DPI+H – health for all through digital public infrastructure

Experts Converge to Discuss the Future of Digital Public Infrastructure for Health at Concluding Session

The session on Digital Public Infrastructure for Health (DPI-H) served as a fitting conclusion to a week filled with discussions on digital innovation and health equity. Laurie Werner of PATH moderated a panel of experts from various organizations, including VitalWave, ITU, the Digital Impact Alliance, Asia eHealth Information Network, and the World Health Organization.

Philippe Veltzos of VitalWave initiated the dialogue by presenting an overview of DPI-H, highlighting its emergent status and the evolving consensus on its definition. He emphasized the importance of DPI-H as a society-wide digital capability crucial for both public and private sectors. Veltzos outlined the infrastructure approach to health, which consists of layers such as technology, foundational DPI, sector-specific DPI, and applications, all underscored by security and interoperability standards. He identified leadership, governance, regulatory capacity, health data governance, and technical workforce capacity as key enablers for DPI-H implementation, particularly in low- and middle-income countries.

Hani Eskandar from ITU offered a compelling insight, suggesting that ‘mega use cases’ should drive the development of DPI rather than isolated projects. He cited Egypt’s universal health insurance program as an example of a significant national goal that necessitates DPI development, arguing that such initiatives could serve as a natural entry point for building DPI structures.

Chrissy Martin Meier from the Digital Impact Alliance called for a shift in the DPI conversation towards solving tangible problems for people and building upon existing components. She stressed the need for long-term financing for technology and unlocking data for broader benefits. Martin Meier also referenced the UN’s working group on safeguards for DPI, which aims to strengthen the global digital ecosystem.

Jai Ganesh Udayasankaran from Asia eHealth Information Network discussed the potential of convergence workshops in aiding countries with digital transformation. While DPIH has not been a direct focus, these workshops could help countries adopt this approach. Udayasankaran also highlighted the need for better assessment tools to understand the DPI-H status in countries comprehensively.

Garrett Mehl from WHO outlined the organization’s efforts to support countries in adopting DPI-H through tools and guidelines. He underscored the importance of investments in foundational and health-specific DPIs, quality-assured content, and interoperability standards. Mehl introduced the Global Initiative on Digital Health, a WHO-managed network that supports national digital health transformation through collaborative efforts.

The session concluded with Laurie Werner synthesizing the discussions, emphasizing the need for a mega use case to drive holistic infrastructure approaches and long-term sustainable financing. She also noted the shift from testing individual digital health innovations to embracing comprehensive, larger-scale planning for digital health transformation.

The panel collectively highlighted the complexity and multi-layered nature of DPI-H, the importance of intersectoral collaboration, and the recognition that digital transformation is a long-term journey requiring sustained commitment and resources. The insights provided a roadmap for future action in the digital health space, with a clear call for strategic, aligned investments that contribute to broader development objectives.

Laurie Werner:
