Abstract
Digitization of healthcare has attracted considerable attention globally and has transformed healthcare systems. However, it is essential to recognize that not all low- and middle-income countries (LMICs) have the necessary resources or infrastructure to fully embrace digital technologies. This chapter provides an overview of the non-digital trends that continue to influence healthcare in LMICs, and by extension the implementation of digitisation efforts. These trends span many dimensions, including health policy, workforce development, community engagement, and infrastructure improvements. Understanding these non-digital trends is vital for the successful integration of digital solutions into health systems in LMICs. Thus, highlighting the challenges and opportunities for digitizing medicine in LMICs is essential, to understand the needs of medical support tools in LMICs now and in the future.
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Keywords
- Low- and middle-income countries (LMICs)
- Digitisation
- Healthcare
- Non-technology trends
- Health policy
- Capacity building
1 Introduction
While digitization has attracted considerable attention and transformed healthcare systems worldwide, it is essential to recognize that not all low- and middle-income countries (LMICs) have the necessary resources or infrastructure to fully embrace digital technologies. This chapter explores the non-digital trends that continue to shape healthcare in LMICs. These trends span many dimensions, including health policy, workforce development, community engagement, and infrastructure improvements. Understanding these non-digital trends is vital to integrate digital solutions into health systems in LMICs effectively. A broad overview of the current situation and highlighting the challenges and opportunities for digitizing medicine in LMICs is essential, to understand the needs of medical support tools in LMICs.
2 Health Policy and Regulations
In LMICs, health policies and regulations play an important role in shaping health status. While digitization offers potential benefits, policy frameworks need to be in place to ensure equal access, patient privacy, data security, and interoperability of digital systems. For example, Ghana’s National eHealth Policy (2015) emphasizes integrating digital technologies into the healthcare delivery system to increase efficiency and improve patient outcomes (Ministry of Health of Ghana 2015). Similar initiatives have been seen in other countries, such as Rwanda’s National eHealth Policy (2018), to use digital technologies to strengthen health systems (Ministry of Health Rwanda 2018). These policies lay the foundation for future digitization efforts while addressing existing challenges and constraints.
3 Workforce Development and Capacity Building
A healthy healthcare workforce is vital to the successful adoption and adoption of digital solutions. LMICs often face a shortage of skilled health workers, exacerbating digitization challenges. Therefore, investment in workforce development and capacity building becomes vital. Educational programs and initiatives focused on digital health literacy, data management, and telemedicine enable healthcare professionals to use digital tools and technologies effectively. For example, Uganda’s African Health Innovation Exchange (AHIX) project trained healthcare professionals in digital health solutions, increasing their skills and confidence in using technology for patient care (Mamuye et al. 2022). By strengthening the workforce, LMICs can optimize the benefits of digitalization in healthcare.
4 Community Involvement and Empowerment
In LMICs, community participation and empowerment are critical to successful health interventions. While digital technologies open up new patient engagement and education opportunities, they must be accessible and inclusive. Many LMICs have limited internet connectivity and low levels of digital literacy, especially in rural areas. Thus, non-digital approaches such as community health workers (CHWs) remain essential in health service delivery. CHWs act as trusted intermediaries, providing education, preventive care, and primary treatment to low-income communities (Perry et al. 2014). Integrating digital tools into existing CHW programs can increase their effectiveness and improve data collection for decision-making.
5 Infrastructure Improvement
One of the main problems in LMICs is the inadequacy of the health infrastructure. Limited access to electricity, internet connectivity, and medical equipment hinders the adoption of digital technologies. Improving infrastructure is a prerequisite for successful digitalization. Initiatives such as the Global Digital Health Index (GDHI) assess the readiness of countries’ digital health infrastructure and provide insight into areas that need improvement (Global Digital Health Index). In addition, partnerships with international organizations, governments, and the private sector can help fill infrastructure gaps through funding, resource allocation, and technical assistance.
