The World Health Organization (WHO) addressing digital health as a global strategy in 2020-2024 and its digital health defines digital health as “the field of knowledge and practice associated with the development and use of digital technologies to improve health” It is a broad umbrella term encompassing mobile health, eHealth, telemedicine and advanced computing sciences like genomics, artificial intelligence (AL) and big data.
Digital health is a rapidly growing industry that, according to some estimates, is expected to be valued at US$ 504.4 billion by the end of 2025. It is being viewed as an accessible and affordable solution for the people who do not have access to the traditional health system, and an important tool in achieving sustainable goals,
Digital technologies like artificial intelligence (AL) and machine learning (ML) are an integral part of many businesses and companies in the developed countries around the world. They are a driving force in multi-million-dollar industries such as automotive manufactures, who rely on AL to, for example predict when cars might need repair to ensure the safety of the passengers, the banking sector where AL is applied to detect fraudulent transaction, and Silicon Valet genes like Google, Facebook and others who have formed a consortium for conducting research intended to improve the understanding of AL technologies for the improved welfare and well-being of the society.
The health sector is also embracing the digital; digital health technology in developed countries is being employed in major aspects of the health care process, including construction, diagnosis treatment, monitoring patient education, behavioral modification and medication adherence to in the fast-growing field of health Al, a recent study in Japan used an Al based diagnostic system that racy for esophageal carcinoma than those from conventional methods.
A retrospective study conducted to evaluate the accuracy of Al in producing the mammograms of biology of biopsy -proven breast cancer patients showed that Al outperformed all the human readers. Similar studies con ducted on dermatological lesions using deep convolutional neural network have shown that the ability of AL to classify malignant and nonmalignant conditions correctly is comparable to that of board-certified dermatologists.
The expansion of mobile technologies offers an unprecedented opportunity for global health delivery in low and middle-income countries. Digital heath innovations are addressing issues such as maternal, new born, and child health: low immunization cover age, lack of access to life-saving medications, infectious diseases outbreaks, and the increasing burden of noncommunicable diseases.
Sub-Saharan African countries are. using an SMS text messaging technol ogy project, SMS for Life, to ensure accu demonstrated a higher diagnostic accurate reporting of real-time facility stock data to reduce anti-material drug stock outs.
India is using digital health tools to combat tuberculosis pandemics through compliance, which helps to monitor patients in real-time, ensure better medication adherence, and decrease treatment default rates.
Bangladesh is storing its health information data in aa common data repository called the District Health Information Software 2 (Health Information Systems Program) which allows for real-time monitoring, accurate localization of under-resourced areas, and better resource allocation.
And in Pakistan, the doctor-to breaks and with isolating cases and their spreads.
patient ratio is close to 0.83 physicians per 1000 individuals in the population. Digital health interventions are being designed to address various health care needs. Several SMS based interventions are being used to improve medication compliance in patients with non- communicable diseases and tele- medicine tools are being used to educate patients and to keep health care professionals abreast of medical advancements,
Moreover, as many female doctors leave clinical practice due to household and children responsibilities, telemedicine initiatives such as eDoctor (SE software Technologies) and Sehat Kahani enable them to conduct their medical practices remotely via online patient consultation through a telehealth platform
Another intervention, a mobile app called Tasku (Agha Khan University) aimed at helping vaccinators record immunization data, generated reliable data for better monitoring and improved the coverage of expanded program on immunization (EPI) vac cines such as the pentavalent and pneumococcal conjugate vaccine, Outbreak investigation and surveil lance is another relevant public health domain that can be improved with digital health interventions.
In 2011, after a particularly severe Dengue outbreak, a GPS-enabled mobile application called the Dengue Activity Tracking System (Punjab Information Technology Board) was developed to track suspected and confirmed Dengue cases.
In two recent epidemics of the extensively drug-resistant typhoid and human immunodeficiency virus (HIV) in the province of Sindh, geospatial mapping helped considerably with identifying the root causes of the out
These aforementioned programs are just a few examples of successful digital health interventions carried out in Pakistan despite limited resources available due to the financial constraints of the country.
Mobile app solutions and social media have shown to be quite effective in various programs worldwide but there is limited data available on the use of emerging technologies in improving health care services.
According to a study carried out last year in Pakistan, the health domains targeted by the interventions included general health 46 %, immunization 26 %, diagnostics 10 % and mental health and behavioral change through 6%.
The diseases outcomes targeted were in 56% of the interventions, infectious disease in 33% of the interventions and mental health in 7% of the general population, 30 % were specifically for the children and adolescents and 20 % targeted adults only.
The targeted population belonged to all the various socio-economic classes including 39 %, belonging to the middle class, 38% to lower socio-economic class and 23 % to upper socio-economic class as per the participants self-rating
Overall, digital health or the use of technology in all domains of health is an emerging factor globally and especially in resource-constrained: it can be a powerful solution for improving health outcomes locally and at the grass-root levels.
Due to resources constraints, the current infrastructure of Pakistan is still struggling with providing access to high-speed internet and smartphones to two-thirds of its population. Furthermore, high budget requirements in the establishment and implementation of technology-based interventions including human resources and infrastructure costs like software and servers, is a major barrier among countries under-budgeted for technol ogy and health sectors such as Pakistan. While smartphones offer an interactive interface and allow for more complex
web-based applications to be developed, the generalizability of these interventions or programs somehow remain limited due to the non-suspensibility of smartphones to the majority of the population in present-day Pakistan. Hence,
looking at the ground reality, any successful interventions with an excellent outreach would have to be generalizable to a majority of the population, even it is not the most advanced technology:
One major gap identified in the study was the lack of ethical and legal regulations at the national level. The Ministry of Health and the Ministry of Information Technology and Communications in Pakistan have to work together to implement a policy for regulating the use of technology in the health sector and standardize the procedures for developing and executing digital health-based projects. However, health is a provincial matter in Pakistan and IT is a federal subject, this will obviously present a challenge in this regard.
Digital health-based interventions are, slowly but steadily, being ushered in the existing heath system of Pakistan. But there are still significant hurdles, barriers and roadblocks in the form of limited internet facilities, phone owner ship, network coverage, non-availability of regulatory frameworks, data protection and security regulation, accessibility, affordability and paper based health records, limiting the types of technologies that can be utilized for effective interventions,
However, despite all the challenges, digital health is steadily expanding through the efforts of multiple stake holders in both the public and private sectors. However, it is difficult to say how much effective these interventions have bee, as not all interventions are being evaluated and published.
The future for digital health does look bright especially after the government’s new initiative to digitalize the public sector in Pakistan.