How can the G20 build stronger digital health systems?

Digital health has emerged as a transformative force that could revolutionise healthcare delivery across the globe. It is already improving the quality of care, increasing accessibility to health services, and creating efficiencies across the sector. The G20—collectively accounting for 85 percent of the world’s GDP and two-thirds of its population—could play a critical role in shaping the global digital health landscape. Indeed, the recent G20 Health Ministers’ Meeting during the Indian presidency reaffirmed the “significance of digital health and health data modernisation in strengthening healthcare systems”, and pledged to “support an interconnected digital health ecosystem”.

Key challenges to digital health

Despite its potential, however, digital health faces several challenges within the G20. These include disparities in the approaches and levels of advancement of different national digital health strategies; data privacy concerns; interoperability issues; and the need for better coordination when responding to global health crises.

As digital health systems collect and process sensitive personal health information, robust data protection frameworks become essential.

A 2019 study by the Organization for Economic Co-operation and Development (OECD) indicated that relatively few G20 member states had comprehensive digital health frameworks and that differences in standards, infrastructure, and governance mechanisms posed challenges to e-health access and cross-border collaboration. Second, ensuring the protection and privacy of health data continues to be a concern, not just within the G20, but around the world. As digital health systems collect and process sensitive personal health information, robust data protection frameworks become essential. The fear of data breaches and misuse can hinder the adoption of health-tech and erode patient trust. Third, interoperability between electronic health record systems is crucial for the seamless exchange of health data. In the European Union alone, for instance, the lack of e-interoperability was estimated to cost 1.1 billion euros annually. Besides, cross-border data flows face additional complications due to varying data protection regulations. And finally, The COVID-19 pandemic has underscored the need for coordinated responses among countries and healthcare providers with respect to digital health. Indeed, uneven responses have sometimes had the effect of impeding pandemic management efforts.^[i]

The G20’s approach

Exploring the use of technology and digital innovation to strengthen health systems has become a core focus of the G20 since the Sustainable Development Goals came into effect in 2016, and Goal 3 articulated the need to ‘ensure healthy lives and promote well-being for all’.

The COVID-19 pandemic has underscored the need for coordinated responses among countries and healthcare providers with respect to digital health.

Since the Argentine presidency of 2018, addressing the four challenges outlined above has emerged as a G20 priority. The leaders’ statements and health ministers’ statements issued during the five presidencies preceding India’s tenure have collectively advocated for the urgent need to promote consistency and alignment in the design and implementation of e-health systems (including sharing related best practices); to strengthen measures to protect health data; to improve the interoperability of digital health information systems; and to evolve a tech-enabled, coordinated pandemic response mechanism (e.g., a new G20 Digital Health Task Force was created in 2020, and mandated to develop a ‘Digital Health Pandemic Management’ methodology).

Possible steps for strengthening digital health

The G20 could consider the following eight measures to advance digital health across its member states.

• Creating a common minimum framework (CMF) to protect health data: The G20 could help safeguard health data by setting up a CMF that calls for four levels of action. First, member states should map their existing provisions for data protection, check if they apply to the particular needs of health data, and, if not, amend or customise them accordingly. Second, the roles of agencies controlling the flow and processing of data should be reviewed. Third, the security and resilience of health data systems should be enhanced. Fourth, national health institutes and other public health institutions must undertake to sensitise stakeholders about the importance of the privacy and security of health data.

• Promoting secure cross-border exchanges of health data: Within the G20, there are divergent views about the issue of cross-border data flows, but there is also a growing recognition that the selective sharing of health data could boost research, innovation, and policymaking. Globally, there have been a few successful initiatives of this kind, such as a Nordic programme under which Norway, Sweden, Denmark, Finland, and Iceland pooled their health data and biobanks. The G20’s Health Working Group could study these models and develop guidelines for clusters of countries to share certain types of health data for targeted research.