I’m going to use. Can you hear me? Yeah. I feel like it’s very far away. Hello. Hello. Yeah, that’s really loud, but all right. Well, Pani shows up. Okay. Great. Thanks everyone for being here. And for those of you online, thanks for joining us today. We’re going to get the session started off talking about digital public infrastructure for health. I’m Laurie Werner. I head the Center for Digital and Data Excellence at PATH, which is an international NGO that works to advance health equity through innovation and partnership. And I’ve been honored to represent PATH as we close out this week, which has been full of insights around not only DPI-H, which we’ll talk about today, but about AI, many conversations about AI, about different country priorities and various regional efforts. Today, we’ll be focusing on the topic of digital public infrastructure for health or DPI-H and how an infrastructure approach to health can create a more efficient digital health ecosystem by leveraging a common set of open, widely scaled digital functions for health systems and aligning innovators, implementers, and governments around that approach. We know that DPI-H is critical for promoting individual public and population health, and as a component of broader DPI, for promoting the SDGs, the Sustainable Development Goals, because health intersects with other sectors, such as education with health literacy, finance with financial services for health, agriculture with nutrition, and the environment with environmental risks to health. We also know that many low- and middle-income countries have made significant progress over the last decade in developing digital health governance structures, planning for digital health systems, and drafting and adopting digital health strategies and enterprise architectures that provide a backbone for digital health governance. However, countries still experience challenges to implementing DPIH, and there is more we can do as people working in the digital health space to strengthen the DPIH infrastructure approach, globally and in countries. So earlier this week, myself and many others participated in the first global convening of the Global Initiative on Digital Health within part of this World Summit of the Information Society, where myself and many others spoke on this very topic and specifically how the Global Initiative on Digital Health, or GUIDE, can play a role in enabling countries to adopt digital health approaches that rely on DPIH to support a thriving digital ecosystem. We see this conversation as a continuation of that event, and I’m looking forward to hearing from our panelists their perspectives on where we are currently and what is needed to continue making progress on this front. So with that, I’m going to introduce our panelists, our speakers and panelists. So I’ll start with Philippe Veltzos. He is the Chief Technology Officer for VitalWave and brings over 20 years of strategic leadership and implementation experience working with public health agencies, partners and global donors. And prior to joining VitalWave, he was the Technical Director for the Center at PATH. Hani Eskandar is the Head of the Digital Services Division at the Digital Society Division of the Telecommunication Development Bureau at ITU. He has more than 30 years of extensive on-the-ground experience in the field of ICT for development. Chrissy Martin-Meyer is currently the Director of Policy at the Digital Impact Alliance and has experience working with both private and public institutions, including World Bank, Swiss Capacity Building Facility, GIZ, Center for Financial Inclusion at Action, and USAID and many others. Jai Ganesh Udayasankaran is the Executive Director of Asia eHealth Information Network, or AIHN. Jai has over 20 years of experience in planning, procurement, implementation of a wide spectrum of enterprise digital health solutions. And Garrett Mell, who is the Unit Head of Digital Health Technology in the Digital Health and Innovation Department at the World Health Organization. So I’m gonna hand it over to Phil now, who’s gonna present on a piece of work that was done in partnership with Vital Wave and Digital Square, which is PATH’s flagship digital initiative. So Phil, over to you.

