UNICEF's Approach to Digital Health
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UNICEF’s Approach to Digital Health
UNICEF’s Approach to Digital Health
Acknowledgements
This document was prepared jointly by the UNICEF Health Section
Implementation Research and Delivery Science Unit and the Office
of Innovation Global Innovation Centre, under the coordination
of Maria Muñiz, Katharine McFadden and Stuart Campo. We
thank Dr. Marion McNabb for her background research and for
preparing the first draft of the document, conducting interviews
and facilitating the stakeholder consultation and internal task
force meetings. We also thank the internal task force members
(Thierry Beniflah, Luisa Brumana, David Hipgrave, Debra Jackson,
Kumanan Rasanathan and Lori Thorell) for their guidance and inputs
on the preparation of this document, as well as colleagues who
participated in the original consultations, the open comment period
and the in-person feedback session.
ii UNICEF’s Approach to Digital HealthAcronyms
AeHIN Asian eHealth Information Network
DHIS2 District Health Information System 2
HIS Health information system
HSS Health system strengthening
ICT Information and communication
technology
OpenHIE Open Health Information Exchange
SDGs Sustainable Development Goals
SMS Short messaging service
UNICEF United Nations Children’s Fund
WHO World Health Organization
UNICEF’s Approach to Digital Health iiiContents Acknowledgements ii Acronyms iii Executive summary 2 I. Background and Context 6 II. UNICEF’s Approach to Digital Health 10 i. What is digital health? 11 ii. UNICEF’s comparative advantages in digital health 14 iii. UNICEF’s vision for digital health 15 iv. How UNICEF engages in digital health 16 v. Digital health contributions to support health strategy actions 20 III. UNICEF’s two-year internal roadmap for digital health 24 IV. Conclusion 27 V. Annexes 28 Annex 1: References 28 Annex 2: What is digital health? 30 Annex 3: Internal UNICEF digital health resources 42
List of Figures Figure 1 Sustainable Development Goals 6 Figure 2 UNICEF Strategic Plan, 2018–2020 8 Figure 3 Digital technologies and applications, Broadband Commission, 2017 12 Figure 4 Principles for Digital Development, 2016 16 Figure 5: UNICEF HSS Approach, 2016 18 Figure 6: UNICEF and Frog Design (2012) 19 Figure 7: UNICEF Health Strategy (2016-2030) Summary 21 Figure 8 WHO-International Telecommunications Union National eHealth Strategy Toolkit, 2012 31 Figure 9 Twelve functions of digital technologies 32 Figure 10 Examples of common mobile phone functions related to ICT for health 33 Figure 11 WHO classification of digital health interventions v1.0 34 Figure 12 WHO HIS system categories, 2018 35 Figure 13: OpenHIE Framework, 2016 37 Figure 14: AeHIN Regional Network Approach, 2017 38 Figure 15: Myanmar HIS, 2016 39 Figure 16 AeHIS Geographic Information System Lab, 2016 40 Figure 17: Monitoring and Evaluating Digital Health Interventions, WHO 2016 41
Executive summary
Background
With the launch of the 2030 Agenda for An increasingly connected world provides device connectivity and data analytics are
Sustainable Development, the world opportunities to achieve these goals. More accelerating conversations on the promise
has resolved to leave no one behind by than 7 billion people (95 per cent of the of digital health.4 In this context, UNICEF
ending extreme poverty and preventable global population) live in an area that is can harness the power of information
child deaths, and calling for integrated covered by a mobile-cellular network, and and communication technologies (ICT) to
action across sectors to tackle complex nearly 41 per cent of people in developing effectively support countries to ensure that
development challenges. UNICEF has countries have a mobile broadband every child survives and thrives.
recently launched both its new Strategic subscription.3 Advances in technology,
Plan, 2018–20211 and the Strategy for such as improved network speed and
Health, 2016–2030.2 The Strategy for efficiency, cloud computing,
Health has two overarching goals: 1) end
preventable, maternal, newborn and child
deaths; and 2) promote the health and
development of all children.
1 United Nations Children’s Fund, ‘UNICEF Strategic 4 Broadband Commission for Sustainable Development,
Plan 2018–2021’, UNICEF, New York, January 2018, Digital Health: A call for government leadership and
, accessed 17 August 2018. Commission for Sustainable Development,
2 United Nations Children’s Fund Programme Division, 3 International Telecommunications Union, ‘ICT Facts and ITU and UNESCO, February 2017, , accessed 17 August 2018. 17 August 2018. 17 August 2018.
