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  • Michael Calopietro—Denmark

Paving a digital pathway to universal health coverage

Digital innovation that aims to deliver hypertension and diabetes care to millions in low- and middle-income countries demands collaborations that balance the future of digital healthcare with scalable solutions today.


Diabetes and hypertension disproportionately affect low- and middle-income countries, posing significant global health challenges.


In a world where health disparities persist, and access to quality care remains a challenge for many, the global stage at this year's UNGA is set for an essential dialogue. The assembly aims to accelerate progress toward universal health coverage (UHC), a process which, according to newly released report by the WHO and World Bank, is “alarmingly stagnant”. The integration of prevention and treatment services for non-communicable diseases (NCDs) into routine primary-care services will be an essential part of this conversation.


Today, one billion people in LMICs live with hypertension and only 10% of them have controlled blood pressure. Of the 350 million people in LMICs who live with diabetes, 77% do not receive adequate care.

Diabetes and hypertension are global health crises that are hitting low- and middle-income countries (LMICs) the hardest. Today, one billion people in LMICs live with hypertension and only 10% of them have controlled blood pressure. Of the 350 million people in LMICs who live with diabetes, 77% do not receive adequate care. These numbers will grow significantly in the next decade, putting immense pressure on healthcare workers and healthcare systems. As hypertension affects 70% of all people living with diabetes, these diseases are closely intertwined. Collectively, they stand as leading causes of morbidity and mortality, and the sheer volume of patients requiring treatment in the coming years is staggering. In LMICs, universal health coverage isn't just a goal—it's an imperative.


Digital solutions as powerful enablers of UHC


Achieving UHC in LMICs will require a multi-faceted approach with technology as a key accelerator. It requires engagement with the whole ecosystem, involving many stakeholders—including government agencies, healthcare providers, health-related and technology businesses, non-governmental organisations, patients, and funders.


We agree that the time has come to think beyond enhancing health systems through the introduction of individual digital technologies. This requires a digital transformation of health systems in its broader sense, removing the underlying barriers to sustainability and scalability of these solutions. However, while the long, hard work of digital health transformation continues, we believe there is an urgent need for complementary solutions that support the delivery of basic NCD health services. The diabetes and hypertension burdens are simply too large and too costly.


Solutions for today and tomorrow


In Sri Lanka, the World Diabetes Foundation currently follows a two-fold approach. We are collaborating with the Ministry of Health, technology developers, and national professional associations to support the multi-year, complex digital transformation of the health system—while simultaneously launching easy-to-use solutions that strengthen diabetes and hypertension care today.

In Sri Lanka, the World Diabetes Foundation is collaborating with key players to support the digital transformation of the health system.

Photo: Diabetes Compass


The ambitious goal of digital transformation is rooted in the recently crafted National Digital Health Blueprint, a comprehensive strategy designed to guide Sri Lanka's healthcare system towards a digitally empowered future. The blueprint envisions a seamlessly interconnected digital health ecosystem, fostering the exchange of critical information between various digital health solutions through open, consistent, and readily available application programming interfaces. The Diabetes Compass project establishes a foundation for realising this vision. Specifically, it digitises clinical workflows for the management of diabetes and hypertension, integrates multiple health platforms into a connected ecosystem, and establishes a Fast Healthcare Interoperability Resources (FHIR) server that interoperates with these platforms while creating the foundation for a future shared electronic health record for every person in Sri Lanka.


At the same time, we have introduced solutions that can be launched and scaled up immediately. This includes a community-based screening app that empowers local community workers to detect diabetes and hypertension early and refer them to a health facility where an updated electronic medical record platform will be used by healthcare professionals during routine clinical visits by people living with diabetes and hypertension. Together, these solutions will help strengthen the diabetes and hypertension care pathways immediately.


While broad digital transformation will be truly impactful in the long run, this work must be complemented by pragmatic solutions that solve immediate needs on the ground. The road to UHC will involve solutions both for today and tomorrow—and these should go hand in hand if we are to reach the billions of people living with hypertension and diabetes.

 

The opinions expressed are those of the authors and do not necessarily reflect the position of Re:solve Global Health.


Michael Calopietro is the Head of Digital Solutions at World Diabetes Foundation and is working closely with health ministries in Malawi, Sri Lanka, and Tanzania to support digital transformation through the Diabetes Compass project.

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