• Prioritising digital public infrastructure (DPI) for health: The G20 should extend its emphasis on DPI, initiated during the Indian presidency, to focus on health-sector-specific DPIs. Health-related DPIs could prove crucial for providing services like digital identification, cash transfers, and the consolidated storage of health records. The G20 could encourage knowledge-sharing, innovation, and public-private partnerships with respect to health-sector DPIs. In this regard, India’s proposal for building a Global DPI Repository, which has been received enthusiastically by the G20, provides an opportunity to begin creating a global knowledge hub around DPI. Digital health should be made a key focus of this effort from inception, with sustainability and inclusivity as fundamental principles. 

• Setting up centres of excellence (CoEs) in AI and emerging tech for healthcare: Developing AI- and emerging-tech-based solutions for healthcare holds significant potential but requires careful planning and collaboration. Establishing CoEs that specialise in researching, piloting, and implementing health-tech solutions could be a way forward. G20 member states could jointly develop such CoEs to ensure ethical and inclusive health-tech development, promote innovation, share knowledge, build capacity, and offer technical guidance. Existing institutes such as the United Kingdom's (UK) Alan Turing Institute and the UKRI artificial intelligence Centres for Doctoral Training, and Singapore's SG could serve as a model for the G20's multilateral health-tech-focused CoEs.

• Setting up a telemedicine task force: The G20 could set up a dedicated task force for promoting telemedicine. Its goals would be to identify best practices, share knowledge, develop guidelines for the ethical use of telemedicine, and explore opportunities for collaboration and investment, particularly in low-resource areas. Through these interventions, the task force would leverage the increased acceptance of remote care during the pandemic, and help accelerate the adoption of telemedicine across the G20, ultimately improving healthcare access and outcomes.

• Financing digital health innovations: An estimated investment of US$ 12.5 billion is needed to achieve the digital transformation of healthcare systems in low- and middle-income countries (LMICs) over the next five years. To support this process, and streamline the process of coordinating funding, the G20 could consider creating a US$ 150-million fund, potentially housed within the World Health Organization (WHO), to support global-impact digital health startups, particularly those innovating to address the digital gender gap and advance health access for marginalised communities. The G20 could also draw on existing mechanisms like the World Bank's Digital Development Partnership (DDP) to fund digital health innovations.

• Supporting joint responses to large-scale health crises: To enable coordinated responses to global health crises, the G20 could consider setting up an international health-tech-focused think tank with funding from G20 governments. This think tank could be led by the WHO and staffed by experts in public health, digital health, and computer modelling. It would aim to develop tech-enabled pandemic response strategies, address digital health capacity gaps within the G20, and support global efforts like the Access to COVID-19 Tools (ACT) Accelerator.

• Building a digital health repository: Following the general approach of the G20 Repository of Digital Policies established during the Argentine Presidency (2018), a dedicated open-access G20 Digital Health Policy Repository (DHPR) could be built to facilitate the global exchange of knowledge and best practices in digital health. The DHPR would host member states’ digital health laws, policies, and strategies, as well as data protection regulations related to health missions and health identifier programmes. 

For the G20 to evolve more robust digital health systems, strategic partnerships and joint actions like the ones suggested above will be crucial. Meeting in India in August 2023, the G20 health ministers acknowledged the need for enhanced inter-country collaboration, observing that while many institutions are working towards the digital transformation of health systems, “they are primarily operating in silos leading to reduced country-level impact”. Going forward, every effort must be made to actualise the ministerial recommendation that “existing initiatives [be] closely coordinated to complement and support an interconnected digital health ecosystem”, while continually exploring newer avenues to promote digital health. 

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Anirban Sarma is a Senior Fellow and Deputy Director at Observer Research Foundation  Varun Kaul is a digital health professional with expertise in public health, innovation management, impact funding and implementation. Currently a Program Officer for the Digital Health team at PATH South Asia Note: The ideas outlined above have been explored in greater detail by the authors in the T20 Policy Brief, Promoting Digital Health: Envisioning Strategic Partnerships within the G20. ^[i] Bill Gates, How to Prevent the Next Pandemic (London: Allen Lane, 2022), 46-8.

• International Affairs
• Healthcare
• Internet Governance
• Artificial Intelligence
• India
• Data privacy
• Digital Health
• ecosystem
• financing
• G20
• global health crises
• innovation
• Inter-country collaboration
• interoperability
• telemedicine

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