2 UNICEF’s Approach to Digital HealthUNICEF’s Approach to Digital Health UNICEF’s comparative
advantages in
The term ‘digital health’, which includes Data for Children Strategic Framework;7 digital health
both mHealth and eHealth, describes the and 3) describe UNICEF’s comparative
general use of ICTs (digital, mobile and advantage in supporting governments
wireless) to support the achievement of and coordinating and aligning with other UNICEF has long been a leader in
health objectives.5 UNICEF developed its organizations, civil society actors, private designing, enhancing, and scaling
Approach to Digital Health to: 1) outline a sector partners and communities to digital health interventions globally and
common organizational vision for digital leverage digital technologies to accelerate applying these solutions to its core
health; 2) identify strategic priorities for the achievement of health sector and mandate and focus on child health and
investments in digital health that align Strategic Plan priorities. The development rights. The organization’s strong field and
with the organization’s Strategy for Health, of this approach was guided by more than convening presence allows it to form
2016–2030, Health Systems Strengthening 30 UNICEF staff interviews, a consultative and sustain multi-sectoral partnerships,
Approach,6 Strategic Plan, 2018–2021 and workshop, a task force and an open support the alignment and coordination of
comment period. investments, and strengthen the enabling
environment (i.e., policies, regulation,
governance and coordination structures)
to leverage ICT-based solutions to support
the achievement of health objectives. In
addition, UNICEF’s global leadership in
child and adolescent health-focused data
collection and use can further government
accountability and transparency in ensuring
5 World Health Organization, Monitoring and Evaluating
Digital Health Interventions: A practical guide that all children and adolescents are
to conducting research and assessment, WHO, reached with high quality health services.
Geneva, 2016, , For these initiatives, UNICEF works with
accessed 17 August 2018. 7 United Nations Children’s Fund, ‘Data for Children governments to design, enhance and scale
6 United Nations Children’s Fund, ‘The UNICEF Health Strategic Framework’, UNICEF, April 2017, , accessed 17 August 2018. 17 August 2018.
to reach every child.
UNICEF’s Approach to Digital Health 3UNICEF’s vision for Digital health contributions to advance the
digital health UNICEF’s Strategy for Health actions
UNICEF envisions a world where the Priority areas where digital health can *Strengthening service delivery using
health and well-being of children and contribute to UNICEF’s Strategy for Health digital tools that contribute to building
adolescents are improved through digitally- actions (identified through UNICEF staff capacities of health providers and
enabled health systems, and where digital interviews, workshop consultations and support management of programmes, in
health technologies are used to enhance task force inputs) include: particular at the community level and in
the quality and reach of vital health emergencies, and strengthen supply chain
information and services, including for the *Advocacy for every child’s right to systems (e.g., e- and mHealth learning
most disadvantaged children, adolescents health using digital tools and approaches platforms, digital solutions for diagnosis,
and their families. that support real-time data capture, clinical decision support, supportive
evidence generation and data use to supervision, referral coordination, client
To realize this vision, UNICEF works identify and deliver services to children and identification and registration, and supply
with governments, partners and adolescents most in need; protect patient management, financial transactions
communities to respond to government privacy; promote community engagement, and incentives).
and community priorities for child and equity and transparency; and increase the
adolescent health and rights, and support accountability of governments to ensure *Empowering communities using
efforts to strengthen the approaches, every child survives and thrives. digital tools that support social and
tools, evidence-base and enabling factors behavioural change, generate demand
necessary to support digitally-enabled and *Influencing government policies and strengthen accountability (e.g.,
child- and adolescent-focused interventions using digital tools and approaches that targeted communication and citizen-
at all levels of the health system. support evidence-based policy-making based reporting).
and financing (e.g., systematic planning
and analysis tools); promote the scale-up
of effective interventions and innovations;
and share knowledge and promote
South-to-South exchange (e.g., through
collaboration platforms).