Philippe Veltsos:
Thank you very much, Lori. Good morning, everybody. Happy Friday, even though for some of you it’s raining in Geneva, but hopefully you have better weather on your respective sides. So I’ll try to be short, but again, a lot of the things that we’ve been discussing this week are about digital public infrastructure. And of course, we are also focused here also on digital public infrastructure for health, or DPIH. I’ll try to be brief and also like have some time at the end for the panels to answer a question, but also for everybody in the room to be able to contribute as well. So that being said, DPI is still emerging. And even though it’s something that has been somehow talked about for over three years now, there is no official definition yet. We’re seeing quite a few definitions coming out, but there’s a consensus emerging onto what it is. And here you’ll see three different definitions, but there is a consensus around the approach being mostly society-wide around digital capabilities that are essential for markets, for citizens, for entrepreneurs, for consumers. Part of the Digital Public Goods Alliance also adds the fact that it should be about functions and services in the public and private sector. And the World Health Organization also adds the fact that it should also foster new functional digital services. for people leveraging those digital building blocks at society scale. On the right hand side, you’ll see that most of the time we’ll talk about ID payments and exchange. And even though not explicitly stated, you’ll see that security plays an essential role. Infrastructure as we know it is critical. So without having a secure infrastructure, ID payments and exchange would be kind of like exposed. And as you know, in the digital world nowadays that means we’re getting ourselves into big trouble quite quickly. So while there is a lot in the report that was generated as part of this work, I’m just sharing this QR code for a few seconds. It’s about a 70 page report that you can read at your leisure. We’re not gonna dive into all of the details and the findings, but again, the idea is to provide some of the discussion points, some of the details, as well as some of the enablers and recommendations from that report. So earlier this week, you may have seen this Lego representation of digital public infrastructure by some of our colleagues and presenters that are also here, part of the panel. At the bottom layer, you’ll see technology. Technology being again, connectivity, the telecom side, electricity, data centers, cloud, and so on. This is really the physical technology infrastructure. On top of this, you’ll find the foundational digital public infrastructure. And again, these are the elements that I just mentioned in the previous slides, ID, exchange, payments, but again, all of this has to be emphasized within the realm of security, because if we are to leverage common services as foundational service infrastructure, we need them to be as secure as possible. On top of this, you’ll start seeing some sector-specific digital public infrastructure. And on top of the sector-specific infrastructure, you’ll start seeing, again, sector-specific applications. The idea is to enable an environment where applications are actually easier to build and don’t actually have to build every component, but leverage every component available through the services of the layers beneath. Sandy? You also see a couple of purple highlighted dots. And again, this is a Lego. image of having standards as the basis for that connectivity, right? Again, all of these tack on top of one another, but there are industry standards that enable technology. ITU being one of the organizations promoting these standards and working on these standards. But there’s also health sector specific standards. So leveraging some of the work that was done by our colleagues from the Digital Impact Alliance also present here today. We’re moving from the Lego model to the cake model. So bon appétit everyone. So here we go actually into more granularity where we can see again, those three same layers on left hand side where we still have the foundational digital public infrastructure. With much of the elements that I just mentioned, the domain specific infrastructure, again for health, agriculture, education. And then some examples, some illustrative functional applications at the top. Now this is the digital public infrastructure cake. Now if we were to look at it and apply the health lens to this, we would actually take a slice of that cake. So imagine you’re at a wedding, the groom and the bride are there, somebody cuts the cake and you’re just going to focus on your layer of the cake, which is the health one. But everybody’s getting the foundation at the bottom, which means the cake has been made and you’re all eating the same cake from the same place. So diving into the digital public infrastructure for health area, again, that little section that I just mentioned, you can start seeing that even within just the health world, that digital public infrastructure is made up of registries and terminologies. Interoperability standards that I just mentioned. So while there are standards for interoperability at the lower levels, there’s also health specific standards. We’ll talk about terminologies and taxonomies as well as concepts like ICD, or LOINC, or SNOMED, but we’ll also talk about FHIR. We’ll also talk about different standards that enable, again, that interoperability. We’ll also talk about scaled health services. And this is where, again, shared health record, health information system, lab system, logistics system, all of these systems have to be scaled. The whole point about digital public infrastructure is again to stop being the vertical and really taking a horizontal approach at scale. All of the definition talk about society or population scale, right? So we have to make sure that these scaled health services are really ready for that scale. And last but not least, we’ll talk about central health repositories. And at the bottom of, again, added that health data security framework where health data, as you know, it’s not just as every other data, there’s additional layer that’s specific to the health data. I’m sure you’ve heard it from some of the meetings this week around health data governance, but security for health data is something of the utmost importance and must be considered as part of the digital infrastructure as well. So on top of this, we’ll actually start seeing different functional applications and there are many. So I just wanted to show a couple of examples again, but from, you know, point of service applications to remote consultation or telehealth