How Digital Public Goods Can Transform the Future of Public Health

India’s G20 presidency is centered around the theme of ‘Vasudhaiva Kutumbakam' or the 'World is One Family'. The proposition of viewing core technology and infrastructure as ‘digital global commons’ aligns perfectly with this philosophy. The idea that certain data, information, and digital infrastructure is a shared resource that is co-created, open access, and allows anyone to build upon it, demonstrates a paradigm shift happening in the digital health space.

Last month, I was a part of G20’s 2nd Health Working Group meeting in Goa. One of the key focus areas of India’s G20 presidency is digital health and during the discussions, I made an intervention on Digital Public Goods (DPGs) in health. My focus was on the need to converge global efforts to help increase the availability, adaptability, and maturity (through evidence of scale, funding, and evidence of effectiveness) of DPGs. This can be the key to our common digital future.

At present, at least half of the world cannot obtain essential health services. Digital interventions have a key role to play in enhancing the reach and quality of health services and have proven successful in addressing the gaps in healthcare accessibility and affordability. In 2022, the global digital health market size was valued at US$ 211 billion. It is now projected to grow at a compound annual growth rate of 18.6% from 2023 to 2030. India is an important part of this growth story and has emerged as a global leader in building population-scale digital public goods (DPGs). 

What are digital public goods?

But first, what exactly are digital public goods and digital public infrastructure (DPGs and DPI)?

DPGs are open-source software, open data, open artificial intelligence models, open architecture, open standards, and open content that adhere to privacy and other applicable laws and best practices, do no harm by design, and help move towards attaining Sustainable Development Goals. This definition is operationalized through the DPG Standard, a set of nine indicators that are used to determine whether a solution is a digital public good. Once a solution is recognized as a digital public good, it is discoverable on the DPG Registry. DPGs can enhance the service delivery of public goods such as healthcare, government schemes, and public infrastructure. DPGs are also a key building block of digital public infrastructure (DPI).

DPI refers to solutions and systems that enable the effective provision of essential society-wide functions and services in the public and private sectors. This consists of digital solutions and systems, including secure digital data exchange, that enable the effective provision of services such as digital health records, cash transfers, and digitalized identification and other civil registration.

A report by Co-Develop on ‘Digital Public Infrastructure for an Equitable Recovery’ defines three general functions which are critical for DPIs:

Identification systems that promote trust by verifying information about a person, business, or other entity. Examples include digital personal identification, civil registration and vital statics systems, and digital business registries.

Payment systems that enable transactions and the exchange of value. Examples include digital money transfers or government-to-person payments.

Data exchange layers that allow information to be managed and shared easily but securely among a diverse network of users. Examples include health information exchanges or information management systems, logistics management systems, integrated social registries, and integrated financial management systems. 

The India Story

India has emerged as a leader when it comes to building DPI and DPGs. It has applications for all the three functionalities defined above – Aadhaar, UPI and Account Aggregator built on the Data Empowerment Protection Architecture or DEPA.

India Stack- a set of open APIs to build a unique digital infrastructure to help solve population-scale problems, under which initiatives such as Aadhaar for identity, UPI for payments, etc are active – has been a  game changer in India.

The proposed National Health Stack is designed to leverage India Stack and will link to national health electronic registries, a coverage and claims platform, a federated personal health records framework, a national health analytics platform as well as other horizontal components.

Other Indian DPGs such as CoWIN, eSanjeevani, and Aarogya Setu also have the potential to be contextualized and deployed in other countries. 

Challenges on the way

As countries work to develop, expand, and maintain their DPIs & DPGs, they face many challenges.  The potential of DPGs can be harnessed only if we overcome the challenges of a fragmented digital sector, achieve regulatory harmonization, address data privacy and unequal access, resolve interoperability of systems, and create robust governance frameworks.

When DPGs are haphazardly designed, they can contribute to inequity and introduce data privacy issues. When designed and deployed intentionally with safety, inclusion, and trust at the core, alongside clear direction from government leaders, DPGs can provide sustainable benefits to an entire population.

When the challenges are addressed and there are well-designed DPGs and DPI, they can help both public and private stakeholders increase equity and provide a scalable, future-ready approach to cross-sectoral digital services. DPGs also have the potential to address the critical health needs of low- and middle-income countries (LMICs) if they are sustainably managed, and governments in these countries have the information, motivation, funding, and capacity to effectively incubate and implement DPGs.

G20 Global Initiative on Digital Health (GIDH)

One of the outcomes identified as part of the digital health agenda at the G20 is a Global Initiative on Digital Health to enable global digital public health goods, among other objectives. On the sides of 2nd Health Working Group, PATH, in partnership with Observer Research Foundation (ORF) and Digital Square, organized a thought leadership event to discuss what it takes to develop ‘A Global Digital Health Framework for Connected Healthcare’ on April 13, in New Delhi. The meeting brought together experts from government, academia, non-profit organizations, and the private sector and facilitated discussions on accelerating digital health adoption, health data governance, and building capacity and collaboration.

This was followed by a co-branded event with the Ministry of Health & Family Welfare and Digital Square on April 20 titled “Prioritizing digital health investments: Reinforcing the enabling environment”, to facilitate discussion on coordination, alignment, and commitment to supporting resourcing for the digital health ecosystem. 

Digital Square at PATH contributes to strengthening the DPG ecosystem by bringing its resources, coalitions, and portfolio of global goods together to support large-scale, high-quality, sustainable implementations of digital health interventions. We share the belief that this is crucial for saving lives and improving health around the world. Free and open source digital health tools can be used across different countries and health program verticals, cutting down on fragmentation and duplication to accelerate scale and health impact. 

Future of digital health

Countries around the world are transforming their health systems to take advantage of the digital tools, approaches, and data they produce as they work toward universal health coverage. Achieving health equity is increasingly reliant on ensuring that everyone has access to and benefits from health services which can be enhanced by implementing appropriate digital technologies. Making this vision a reality is only attainable through robust, aligned partnerships.

There is a felt need to build a global digital health framework that will facilitate a collaborative ‘One Health’ digital agenda across policy, strategy, governance, financing, and digital solutions to achieve Universal Health Coverage and equity. Such an initiative would be driven by countries including - governments, technology developers, implementers, academia, innovators, and donors.

We also need to move away from constantly reinventing the wheel in developing global DPGs for health and refocus on investments in enterprise architecture and DPIs. At the same time, community ownership and participation in health data governance are key to addressing the concerns around public commons and privacy. Ecosystem and technological enablers such as legal, policy, infrastructure, privacy, and security pathways have the potential to play a critical role in strengthening health data governance frameworks.