4 UNICEF’s Approach to Digital HealthDigital health Conclusion
implementation roadmap
An internal two-year roadmap was As technology continues to evolve rapidly,
developed to support UNICEF staff to UNICEF will prioritize efforts to internally
provide high quality technical assistance align and consolidate its approaches to
to governments to scale child- and digital health and build the capacities of
adolescent-focused digital health staff to effectively respond to government
interventions that contribute to Strategy needs in this area. UNICEF’s Approach
for Health actions. The roadmap includes to Digital Health and its two-year
the following priority areas for investment/ implementation roadmap were developed
strengthening: to help the organization shift its mind-set
towards mainstreaming digital health as
• UNICEF staff knowledge and awareness
a routine aspect of health programming
of digital health;
and partnerships. As digital health
• Enhanced coordination and multi-
increasingly becomes a core component
sectoral collaboration, operational
of government health strategies, UNICEF
resources and strategic partnerships in
will strengthen its support to governments
digital health;
to scale these technologies to enhance
• Knowledge management, case studies
health service delivery and achieve health
and communities of practice for digital
goals. This approach and roadmap will
health, including inventory of UNICEF-
support UNICEF staff to effectively advise
supported initiatives; and
and support governments, in coordination
• Implementation research and
with partners, to leverage ICTs to
monitoring and evaluation of digital
contribute to equity-based investments in
health investments for children
reducing maternal and child morbidity and
and adolescents.
mortality worldwide.
UNICEF’s Approach to Digital Health 5I. Background and Context
With the launch of the 2030 Agenda for Figure 1 Sustainable Development Goals
Sustainable Development, the world
has resolved to leave no one behind by
ending extreme poverty and preventable
child deaths, and calling for integrated NO ZERO GOOD HEALTH QUALITY GENDER CLEAN WATER
action across sectors to tackle complex POVERTY HUNGER AND WELL-BEING EDUCATION EQUALITY AND SANITATION
development challenges. To reach the
ambitious Sustainable Development Goal
(SDG) targets for 2030, it is imperative that
UNICEF strengthen its approach to health AFFORDABLE AND DECENT WORK AND INDUSTRY, INNOVATION REDUCED SUSTAINABLE CITIES RESPONSIBLE
CLEAN ENERGY ECONOMIC GROWTH AND INFRASTRUCTURE INEQUALITIES AND COMMUNITIES CONSUMPTION
and related sectors, as well as its focus AND PRODUCTION
on equity-based approaches to health and
development. Building on lessons learned in
global health and development over the past
CLIMATE LIFE LIFE PEACE, JUSTICE PARTNERSHIPS
25 years, UNICEF has intensified efforts to ACTION BELOW WATER ON LAND AND STRONG FOR THE GOALS
INSTITUTIONS
design interventions and approaches that
reach the world’s most vulnerable children,
adolescents and their families, in a more
cost-effective and equity-focused manner.
UNICEF’s vision of a world where no child Adolescents’ Health, 2016–2030, and the Plan, 2018–2021,8 which will guide the
dies from a preventable disease and all Convention on the Elimination of all Forms organization’s investment in ensuring every
children have the opportunity reach their full of Discrimination against Women. To realize child survives and thrives, and underscores
potential in health and well-being is grounded this vision, UNICEF launched its Strategic its commitment to achieving the SDGs.
in the Convention on the Rights of the Child,
the United Nations Secretary-General’s 8 United Nations Children’s Fund, ‘UNICEF Strategic
Plan 2018–2021’, UNICEF, New York, January 2018,
Global Strategy for Women’s, Children’s, and , accessed 17 August 2018.
6 UNICEF’s Approach to Digital HealthTo advance the Strategic Plan priorities, and foster meaningful improvements in per cent of people in low-income countries
UNICEF launched the Strategy for Health, health outcomes. have a mobile broadband subscription.11
2016–2030,9 which has two overarching This new global reality can make it easier
goals: 1) end preventable, maternal, To support countries to meet the health and often more cost effective to use digital
newborn and child deaths; and 2) promote needs of the most vulnerable children, tools to improve communication, data
the health and development of all children. UNICEF is taking a wider view of the reporting and feedback from communities,
drivers of health and development, and deliver critical services to hard-to-
UNICEF’s Strategy for Health shifts the including health systems and the reach communities.12 Even in settings
organization’s approach to consider the underlying determinants of health. UNICEF where connectivity may not be consistently
health needs of the child at all life stages, has also developed a new Approach to available, many digital health tools work
while emphasizing the importance of Health Systems Strengthening10 (HSS), offline and have the ability to sync when
prioritizing the needs of the most deprived which articulates how UNICEF can connectivity becomes available. As the
children and promoting multi-sectoral drive improvements in the performance world becomes even more connected,
approaches to enhance child development of health systems to effectively use governments are also learning to strengthen
and address the underlying causes of resources to reach the most vulnerable. or replace paper-based systems and further
poor health outcomes. It also shifts utilize ICTs within the health system to
UNICEF’s focus away from vertical disease An increasingly connected world provides
improve the efficiency and reach of vital
programmes towards strengthening opportunities to leverage ICTs as potential
health and development interventions.13
health systems and building resilience, solutions to overcome bottlenecks in
including better integrating humanitarian key health system areas (e.g., quality of Digital health is becoming a core part of
and development health interventions by care, supplies, front-line health worker broader government health strategies, and
encouraging risk-informed programming in supervision, training and communication, UNICEF is strengthening its support to
all contexts. The Strategy also reorganizes community engagement and participation governments, in coordination with other
the types of technical assistance provided in health services, and the availability and
to countries based on their level of use of routine data by decision-makers
11 International Telecommunications Union, ‘ICT Facts and
capacity and lays out new approaches and health care managers). More than 7 Figures 2016’, ITU, , accessed