to direct messaging apps, to outbreak analysis, forecasting, and, you know, different dashboards that you can see. We now have a cake that’s actually a full detailed cake. And ideally at the bottom layer, I’m not sure whether you can read it from this side, but there’s a service gateway that enables all of the interface with the actual foundational digital public infrastructure services. What is it that would make DPIH actually work across low and middle income country landscape? Again, this was the focus of the report. So there was quite a few analysis done, a lot of research, including around existing tools being used. And one of the things that we did find out is there’s about three broad, you know, enablers across the ecosystem. And while there’s only three, they’re of utmost importance again, leadership, governance, and regulatory capacity. It’s a very simple sentence, but it means that all the way from the top, there’s recognition of the approach. There’s the leadership and capacity to actually. enable digital health strategy, health enterprise architectures, to put forward the roadmap, including the cost of the elements and the investments required to actually make this happen. On the regulatory side, we need to make sure that we can check that everything that is being implemented is actually based on the standards, following the architecture, making sure that again, it fits within the governance and the policies that have been established. Which brings us to the next point, the health data governance. I think most of you hopefully have heard HDG this week, if not, there’s quite a lot of material from our colleagues from Transform Health. Health data governance was a huge topic this week. And again, just to emphasize the fact that we have on the health side, a lot of work to be done. Countries are moving forward in that space. New policies are coming up. The model law is being drafted, but we need to consider privacy. We need to consider the old population security side of things as part of health data governance. And last but not least, the technical workforce capacity. While digital public infrastructure for health is a great approach, it will require a lot of capacity building and not just at the digital side, across all layers. Again, from the top, all the way to the Ministry of Health, all the way to the global actors, there’s a need for the technical capacity to understand what does it take to implement it. Health enterprise architectures have been unfortunately sometimes simplified to a point where people think it’s very easy. But if you’ve ever built a house, you know that it’s not that simple. If you put a plan or floor plan for a three-bedroom house and you want a 12-bedroom story house, then it’s a different blueprint. So again, architectures are complex. Strategies are complex. Costed roadmaps. We still don’t fully understand costing of elements. Unfortunately, TCO, which is a total cost of ownership, often overlooks things like operationalization, things like security, things like evolution, and keeping in mind that digital moves fast. What you think is going to last you five years might only last you three. Your car is something. that you see nowadays, most of your cars have some type of electronic component in it. Cars used to last 20 years. Some of the old Peugeots and Nissans and other cars that you see running had no computer chip. They ran for 20 years. Some of the newer cars, some of you may know that after five or six years, you start having glitches. Technology has to be updated. You need to get a firmware update for your Tesla. That’s an interesting concept, but this is if you have a Tesla and it works. There’s an assumption there. So again, all of this saying that capacity is going to play a huge role and we have our colleague here from the capacity building side of WHO, we can attest that from the health side, a lot of the capacity work has to happen. Digital is great, but digital without the capacity to take it on, to actually operationalize it and sustain it, it’s not going to work. All right. In the last two minutes, I’m just going to talk about some of the approaches that came out of this report. And while again, at high level, the report details in great length, each one of these approaches, but you’ll see that there’s three, I would say very much aligned approaches that are being recommended because they target different segments. The first one is to strengthen the global ecosystem. Why do we mean that the global ecosystem? Well, we need to fill the market gaps, right? There’s need for operationalization of health data security frameworks. We need to actually create and enhance the market for supporting building blocks and the potential digital public goods that can be used for DPI for health. We need to strengthen regulation and governance. We need to make sure that there is greater capacity being shared across and combine this with the country specific approach, which is point number two on the bottom left hand side, which is to provide an enabling environment within the country to actually take on implementation of digital public infrastructure for health. Again, to the three points that I mentioned earlier about leadership in governance capacity, technical capacity, and regulatory capacity, all of these have to be put in place so that we have digital health strategies. enterprise architectures, costed national plans, investment plans, and funding as well that’s in place so that this is not a one-year project. Unfortunately, digital transformation is a process. It’s not gonna happen in a year. It’s not gonna happen in two years. It’s gonna happen over five, 10, 20 years. So the third point talks about coordinating donor investments to allow infrastructural components to operationalize DPI for health. And this means how do we make sure that the donors, as well as the banks, as well as the governments themselves start planning their investments properly. And at the bottom right-hand side, you’ll see that this is not a one-off. Again, too often we look at the capex, which is the capital expenditures at year one, but not the operational expenditures moving forward. Digital and digital transformation means constant evolution, constant review, and therefore constant funding. If your funding is very limited, do not take on an enterprise architecture that will be too complex and too costly to maintain and operate. With that, I’ll stop there. And as mentioned, if you want some more details, there’s a 70-page report that you can read at your leisure, hopefully before bedtime if you feel like falling asleep, or if you’re very interested, there’s also a lot of additional details and links there. Thank you very much.

