Equity must be at the centre of national policies to ensure digital healthcare doesn’t exacerbate existing inequality.
The ITU/UNESCO Broadband Commission Working Group on Virtual Health and Care provides best practice in this area.
Rwanda and Chile are examples proving health and equity can be achieved outside of high-income countries.
It seems a given that delivering health and care services virtually – that is, enabling remote access through digital means – would automatically make it more accessible to more people. You would also hope this increased access would subsequently drive health equity and improve health outcomes for all.
But a new report produced by the ITU/UNESCO Broadband Commission Working Group on Virtual Health and Care, which is co-chaired by the World Health Organization and the Novartis Foundation, and developed with support from Accenture, shows that placing equity at the centre of national policies is vital to ensure the opposite does not happen.
Without adequate policies, people are at risk of missing out on the benefits of virtual health and care due to factors such as their income status, age, gender, race, disabilities or access to broadband internet. This could result in virtual health and care entrenching, or even exacerbating, existing inequities.
Have you read?
Public-private partnerships can improve rural healthcare in the digital age
Approaching health equity from all angles
How connected healthcare will transform our lives
We published the full set of Broadband Commission Working Group recommendations for how countries can ensure they achieve health access and equity through virtual health and care on 6 June, but here is a sample of national best practices we can learn from:
1. Rwanda’s community-based health insurance
We can look to Rwanda for an excellent example of a policy that helps ensure people are included in virtual health and care services whatever their economic status.
A community-based health insurance scheme covers healthcare expenses for all people in Rwanda, with the premiums depending on people’s socio-economic status. Membership covers both virtual health and care services and in-person care – with Rwanda being one of the only countries reimbursing virtual services in this integrated way. As of 2020, it covered 88% of the population.
2. Chile’s digital hospitals
On the other side of the world, an initiative in Chile shows how to use virtual services to close the gap in care between urban and rural areas by enabling rural communities to access expert medical care remotely through digital hospitals.
Launched in 2019 by the Chilean government to accelerate early detection of severe diseases, digital hospitals enable people in rural areas to undergo radiological examinations and access specialty health services through virtual exchange of medical information.
3. The US opens up care across state lines
The US has also made moves to help patients in rural areas better access specialty services. During the COVID-19 pandemic, several American states revised their health and care provider licensing polices to enable virtual delivery across state borders. Previously, people had to travel to urban centres to access specialty consultations. There are now plans to make these changes permanent through appropriate policies.
4. Increased equity for New Zealand’s minority populations
New Zealand sets an example for policies that attempt to ensure that virtual services narrow inequities for minority populations through health-system reforms that seek to ensure representation of its indigenous Māori population.
The reformed governance structure includes provisions to provide more virtual and digital services such as phone and video consultation to people in homes and local communities. Special funding was allocated to health and care providers to establish remote working arrangements including digital outreach support services and a dedicated telehealth service for the Māori population.
5. Germany’s inclusivity of people with disabilities
Meanwhile, Germany provides an example of how to embed inclusivity for people with disabilities in policy-making.
Since 2000, health disparities have been implicitly mentioned in Germany’s national health goals. More recently, licensing requirements oblige digital health applications (including virtual delivery solutions) to offer support for people with vision, hearing and motor skills disabilities by either including operating aids for people with disabilities, or supporting the aids offered by the platform.
6. UK efforts towards inclusive data governance
A UK policy sets an example of how to embed inclusivity at the heart of virtual health and care.
The UK National Health Service prescribes a Data Ethics Framework to prevent unintended harm or discrimination that can benefit one group at the expense of others while developing solutions or delivering health and care. The framework guides responsible data use in government and wider public sector for anyone working directly or indirectly with data including virtual health and care data. It recommends a self-assessment model to evaluate fairness and eliminate the potential of unintended discriminatory effects on individuals and all social groups by identifying which aspects of the project need refinement.
As you can see, the above examples come not only from high-income countries, but from low- and middle-income countries too. This is evidence that virtual health and care can help drive better access and inclusion for people all over the world.