6 Privacy and Security Issues
Digitization in medicine requires strong privacy and security measures to protect sensitive patient data and build trust in the healthcare system. In LMICs, where legal frameworks and data protection infrastructure may be less developed, addressing privacy and security issues becomes even more critical. This subsection discusses vital privacy and security considerations in the context of the digitization of medicine in LMICs.
Protecting patient privacy and providing informed consent are fundamental ethical principles in healthcare. In LMICs it is crucial to establish clear guidelines and rules on data privacy and agreements to protect the rights of individuals and build trust in digital health systems. Developing comprehensive data protection laws and policies is critical to protecting personal health information. For example, in Malaysia, the Personal Data Protection Act governs personal data collection, storage, and use, including health information (Malaysia Privacy Commission). Similar legislative efforts are needed in other LMICs to ensure the privacy rights are respected in the digitization of healthcare.
7 Data Security and Encryption
Protecting medical data from unauthorized access, hacks, and cyber threats is of paramount importance. LMICs should prioritize investment in robust data security measures, including encryption, firewalls, and secure storage systems. Implementing internationally recognized security standards such as ISO/IEC 27001 can be the basis for building and maintaining secure digital healthcare infrastructures. In addition, establishing incident response mechanisms and regular security reviews can help identify vulnerabilities and effectively mitigate risks.
8 Compatibility and Communication
Interoperability is vital for seamlessly exchanging and integrating medical data across different digital systems. LMICs should strive to develop interoperable standards that enable secure and standardized data exchange between healthcare providers, systems, and organizations. The introduction of technologies such as Health Information Exchange (HIE) can facilitate the secure exchange of patient information while maintaining confidentiality and security standards. Countries such as India have made progress in this area through initiatives like the National Digital Health Mission, which aims to establish a federal health information architecture for secure and functional data sharing (National Health Administration 2020).
9 Cyber Security Capacity Building
Strengthening cybersecurity capabilities is critical to protecting against new threats. LMICs should invest in training and capacity-building programs to develop a skilled workforce capable of addressing cybersecurity challenges in healthcare. Collaboration with international organizations and cooperation with more technologically advanced countries can provide valuable support and knowledge sharing. The World Health Organization (WHO) has recognized the immense weight of cybersecurity in healthcare and offers recommendations and capacity-building initiatives to help countries strengthen their cybersecurity defenses (World Health Organization 2020).
10 Public Awareness and Education
Raising awareness and educating the public about the privacy and security risks associated with digitization is essential. LMICs should invest in public campaigns and educational programs to enable people to make informed decisions about their health data. This includes informing patients about their rights, the necessity of strong passwords, and the risks of sharing sensitive information through insecure channels. Joint efforts involving governments, healthcare providers, and civil society organizations can help spread knowledge and promote the responsible use of digital health technologies.
11 Conclusion
Privacy and security considerations are vital to successfully adopting medical digitization in LMICs. Data privacy and consent, data security and encryption, interoperability and data exchange, cybersecurity capacity building, and public awareness are important areas that require attention. By prioritizing privacy and security, LMICs can build trust, protect patient data, and create an enabling environment for the sustainable integration of digital technologies into healthcare.
However, digitization has the potential to revolutionize healthcare in LMICs, but it must be done in the context of existing non-digital trends. Health policy and regulation, workforce development, community engagement, and infrastructure improvements are critical elements in determining the adoption and success of digital solutions. Understanding and addressing these non-digital trends is critical to developing sustainable and inclusive digital health ecosystems in LMICs. By building on existing strengths and addressing challenges, LMICs can pave the way for a fair and efficient digitization of medicine.
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Sargsyan, K. (2024). Non-digital Health Trends in Low- and Middle-Income Countries. In: Kozlakidis, Z., Muradyan, A., Sargsyan, K. (eds) Digitalization of Medicine in Low- and Middle-Income Countries. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-031-62332-5_27
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