Laurie Werner:
Yes. Great, thank you so much, Phil. And I think it’s such a great body of work that really shows a lot of what needs to happen with some really concrete recommendations. So thanks so much for that. So now I’m gonna go to our panel and we’re gonna build on that. And as I said before, build on the two-day meeting that happened earlier this week. And I’m gonna start with Hani, actually. And so thinking of the two-day event that we had earlier this week and what Phil was just sharing, we’d love to hear from you what you think was an important takeaway from the two-day guide event about what is needed for DPIH and those efforts and from your lens at the ITU.

Hani Eskandar:
Okay, thank you very much. I think, first of all, it was very good to have to do this event and I think we should make it like an annual event because as it was said that the DPI is a long journey and this is something that would not be solved in a year or two. Actually, I’ve been reflecting on the two days and you know what, I got a huge insight which I would like to share. It’s one insight. I think countries are getting the importance of DPI, they really understand the usability, the building block, it’s fine. I mean, this is not something very complicated to understand and I think they get it. The big question is how to approach the development of DPI. This is a big question and the insight I got is the following. The entry point of building a DPI structure entry point of building a DPI should not let’s build a DPI. Let’s guys, let’s create the environment for a DPI. This I don’t think that this is the right entry point. Why I’m saying this? Because the DPI is a mega undertaking and it needs a mega use case to drive it. This is I think one of the, it’s not the only one, but let me explain what I mean by that. If we just say to a country, yeah, you need to build your DPI, you need to build your regulatory environment. This is what we try to do to some extent when we were thinking about this e-health strategies, etc. And then you can cost it and say this will cost me 10 million or whatever and then you get, it’s very difficult to drive the ecosystem. I think the entry point to build a DPI should not be DPI at all. It should be a mega use case that the health sector is gonna do anyway. And the insight I got really, it was from Egypt. was about to build this universal health insurance program. Basically, because I’m Egyptian from origin, so I know a little bit more about this thing. It’s very simple, it’s to say 120 million people in a country, everyone needs to have health insurance. Even if you are not a government employee, if you don’t work in a private company, you need to have a health insurance. If you have nothing, you will just pay a small fee and then you will have some health services. Basically, you need to register in this program and when you register, you can make an appointment and then go to your doctor and then it will be for free, blah, blah, blah. So the government anyway will want to see to develop this universal health insurance, which as you can imagine, it’s billions, not millions, it’s billions of dollars of investment. So digital here is not even an option. Digital, you have to do, you have to control this program. Otherwise, it’s gonna be like a big mess and knowing, I mean, this is off record, right? You will have fake patients maybe more than the real patients, I’m joking, of course. So it’s open the door for corruption and for fraud and everything. So there is no other option to be able to manage and control well this program. So even the government, they don’t need to get this money from the World Bank because they are going to do this investment anyway. And if the investment even won 10% in making sure that the digital systems exist to manage well this program, so what they are gonna do? They need to know, really be sure of the identity of the people. So identity becomes like almost a natural thing. They need to know what happened. You have to have your EHR because you go to a doctor and then how can I know what happened? You need to have your EHR. You need to enable the exchange because of referrals and everything. You need to make the payments. right, manage prescriptions. So, and sorry, I forgot the most important thing you need to build. First thing, you need to build your registries because you need to know exactly because this health insurance would be deployed through primary health scale, essentially. Of course, in hospitals as well, but the need really is for the people who are on the bottom, right? So they would go. So you need to know exactly the registries of facilities, you know, the professionals, the drugs, the terminologies. This is your DPI for health. All the components I just mentioned, this is your DPI for health. So now it’s not only that, that also you need to link with the national ID if you have one. Many countries do have a national ID. You need to link with your payments infrastructure because of the payments that you are doing. And then you need to ensure privacy and security. So what, I have this image in mind. Think about it as a train that is moving, which is this universal health insurance, and the train is moving anyway. And this train will pull the whole ecosystem behind it because it’s a must. It’s not a good plan. I honestly don’t think that the ministries, they need to have this killer use case. It, health insurance, just one example, but it could be other things. But unless you have the investments the entry point is a public national goal that will be funded anyway. And this will make the investments in DPI almost a must. And this is where everything should follow. And I think a last point I would like to mention, I think this, the idea of having a blueprint will really help to cut the time and cost to develop because it takes time and it takes a lot of skills. I fully agree. It’s not something that is easy. That’s why blueprint might cut the cost. But more importantly, this blueprint needs to be built on stages. Where to start? Logically speaking, you start with your registries, health ID, then you move to the HR, enable exchange. Done. That’s it.

