In this 5th section on our module on digital health, I want to say a few words about the enabling environment. Now many have criticized the space of eHealth and digital health as one where there has been a proliferation of pilot projects and test ideas few of which have been sustainable over a long period of time, and even fewer that are scaled to really national level solutions. Now, it's important to understand that digital health solutions as we've talked about in previous modules, don't operate in a vacuum. It's really important to appreciate that the enabling environment is essential to be able to support these technologies as they scale and as they grow in the number of users and in their complexity. Now in addition to the intrinsic features and functions often application or a strategy that is to say the cogs and gears that run the system on a day-to-day basis, it's really critical to consider the external context of the deployment. Think of it as planting a seed in the soil that is not prepared to encourage the growth of that plant. Is there the necessary fertilizer present? Are the nutrients present in the soil to make sure that that plant thrives as it goes through its stages of maturity? This consideration of the enabling environment is absolutely critical. Now the World Health Organization and the International Telecommunications Union developed this eHealth Strategy Toolkit many years ago to help characterize this national contexts. They classified this into really two different axes whether the environment in this country setting is either emerging or established, and whether the enabling environment is emerging or established. You've seen here how in the bottom left quadrant we see a lot of experimentation and early adoption, but as this technology environment and eHealth environment matures, we start to push projects towards scaling up and mainstreaming. Now, the way in which they envisioned the analysis of maturity was according to these seven critical building blocks. You can see here these building blocks are described as leadership or governance, strategy and investment, legislation policy and compliance, workforce, standards and interoperability, infrastructure, and then services and applications. I'm not going to sit here and read through this description for you but what you can see is, these are the elements of the fertility of the soil if you would, that help to grow and mature digital health solutions. Is there adequate governance like we talked about or are there standards that have been adopted at a national level? Is there an investment climate that is commensurate with the level of scale that's trying to be achieved by this digital health solution? Is the workforce available to fuel the growth of these programs? Or are individuals being trained in digital health or even informatics or even hardware to help maintain the growing body of technology that is now being used for the implementation of that particular solution? In the past few years one of the tools that I mentioned earlier that is now being used widely is the global Digital Health Index, and set of indicators has been developed based on these seven pillars to assess the country level maturity in terms of digital health readiness for scale and sustainability. You see here a snapshot of the website at Global Digital Health Index that looks at a few of the countries that have been highlighted for this particular illustration. We see a lot of reflection around things like connectivity, device availability, human resource availability, whether there's pre-service and in-service training available to folks working in this space. Are there digital health or data protection policies in place that include incentives for workers, incentives for supervisors, but even fundamental things like, can frontline workers or users of these decision support technologies make decisions when they're working with their digital health solutions without constantly checking with their supervisors which would limit the potential impact of the work that they're doing? You can see here the report that came out in 2019, that looks at where we are globally across the countries that participated in the first round of the index, and you can see that leadership and governance has been really an area that has seen marked maturity over the past decade, but across the rest of these pillars of investment we still have a ways to go before we can say where we're really in an advanced stage of maturity as a globe. From a leadership perspective I think one of the things the report found is that countries were doing well in prioritizing digital health planning. Most of the countries included in the Digital Health Index do have digital health included in their national health strategies or plans. Many have functional digital health bodies but we still have a ways to go given that the first pass of the index only had 22 countries that participated in this information gathering. From an investment level, the investment in national digital health strategies was sub-optimal, only about half of these countries have a costed plan that has been implemented. When you look at most of the countries have a very small marginal amount of public health budgets allocated for digital health investments, so quite some work to be done on that level. From a legislation point of view, most countries do have laws on data security and privacy, and most countries lack mechanisms for regulating and certifying digital health devices and services which is a cause for concern. Although this is clearly an area that needs investment workforce development for digital health, most of the countries that participated in this landscaping provided no digital health training to help professionals as part of their pre-service training requirements. You can imagine the uphill battle that will be faced when introducing digital health solutions into these geographies. About half of the countries surveyed did not have national digital health architectural frameworks or information exchanges established, but many countries were working on implementing data standards. This a good news but exactly where we expect to be based on the growth that we're seeing in this particular space. Looking at infrastructure, I think clearly one country emerged that is New Zealand as having an advanced level of infrastructure but most of the countries that participated are in need of substantial investment to continue that growth in infrastructure. Then finally the death of fully scale digital health platforms is one that continues to be a source of concern, that with the exception of some electronic registries for births or immunizations many countries still have major gaps in national level digital health solutions. Most solutions tend to be focused either on a sub-national or regional level, or still limited to the footprint of a particular digital health project. We've developed other tools including this one you see here known as the MAPS Toolkit to help assess and plan for scale, and so this is a tool that's available through the WHO that is a self-examination worksheet based strategy that looks at assessing a particular digital health project's maturity in terms of these six different axes from groundwork to partnerships to financial health to technology and operations to monitoring and evaluation. If folks are interested more in maturity and assessment for scale, I think this is a very useful tool that you can find on the WHO website