17 August 2018.
improve the quality of services at all levels population) live in areas that are covered
12 Mehl G. and A. Labrique, ‘Prioritizing integrated mHealth
by mobile-cellular networks and nearly 41 strategies for universal health coverage’, Science, vol.
345, no. 6202, 12 September 2014, pp. 1284-7.
9 United Nations Children’s Fund Programme Division, 10 United Nations Children’s Fund, ‘The UNICEF Health 13 Labrique A.B. et al., ‘mHealth innovations as health
‘UNICEF’s Strategy for Health (2016–2030)’, UNICEF, Systems Strengthening Approach: A synopsis’, UNICEF, system strengthening tools: 12 common applications
2015, , accessed 17 August 2018. no. 2, 2013, pp. 160-171.
UNICEF’s Approach to Digital Health 7Figure 2 UNICEF Strategic Plan, 2018–2020 UNICEF delivers change by combining
high-quality programmes at scale,
Realizing the rights of every child, especially the most disadvantaged harnessing innovation and collecting
evidence, in partnership with governments,
other United Nations organizations,
civil society organizations, the private
sector, communities, children and
2030 adolescents. UNICEF has a history of
GOAL AREA 1 GOAL AREA 2 GOAL AREA 3 GOAL AREA 4 GOAL AREA 5
fostering innovation and pioneering the
Every child Every child Every child is Every child
survives and learns protected from lives in a safe
Every child has use of new technologies to help children
an equitable
thrives violence and and clean
chance in life
and adolescents at greatest risk and in
exploitation environment
greatest need. In line with the Strategic
Plan, UNICEF’s Approach to Digital Health
2021 RESULT AREAS aims to:
• Enhance the use of new technologies
to strengthen systems, improve service
HOW: Change strategies
delivery and engage communities,
citizens and civil society organizations in
public decision-making; and
ENBLERS: help to deliver the WHAT and HOW
• Identify the most promising programme
innovations and work with partners to
adopt, adapt and scale up the most
successful approaches.
partners, to use digital health technologies Fostering innovations in programming
at scale to strengthen health service and advocacy process and practices to Achieving scalability and sustainability in
delivery and achieve health goals. promote the use of new technologies is a digital health is not without its challenges.
core UNICEF change strategy and will be It requires strong investment cases and
central to achieving results under Strategic sustainable funding for workforce capacity,
Plan Goal Area 1 – every child survives training, maintenance and upkeep;
and thrives. establishment and alignment with national
eHealth strategies and policies; and strong
8 UNICEF’s Approach to Digital Healthgovernment leadership and coordination Working with partners, UNICEF is
to reduce fragmentation of systems, committed to supporting countries to
duplication and data silos.14 Sustaining leverage existing open-source digital
proven digital health interventions requires tools that are designed, tested and
a long-term strategy, including stable and proven to enhance results at scale.
secure financial and technical resources,
enduring partnerships and the ability
to continuously adapt and respond to
evolving operational needs, demands
and environments.
As described in below, UNICEF’s
approach to digital health is centred
on supporting government-led digital
health initiatives, working with partners,
reducing fragmentation, and investing
in scalable interoperable technologies.
With its in-country presence and ability to
convene governments, civil society actors
and partners, UNICEF is well positioned
to help scale such programmes at the
national level.
14 Broadband Commission for Sustainable Development,
Digital Health: A call for government leadership and
cooperation between ICT and health, Broadband
Commission for Sustainable Development,
ITU and UNESCO, February 2017, , accessed 17
August 2018.