Laurie Werner:
Piece of cake. Got it. Literally, it’s a piece of the cake. Okay. That’s great. I actually really love that insight because especially when you tie things to money, it’s a great incentive. Great. Well, thank you. Chrissy, I’ll go to you now. As part of Dial, which does not work specifically in health, but in broader DPI, we’d love to hear a little bit about some of the work that Dial’s doing that’s contributing to the larger ecosystem of DPI, which of course then can strengthen the ecosystem for DPI for Health.

Chrissy Martin Meier:
Great. Thank you so much. And it’s great to be here and hear the summary of the two days. So I can just skip the two days and have our 45 minutes since I wasn’t there. Yeah. So this is a really interesting conversation. I think I would really agree with Hani that this idea that we need to build on what’s already happening and focus on outcomes for people is a message that Dial is really trying to push. I think that the bigger DPI conversation, again, outside of health, has really benefited from leadership from countries like India and Estonia that kind of led the way. And that really happened last year with the adoption of DPI as a critical enabler of development with the G20, which Dial supported some of those conversations. The negative that we’re seeing now, so there was all this attention and it was great that came out of these models, but now what we’re seeing is as we go and we try to translate those to other countries, there’s this kind of false, this is the model, or maybe there’s two and you can choose from one of these two, but you need to do these things and you kind of maybe need to start from scratch, right? So there’s talk of building ID systems to replace existing registries, right? All of these things are gonna really increase costs and might not actually tie back to any specific use case. case. So just to echo Hani’s point that I think we need to really shift the conversation on DPI to what is the problem that we are solving for people and then a lot of countries already have a lot of these components and it doesn’t really need to be like three things or four things, it needs to be a kind of what works to solve those problems. So that’s just to say, you know, I think we do need to shift the conversation that way. I also see that there’s a lot of places where investment in DPI more broadly can benefit this DPI for health conversation and hopefully lower the cost, right? So we did some work last year on financing of the non-technical aspects of DPI and I think what we found was there’s a lot of that enabling ecosystem that kind of gets underfunded by donors and governments. So things like data protection agencies or legal defense funds, right? So there’s a lot of focus on the regulatory environment but a data protection law can only do so much. It cannot actually be used as a way to undermine people’s privacy by governments unless you have these enforcement mechanisms and ways for people to actually use those redressal systems and I think those are systems and institutions that if funded and if funded with long-term funding can benefit any sector, right? If you have a good strong data protection agency or a good legal defense fund, if you’re training judges to be able to actually litigate data governance cases, all of that’s going to benefit the wider ecosystem. And so a lot of this work is now being taken up. Hopefully some of you have seen the UN recently convened a working group on safeguards for digital public infrastructure which my CEO Priya Bora is a part of. So that’s something just to call your attention to. They put out a draft report for comment and should help to push forward some of these conversations around the security of the of the broader ecosystem. And the other thing, one other point I wanted to make is during that financing research, one of the things that we saw was that there really needs to be a shift from thinking about financing from kind of this massive upfront investment to financing over the longterm. So technology has been more of a massive upfront investment in the past decade, but now as we shift towards cloud infrastructure and things like AI, we’re actually seeing that we need to be funding for, wait, cloud, it costs every month, right? Every month for infinity. And so if you’re only getting donor funding for these like kind of one-time CapEx expenditures, you’re gonna miss a lot of the long-term financing that needs to go forward. And then finally, I will say that when we’re thinking about the value for people of any of these DPI investments, it really comes from unlocking data and investing in secure data sharing. And so we have an effort right now called the Joint Learning Network and Unlocking Data for Climate Action, where we’re looking at different models for data governance and sharing that can help to get data kind of unlocked. So where it’s maybe trapped in by the private sector or in outdated government infrastructures. So things like data trust as a noun, right? And not trust in data, but a data trust. Data spaces or peer-to-peer decentralized data sharing like the backend protocol that’s coming out of India. There’s a lot of new ways that we can look at unlocking data and a lot of those new ways are coming out of the private sector. So one thing that Dayal says that I don’t think many others say is that DPI doesn’t have to actually be a government-led approach, that we do see components of DPI coming out of the private sector and we should be open to that as well, as long as the government is creating that secure and enabling environment for DPI. Thank you.

