The use of digital health technologies to optimise service delivery platforms during the COVID-19 pandemic

Author

Dr Arvind Mathur, WHO Representative, Maldives

Country

Maldives

Key Learning Points

• Digital health strategies can play a key role in maintaining the continuity of essential health services across all levels of the health system.

• Scaling up such interventions in a short time period can present particular challenges with regards to governance and interoperability with existing platforms.

• Integration of digital health into existing service delivery platforms may have unintended consequences, i.e. widening inequities for vulnerable and marginal populations who may not have access to, or familiarity with, telemedicine platforms.

How has COVID-19 impacted essential health services in Maldives?

In response to rising cases of COVID-19, Maldives imposed a full nationwide lockdown in mid-April 2020, banning all non-essential travel between islands across the archipelago. Due to the lockdown, there was significant disruption to the delivery of health services across the country. This included disruption to in-person care at primary health care clinics due to concerns about COVID-19 transmission. In addition, secondary and tertiary care services for patients with complex health needs were also affected.

What were the interventions to help mitigate this impact?

During the lockdown, service delivery platforms were optimized to maintain essential health services. This included strengthening digital health services by leveraging existing internet connectivity in the country. Indeed, whilst the resident population is approximately 560,000, Maldives has 785,000 mobile subscribers and 316,000 internet subscribers (National Bureau of Statistics, 2020). In 2016, the International Telecommunication Union reported that Maldives has the highest internet penetration in South Asia.

In light of this, telemedicine services were scaled up to allow for online consultations between health workers and patients at the primary health care level. This was supplemented by electronic prescription of regular medications for vulnerable groups (i.e. patients in long term care facilities or with chronic, complex health conditions). Furthermore, a tele-consultation programme was developed with partner hospitals in India to provide specialist clinical input for patients with complex health conditions in secondary and tertiary care, who were unable to travel abroad for treatment. This was to mitigate the impact of international travel restrictions due to the pandemic.

How did this intervention help in the maintenance of essential health services?

• The strengthening of telemedicine services aided the continuity of care at all levels of the health system during a time of significant disruption. has created momentum for integrating digital health strategies into service delivery platforms in the future.

• The online consultation service and electronic prescribing has been extended to atoll level and will be expanded to include additional health service facilities. This will mitigate against future disruption to care delivery as a result of the pandemic.

• Long term establishment of the international tele-consultation initiative between Maldives and partner countries could bring cost savings by reducing the need for patients to travel abroad if initial consultations are managed online.

What were the key challenges involved?

• A particular challenge in scaling up these interventions was limited in-house technical expertise in establishing online service delivery platforms (i.e. patient data and interoperability issues with the different online portals for consultations).

• The lack of an integrated electronic patient record system within health facilities hampered communication and continuity between different providers.

Photo Credit: WHO