UNICEF’s Approach to Digital Health 9II. UNICEF’s Approach to Digital Health
UNICEF has extensive experience UNICEF’s experience implementing and for digital health; identifies strategic
designing and scaling digital health scaling digital health interventions in priorities for digital health in line with the
interventions to advance the goals of its various contexts over the past decade Strategy for Health, 2016–2030, the Health
Strategy for Health. For example, digital has generated a number of lessons Systems Strengthening Approach, the
health interventions such as mTrac15 learned and best practices. These insights, Strategic Plan, 2018–2021, and the Data
and mHero16 are now being replicated past evaluations of UNICEF-supported for Children Strategic Framework; and
in a number of countries and have been interventions, and the rapid adoption of defines the organization’s comparative
successfully scaled and integrated into digital health interventions at the regional advantage for working with governments
national programmes. This process has and country levels highlights the need and partners to support the use of digital
been facilitated by UNICEF’s focus on for UNICEF to develop a common multi- technologies to achieve these and other
and efforts to enhance existing health sectoral approach for itself and its partners health sector priorities. It highlights tools
information systems (e.g., adopting to designing, enhancing and scaling digital and approaches that can be leveraged to
ministry of health reporting formats and health interventions. support ministries of health around the
linking into existing platforms such as world, outlines key concepts in digital
the District Health Information System UNICEF’s Approach to Digital Health was health and points colleagues to additional
2 (DHIS2)); align with national eHealth developed to this end. The Approach resources that capture best practices for
policies; and use standards-based outlines a common organizational vision
approaches for information exchange (i.e.,
the Open Health Information Exchange
(OpenHIE)). UNICEF’s Approach to Digital Health is designed to ensure that every child
survives and thrives. It provides guidance on how digital technologies can be
used to further the goals of UNICEF’s Strategy for Health 2016–2030, and outlines
15 mTrac facilitates the movement of data from front-
line health workers to DHIS2 to track the incidence approaches that UNICEF can use to support countries to adopt digital health
of disease, the occurrence of maternal and neonatal
interventions that reach all children, including the most disadvantaged, through
deaths and the stock of tracer medicines in near
real-time. improved data collection and use, increased accountability and transparency, and
16 mHero was developed in response to the Ebola greater reach of high quality health services.
epidemic to create a two-way communication
mechanism between governments and health workers.
10 UNICEF’s Approach to Digital Healthdesigning, implementing and scaling digital
health interventions. Annex 2 provides a
i. What is digital health? antenatal clinical visits and increasing
adherence to life-saving medications
description of the basic concepts, tools or immunization schedules.18 Mobile
and resources available for digital health The term ‘digital health’ refers to the applications have helped community
programmes and country-level assistance. use of digital technologies in health health workers provide essential
In addition, the accompanying roadmap programming and financing. According household services and referrals that have
defines priorities for implementing digital to the World Health Organization (WHO), improved the quality of care offered at
health programmes over the next two digital health can be defined as “the use of the community level.19 Several systematic
years and lays out key steps for expanding digital, mobile and wireless technologies reviews have also documented the impact
and scaling digital health interventions in to support the achievement of health that digital health interventions have had
UNICEF programme countries. objectives. Digital health describes on health outcomes,20 including improving
the general use of information and
The Approach to Digital Health was
communication technologies for health and
developed based on interviews conducted
is inclusive of both mHealth and eHealth”.17 18 Noordam, A.C. et al., ‘Improvement of maternal health
with more than 30 UNICEF staff members services through the use of mobile phones’, Trop Med
Digital health interventions can include Int Health, vol. 16, no. 5, May 2011, pp. 622-6; and
covering UNICEF’s vision for digital health,
various technologies, such as mobile Sondaal, S.F.V. et al., ‘Assessing the effect of mHealth
lessons learned, structural challenges interventions in improving maternal and neonatal care
applications, short messaging service
and opportunities related to applying in low- and middle-income countries: A systematic
(SMS), interactive voice response, health review’, PLoS ONE, vol. 11, no. 5, 4 May 2016, , accessed 20 August 2018.
diagnostic devices, wearables, drones and 19 Braun, R. et al., ‘Community health workers and mobile
was held with representatives from the
big data analytics. technology: A systematic review of the literature’, PLoS
UNICEF Headquarters health, data and ONE, vol. 8, no. 6, 12 June 2014, e65772; Källander, K. et
analytics, information technology, and Digital health interventions have
al., ‘Mobile health (mHealth) approaches and lessons for
increased performance and retention of community health
innovation teams to share interview results demonstrated impacts on a wide range workers in low- and middle-income countries: A review’,
and discuss priorities for UNICEF’s work in of outcomes, including reducing loss J Med Internet Res, vol. 15, no. 1, 25 January 2013,
e17; Hall, C.S. et al., ‘Assessing the impact of mHealth
digital health moving forward. Key findings to follow-up, improving adherence to interventions in low- and middle-income countries – what
from staff interviews and the workshop has been shown to work?’ vol. 7, 27 October 2014.
are available upon request. Following the 17 World Health Organization, Monitoring and Evaluating 20 WHO, with input from partners, including UNICEF,
Digital Health Interventions: A practical guide is conducting a systematic review of digital health
meeting, a task force was formed to guide to conducting research and assessment, WHO, interventions and their impact on health outcomes. The
the writing of this document. Geneva, 2016, , accessed 20 August 2018. newborn, child and adolescent health interventions.