Laurie Werner:
Great, thank you. That was really, yeah, very helpful to hear. like some of the broader thinking in the space and how it directly applies and fits in with the health focus as well. So Jai, I’d love to go to you now. AHIN has been, excuse me, has been supporting countries for quite a long time. And one way you do that is you convene digital health convergence workshops. So has DPIH been a focus of that agenda? And if not, do you think the convergence workshops could be a way to help countries focus on this approach and maybe building on the prior comments too?

Jai Ganesh Udayasankaran:
Yeah, thanks, Laurie. I would say that this is very relevant for us because convergence workshop is a very good forum because it’s not only the Ministry of Health. AHIN brings together a variety of stakeholders, whoever is relevant for the digital transformation in the country. So most often we also bring the Ministry of IT or ICT, sometimes it’s digital economy, and then also Ministry of Planning and Finance, which is very important to bring in the investments. And then also the National Professional Societies Academy, everyone on the table. And then to get some of the top decision makers or stakeholders to be there for the one and a half to two days is a big challenge. And then during that, we need to understand the landscape and then also decide how we can actually collaborate together. So broadly, like as I mentioned previously, sorry to repeat that, there are two categories broadly in which the convergence happens, why a convergence happens. So the country already has a digital health strategy or a blueprint, but it’s in paper or PDF, it’s not into action. The second one, the second one is there is no strategy, but that’s rare now. Probably five, six years back, that was the case, but most of the countries do have, sometimes they do have like till 2023 or 2024, then suddenly the same strategy is extended or sometimes it is updated. But there are countries actually who work together with us also, they actually… added a few things and updated the strategy, but still the investments or the resources have not been mobilized most of the times. And then like I think one of the things that I wanted to pick on from what Phil said that TCO, Total Cost of Ownership, is not considered. Most of the top decision makers are very comfortable with the CAPEX, but when we talk about the operational cost, they said, no, no, not enough. And then that is something that is missing. And then with respect to the DPIH, though we have not directly assessed that because usually I also give you the context. We usually get very short time, one month. The government says, hey, the election is coming before that. I want to do this. And then you conduct this. There’s no landscape assessment report. There is sometimes strategies also kind of outdated or people have not endorsed it still. It is in the draft. That is when we get in. So we often get very less time. And then of course, we focus on the National Health Information Foundations, which we call as GAPs, Governance Architecture, Program Management, which also includes people, and then standards interoperability. We actually use that as a mantra to assess that. And then of course, after GDHM came and then we also worked with Health Enable, wherever that data is available, we use that also as a baseline. But you look at the payment systems, ID is covered more or less in most of this maturity assessment, but payment systems, I don’t recall. And then there is no such tool as, I’m not a great fan of suggesting another tool because I always complain there are more tools than that we use. But still, how do we as an organization, like a HIN, like we actually work with the country, but we often rely on the existing documentation to at least have a baseline. And then for infrastructure, we depend mostly on the other ministries, Ministry of Health or Ministry of IT or someone, but that’s not complete. So that’s the problem that we have. So recently we worked with the country, I’m not taking the name right now, because there is the report has just gone to the prime minister’s office for endorsement on landscape assessment. So we looked at three dimensions. One is strategic at the national level, at the decision-making level. And then the second one is a managerial level, which is at the provincial level, which is where the, and then the operational level at the health facilities level. So we looked at all the several, I think 12 of them of the majority frameworks, and then we added a few more, which is also relevant to the country, which we felt is not covered, and then sent it out to all the health facilities, and then all these three layers of the stakeholders, and got it done in one and a half months, which was a big challenge. So the report, as I talked now today, it’s going to the prime minister’s office for endorsement, because he issued a decree, and then formed three working groups. One of them is landscape assessment, and that’s when the convergence workshop came in, and then we took charge of the landscape assessment. Now, the preliminary things that I can share, for example, the country is very good in regulations, very good, because the prime minister established one of the departments on ICT and communications, and then that has done a fantastic job with respect to the regulations. But if you see those regulations translating, or getting used by the health sector, it is not yet. Connectivity is very good. In some countries, it is still a problem. Here, 90% of the country is well-connected, there is power, but then, if you look at the hardware and infrastructure, they’re outdated. Again, if this is what I connect with Phil, actually, if you, for example, a telehealth use case, what kind of applications we can do on telemedicine depends on the underlying infrastructure. We cannot have a full-fledged CINI, like an ultrasound scan being sent across our life, if we have our infrastructure, which can only support probably 2G or 3G. So, this is something that needs to be focused. And then, the hardware is a big point. in some countries and then cyber security. One of the countries, for the first time, we were asked to do a security audit, support them with that. So this is again coming into picture and then also health data governance. Again, AIHIN works with the transform health on that and also the model law, we did the regional consultation. Without having a clear cut health data governance structure in the country, I don’t think we can move further. So I would like to actually request this forum that how a network like AIHIN can be supported in terms of assessing or better understanding the country’s position or the status with respect to the DPA in H, in health. Because that’s the need. We are trying to actually indirectly assess it and we get very less time and that’s not complete. But again, I’m not suggesting yet another tool, but can we actually get it from the existing tools as an extension? Because for example, when we talk about the network readiness index in the countries, still many people don’t understand what it is. It has to be really explained. And then even then like, you know, it’s not all over the country, it is the same. Some of the places have very good connectivity, have everything in terms of infrastructure, but there are other regions where there is nothing. So yeah, I would put it as an ask. So to answer your question, we are not directly assessed, but indirectly we were able to get. And hopefully this report when it is endorsed by the ministry, of course, I think hopefully that will be in the public domain. So maybe we will be able to bring more insights on that. I hope I answered your question. Thank you.

Laurie Werner:
Yeah, well, you can answer a question with a question. It’s okay. I think it’s a good question. Yeah, no, no, thanks so much, Jay. Okay, well, Garrett, building on the two-day event on Phil’s presentation and the other panelists, could you share how WHO is working? to create tools and guidelines to support countries to take the DPIH approach.

