International organisations affirm need for increased voice and participation of digitally excluded

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On 11th February 2021, more than 35 people from 19 international organisations and NGOs convened online for a two-hour panel and roundtable discussion on global governance and digital cooperation for health moderated by Ilona Kickbusch, Co-chair of The Lancet and Financial Times Commission Governing health futures 2030: Growing up in a digital world. This event is the third of its kind – a follow-up to two meetings with international actors in Sept. 2019 and Jan. 2020 – and provided an opportunity for participating organisations to discuss how digital strategies translate to implementation, specifically focusing on how digital health technologies can and cannot work to improve health equity. The panelists’ and attendees’ contributions were guided by their emerging insights during the COVID-19 pandemic. Organisations in attendance included City Cancer Challenge, Digital Square, FIND, the Global Fund, ICRC, IFPMA, ITU, the NCD Alliance, OECD, the Office of the UN Secretary-General’s Envoy on Technology, PATH, PMNCH, Terre des Hommes, UNAIDS, UNDP, UNICEF, UNITAID, WHO, and the World Bank.  Panelists represented the Office of the UNSG Envoy on Technology, UNICEF, Digital Square, WHO, and the Global Fund. The diverse group highlighted key topic areas including digital access and literacy, capturing value through digital public goods, coordinating digital innovation pipelines, building capacity for governance ownership of digital health, and – reversing historical precedents – how health needs are accelerating the digital transformation during the COVID-19 pandemic. “What COVID has done is bring a sense of what is possible for information,” said John Fairhurst, Head of Private Sector Engagement at the Global Fund. “This should bring a different pace of what it can do moving forward. We have all been accepting digital timelines that are not constrained by technology, but constrained by the ambition, as well as the investment and technical support to achieve it.” The panel discussion triggered broader exchange by attendees about the challenges of realising health equity in digital health interventions. This discussion featured key themes of how to reduce the digital divide while not increasing health inequities for the most vulnerable, especially along racial, ethnic, gendered, or age demographics. “We know from our work with women’s self-help groups that in some contexts, phone ownership rests with the head of the household – which is often not women. So when we create mobile-only solutions, we are missing out on a key demographic. Working with the end-user on design is key because our work needs to build on existing processes, existing structures, and existing societal and cultural dynamics,” said Rigveda Kadam, Head of Digital Access at FIND. The key tension in realising health equity through digital health was the absence of population demand to meet the supply of digital interventions, pushing an agenda that is not necessarily shared. In other words, while there is consistent focus on necessary governance infrastructures for digital health, many programs do not consider the needs and mechanisms of health access for the most vulnerable. “When we look at developing new technologies, we always think about user-testing, but, often, we don’t think about users with different experiences from our own. That’s why it’s important to include different groups and to hear these voices. It’s important they are consulted from as early a stage as possible,” said Jason Munyan, Programme Officer with the Office of the UNSG’s Envoy on Technology. Participants remarked that, when voices of the most vulnerable are not included, digital technologies may bridge the digital divide superficially. Vulnerable populations still risk being left behind, thus failing to achieve the driving principle of the Sustainable Development Goals. Panelists and attendees voiced that these risks often concretely manifest in uneven broadband access, issues of data privacy and data ownership, weak governance capacity, and lack of civil society inclusion.  Mechanisms of accountability are necessary to include those continuously left unheard in digital health governance.