UNICEF’s Approach to Digital Health 11Figure 3 Digital technologies and applications, Broadband Commission, 2017 service utilization,21 quality of care22
and information23, and reducing supply
stock-outs.24 Systematic reviews of the
care Organizatio
literature also provide strong evidence for
alth the feasibility of front-line health workers
ns
He & Policymakers using digital health tools to support health
service delivery, and that front-line health
Healthcare
workers would welcome the integration
of digital health technology into their
Inventory/stock
rofessionals Mitigating work streams.
monitoring P fraud/abuse
Despite the added value that digital health
Point-of-care
diagnosis Patient Decision
support
interventions have shown to date, many
Mobile apps for such interventions have so far been
knowledge/adherence Disease
Shared EHRs, limited in scope and geographic scale.25
surveillance/
real-time Self-testing SMS predicting Historically, investments in digital health
data Telehealth diagnostics Networking
technology outbreaks have been uncoordinated, sometimes
consultations and
Patient connectivity leading to duplication of efforts and making
portals/records with peers it difficult to compare digital systems in
e-learning
Connected 21 For example, reducing loss to follow up, improving
tools
Patient data heath Predictive adherence to antenatal clinical visits, and
management platforms analytics/risk increasing adherence to life-saving medications or
and analysis stratification immunization schedules.
22 For example, adherence to treatment protocols through
the use of electronic decision support and mobile
Streamlining technology-supported referrals that improve the quality
financial of care offered at the community level.
transactions 23 Through the use of mobile devices to improve the
accuracy, speed and completeness of data collection.
24 Through mobile-based reported which has resulted in
greater data visibility of existence of stock-outs.
25 Labrique, Alain B. et al., ‘mHealth innovations as health
system strengthening tools: 12 common applications
and a visual framework’, Global Health: Science and
Practice, vol. 1, no. 2, August 2013, pp.160–171.
12 UNICEF’s Approach to Digital Healtha standardized way.26 Globally, there has national information system architectures. interventions.29 Annex 2 provides
also been a poor understanding of existing As digital health interventions are multi- additional information on digital health and
digital systems, how they function and the sectoral, countries are moving towards available tools.
stages of maturity of interventions.27 aligning health priorities with existing
ICT infrastructure and systems, including
The coming together and alignment of designing frameworks that cover
partners in the digital health community is regulation, governance, standards and
essential to making efficient use of scarce interoperability, workforce and financing.28
resources and supporting government As described below, through its recognized
plans for scale and sustainability. role as a convener and broker with
Partnerships are emerging in the digital strong ties to national/local governments,
health space and alignment around a core implementing partners, non-governmental
set of principles for digital development organizations, civil society and donors,
and principles of donor alignment for UNICEF is in a unique position to support
digital health, both of which UNICEF has governments to leverage regional and
endorsed. It is imperative that partners national investments in digital health
across the digital health landscape to advance child and adolescent health
harmonize efforts and draw on the many and rights. Global partnerships such as
lessons learned from digital health the Health Data Collaborative, which
demonstration projects to accelerate works to harmonize health-related data
country health programming at scale, investments across donors and partners,
including community health. can also be leveraged to support countries
to coordinate resources for data-focused
In response to global needs, WHO
and partners, including UNICEF, have
developed digital health methodologies,
frameworks and guidelines for planning
28 Broadband Commission for Sustainable Development,
Digital Health: A call for government leadership and
cooperation between ICT and health, Broadband
26 Mehl, G., ‘The Digital Health Atlas for Inventories and Commission for Sustainable Development,
Routine Registration of Digital Health Investments’, 2017, ITU and UNESCO, February 2017, , accessed 17 29 Health Data Collaborative, ‘Who we are’, , accessed 20 August 2018.