Garrett Mehl:
Great, I just wanna thank PATH for helping to organize this session and for also inviting WHO to this important event. I just wanna say, I think this has been a really, not rewarding, it’s been actually a really intensive learning experience over the course of the last week. I wanna acknowledge maybe that in our experience, ministries of health are not looking to one-off widgets, flashy innovations to define their digital transformation. They are aiming for what Hani calls mega use cases. Every health worker has a point of care solution that is up to date with the most recent evidence-based patient management and care protocols. Patient continuity of care across time, facilities, providers, health events, and digital solutions is reality. Continuous and uninterrupted availability of essential medicines and medical supplies are happening. Every health worker is paid on time and ideally digitally. Universal health coverage with insurance systems and insurance claims is made possible through digital systems. Every person has a copy of their health record in a portable format. And with a specific use case in mind, every Hajj pilgrim is able to take their health record with them so that it is trusted, available, and portable across borders. I don’t think they’re looking for testing one-off innovations. That’s what’s been happening for 15 years. We need to move on. We need to help countries realize their global transformation and succeed. And the digital health strategy that was created by member states. 194 member states in 2020 really defined this vision over a five-year period. I’m reminded of a presentation that the ministry in South Africa provided where they provided this fantastic illustrative example of needing to know who, where, whom, what, and how much health costs and who’s getting it and ensuring that that then feeds into not only the national health information systems but also the health insurance digital platform. That kind of interconnection is required in order for, and leveraging DPIs makes that possible, both at the foundational and at the health level. Digital public infrastructure in health is not new. It’s been really percolating for many years, but we’ve really in the health space thought of ourselves as being exceptional. We will, if we need identity, we’ll invest in it ourselves and ignore the other sectors that may actually have the mandate to develop identity or financial payment systems or digital wallets. These were areas that we thought, health has to do it alone. That is clearly not the case. Digital public infrastructure at the foundational and at the health specific levels is an important repackaging of foundational components. It enables us to now talk about how health needs to really collaborate and ensure that we’re digitally, we’re assisting countries across sectors in their digital transformation journey. I think countries are really starting to recognize that these foundational and health-specific digital public infrastructure investments are essential. They recognize that it’s less about investment into flashy objects or one-off pilots, and instead are starting to recognize, in the case of the health-specific DPIs, canonical registries, people, providers, facilities, products, terminologies, and shared health records, that these are essential to realize their vision in digital health transformation. The decades of donor investments into digital innovations without the foundations of health DPIs, governance, capacity building, and the investments into interoperability standards have left countries poorly prepared to succeed with digital transformation in health. We have to understand that. We have to call out investments that continue to pursue that approach. One-off projects, pilots, that’s really not what countries are aiming for. They’re really looking to transform and succeed with across sectors and including health. The essential glue that makes digital health transformation possible are these foundational and health-specific DPIs alongside quality-assured content and open interoperability standards like FHIR, ICD, LOINC, and this needs to be enabled by policies, incentives, disincentives, capacity building, and good governance. A full-stack approach that we’ve defined is consisting of open standards, open architecture, open technology, and open and quality-assured content are some of the key components that WHO recommends for the health sector to shift to a self-sustaining, locally produced, and maintained digital transformation in health. DPIs without software that contain this essential interoperability standards and quality-assured content perpetuates the same problems that countries have faced for the past 10 years. Imported software that they cannot maintain or pay for, dependence on expensive outside experts. solutions that look good to a donor, but collapse with project funding. WHO and when the project funding ends. WHO will actively discourage member states from adopting software solutions that don’t have interoperability standards, quality assured content, and local production and maintenance and DPI’s at the heart of their investments and vision. The Global Initiative on Digital Health is a WHO managed network of organizations, institutions, and government technical agencies actively engaged in supporting national digital health transformation. WHO is the steward or the secretariat for the Global Initiative on Digital Health, and it aims to achieve the following objectives through collaborative efforts, assess and prioritize country needs for sustainable digital health transformation, increase the alignment of country level digital health resources and unfunded priorities, support the accelerated achievement of the strategic objectives of the global strategy on digital health, and build capacity and convergence to efforts to encourage local development maintenance and adaption of digital health technologies to continuously changing needs. The kind of investments that are required at a country level for digital health transformation really benefit from four components of the GIDH. One is the country needs tracker. The other is a resource country portal. A third is the transformation toolbox which consists of a set of tools and resources that can help a country to assess where they’re at and help ensure that they’re establishing a plan that others then can help invest into and help them succeed. And lastly, the convening and knowledge exchange. These aspects of country digital health strategy, investment plans, architecture, and use cases that drive these investments are critical for the coordination of donors, technical partners, country based. and external actors, and these are essential. Mechanisms like the convergence workshops that have been mentioned, combined with competency-based training and workshops for local production of software like hackathons are some of the mechanisms that the GIDH will facilitate coordination to ensure countries can succeed with their priority use cases, these mega use cases, and ways to leverage DPIs and quality-assured content to achieve digital health transformation. We’d invite partners to join and work through the GIDH to help countries to succeed with digital health transformation and the use of digital public infrastructure for health and the quality-assured content. The takeaway message, the one message I’ll leave you with, a country that isn’t investing in health and foundational DPIs and quality-assured content and interoperability standards is sure to have regret and contend with technical debt. Global initiative on digital health and the increased coordination will help facilitate countries to achieve their digital health strategy goals. Thanks.

Laurie Werner:
Great. Well, that was a- Yeah. Really well done. Yeah. Well, thanks, Ani. What a great ending to our panel. We obviously ran out of time and don’t have time for questions, but luckily the next session continues on this topic by our colleagues at WHO. But yeah, I think a few key takeaways that I think we can all take is this need for a mega use case, something to drive really the country’s thinking about this holistic infrastructure approach, thinking of long-term sustainable financing and ensuring that focusing, shifting from the one-off testing to really thinking of the larger perspective. So we are out of time, but thank you all so much for joining us here today, for those of you online as well, and we will pass over to the next session. Thank you. Thank you.