how, and for whom is on the research community. As digital health in low- and middle-income continues to grow in magnitude, scope and investment, the collection of articles presented in this new supplement also offers insight into areas that would benefit from more research. These include:

1. providing adequate support and incentives to health workers (many of them women) to improve their work through digital health tools
2. examining how using digital health to access and share information can influence agency, decision-making, intra-household dialogue and other types of power dynamics that are central to health and well-being for individuals and their families
3. ensuring that health data are reliably collected and systems can securely share and analyze them to maximize use by community members and by decision-makers, including for reporting on the SDGs.  

If the global health community is to achieve the global goal of ensuring healthy lives and promoting wellbeing for all at all ages, bodies of research like the one presented in this supplement are critical. Research agendas need to evolve with the times and continue to build evidence on how digital health interventions influence health equity and gender equality wherever they are used. The most dazzling technology will always fall short unless it is applied using a people-centred and rights-based approach to public health.   

Written by Chaitali Sinha, Anne-Marie Schryer-Roy and Montasser Kamal. Chaitali and Anne-Marie are guest editors of the Journal of Public Health supplement, Advancing health equity and gender equality: Digital health in the Global South. Montasser is a Program Leader at the International Development Research Centre, Canada.