UNICEF’s Approach to Digital Health 13ii. UNICEF’s comparative partnerships, and government
relationships reflect the organization’s
human-centred design approaches30
– and the lessons learned from these
advantages in digital multi-sectoral focus on child and experiences can be adapted to save
health adolescent rights. This focus and position
allow UNICEF to bring health and ICT
scarce resources, while promoting
South-to-South collaboration for
ministries and partners together to digital health. UNICEF’s experience
Over the past decade, UNICEF has implement child- and adolescent-focused designing nationally-scaled systems
demonstrated that technology can be used digital health interventions. that are interoperable and responsive to
to address constraints faced by health government needs can be shared with
3. As a decentralized organization
systems and improve approaches to reaching other countries.
operating in more than 190 countries,
the hardest-to-reach children, adolescents, UNICEF’s strong field presence 6. Data collection and use to support
families and communities. UNICEF and gives it both the policy experience HSS – using tools such as the Multiple
its partners are well positioned to support and the field experience to support Indicator Cluster Survey conducted in
countries to design, enhance and scale child- and adolescent-focused digital more than 100 countries31 – is a core
technology-supported interventions that health interventions at all levels of the area of UNICEF’s work in child health.
improve the quality and reach of services health system. UNICEF recently launched the new
and health information, address core health Data for Children Strategic Framework
4. UNICEF’s globally-respected brand and
system strengthening constraints and to define key principles of data work
extensive experience solving complex
target those most in need, while improving and drive organizational investments
issues using digital health interventions
transparency and accountability. UNICEF’s in data collection and use.32 UNICEF is
that address the core issues facing
comparative advantages include: also a core partner in the Health Data
children and adolescents most in need
1. UNICEF’s core mandate and focus foster government trust.
30 United Nations Children’s Fund, Designing Digital
on child health and rights positions Interventions for Lasting Impact: A human-centred guide to
5. UNICEF’s experience scaling digital
the organization to use digital digital health deployments, UNICEF, , accessed 20 August 2018.
by co-creating interventions with
challenges to reaching children, 31 United Nations Children’s Fund, ‘About MICS’,
government and partners, investing in UNICEF, , accessed 20
adolescents and their families with
robust and open-source platforms and August 2018.
quality health services.
interoperability and using systems and 32 United Nations Children’s Fund, ‘Data for Children
Strategic Framework’, UNICEF, April 2017, , accessed
17 August 2018.
14 UNICEF’s Approach to Digital HealthFigure 15: Myanmar HIS, 2016
Collaborative, which works to improve to respond to government and community 2. Coordinating digital health
health data capacity at the country level priorities for child health and rights. operational resources, partnerships
to track progress towards the SDGs.33 UNICEF also supports efforts to strengthen and investments across the
the approaches, tools, evidence base and organization by strengthening
7. UNICEF’s work improving accountability
enabling factors necessary to implement communications, the documentation of
through digital health interventions such
digitally-enabled and child- and adolescent- digital health interventions, knowledge
as U-Report and Scorecards – which
focused interventions at all levels of the management systems and strategic
promote data use and citizen feedback
health system. partnerships, and inventorying and
at the community, district and other
pointing staff to available internal and
levels of the system – can improve the
The Approach to Digital Health will support external resources.
quality and availability of real-time data.
the implementation of UNICEF’s equity
3. Empowering staff from health
and rights-based programmes and the
and other programme areas that
iii. UNICEF’s vision for achievement of the SDGs by:
contribute to health outcomes
1. Leveraging digital health tools,
digital health approaches and experiences to
by building their capacity to design,
enhance and scale digital health
reach the most marginalized with interventions that address key
technology-enhanced solutions that bottlenecks and gaps faced at the
UNICEF envisions a world where the
increase access to essential health country and regional levels.
health and well-being of children and
services and real-time data and thereby
adolescents are improved through digitally-
improve child, adolescent and maternal
enabled health systems. That means
health outcomes.
countries are utilizing technologies for data
capture and use, and implementing digital
health interventions to reach the most
disadvantaged children, adolescents and
families with essential health information A country with a digitally-enabled health system has effectively and efficiently
and services. adopted technology solutions that prioritize reaching the most marginalized and
vulnerable children, adolescents and families with health information and services,
To realize this vision, UNICEF works with while strengthening the ability of the health system to collect, analyse and use
governments, partners and communities health data to continually improve the reach and quality of services at all levels for
children, adolescents and families.
33 Health Data Collaborative, , accessed 20 August 2018.
UNICEF’s Approach to Digital Health 15iv. How UNICEF engages Figure 4 Principles for Digital Development, 2016
in digital health
The Principles
UNICEF’s Approach to Digital Health is
grounded in the Principles for Digital
Development (see Figure 4). 34These
principles highlight the importance of
designing with the end-user, understanding 1 Design with the user 2 Understand the 3 Design for scale
existing ecosystem
local ecosystems, designing for scale and
using open-source technology solutions.
In turn, the Approach is aligned with the
more recently forged Principles of Donor
Alignment for Digital Health. Drawing on
these core principles, UNICEF strives 4 Build for sustainability 5 Be data driven 6 Use open standards,
to adapt existing tools, strategies and open data, open source,
and open innovation
approaches across countries to maximize
investments and consolidate technical
assistance and guidance. This approach
also provides an opportunity for countries
to measure progress against each other
and share lessons learned adapting
approaches to improve efficiencies and 7 Reuse and improve 8 Address privacy 9 Be collaborative
& security
drive results for the overall health system.
UNICEF also works regionally by engaging goals. For example, in many countries
34 Principles for Digital Development, , accessed 24 August 2018. including by defining standards to guide child health records are kept in manual
See also United Nations Children’s Fund, ‘Innovation’,
UNICEF, , accessed 22
interoperability between national health registries and logbooks. This system
August 2018. systems to advance regional health often results in duplication, over reporting
16 UNICEF’s Approach to Digital Healthand underreporting. At the regional
level, UNICEF, in partnership with WHO,
UNICEF East Asia and the Pacific Regional Office: Digital health for
the Asian Development Bank, and
strengthening programmes and systems
development partners such as the Asia
eHealth Information Network (AeHIN) – a Currently the UNICEF East Asia and the Pacific Regional Office, in close
consortium of experts and senior officials collaboration with WHO and other development partners, is supporting the
– advises governments on how to fast Myanmar Ministry of Health and Sports to adopt an interoperable health
track the digitization of health management management information system using OpenHIE. This solution includes the
information and civil registration and development of the Master Patient Index and Client Registry, which generates a
vital statistics systems. Ensuring that unique identifier for everyone, including every child.
children are securely traceable through a
unique identification gives them access
to services and subsidies, and enables the most disadvantaged are reached, tools that will impact health outcomes or
various national/subnational systems UNICEF recognizes that governments will systems.36
to recognize and support them across increasingly invest in domestic spending
sectors. By working at both the national on digital health interventions, while
and regional levels, UNICEF can take a ensuring that the focus remains on the
holistic look at how information systems impact of these interventions on health,
and digital health interventions designed to rather than monetary investments. Based
support HSS can be leveraged to address on lessons learned, the global community
the needs of the most disadvantaged is now shifting to applying a system-level
children and adolescents. approach to improving health system
performance with digital interventions.35
UNICEF acknowledges that digital health Applying an HSS lens shifts the thinking
interventions cannot be implemented in from designing a digital health programme
isolation. Digital technologies are best that works to identifying and adapting
leveraged when they are embedded
within public health interventions that
address the key determinants of mother
and child morbidity and mortality. With 36 Labrique A.B. et al., ‘mHealth innovations as health
35 Mehl G. and A. Labrique, ‘Prioritizing integrated mHealth system strengthening tools: 12 common applications
a renewed focus on ensuring that strategies for universal health coverage’, Science, vol. and a visual framework’, Glob Health Sci Pract, vol. 1,
345, no. 6202, 12 September 2014, pp. 1284-7. no. 2, 2013, pp. 160-171.
UNICEF’s Approach to Digital Health 17UNICEF uses a seven-step process within Figure 5: UNICEF HSS Approach, 2016
its HSS approach to design equity-focused
health interventions.37 Once bottlenecks
have been identified in stage four, project UNICEF system-wide approach…
leaders can then assess whether a digital …to design evidence-based
health intervention is the right solution to Identify underserved groups 1 equity-focused RMNCAHN strategies,
plans and policies;
implement, given the stage of ICT adoption
and maturity in the country or region of
Identify main causes of mortality ,
morbidity and malnutrition 2
interest. UNICEF is cognizant that digital …and to improve management
health interventions should be part of the
Identify priority interventions
to address them 3 capacity and implementation at
sub-national and community level.
national health information system (HIS) Identify bottlenecks in coverage
determinants and their causes 4
architecture, and require engaging both ICT
and health stakeholders to ensure that the Identify solutions to bottlenecks 5
interventions complement both health and
ICT sector priorities.
Develop operational plans 6 6 Model lives saved
A systematic approach should be taken
Monitor implementation and
to determine whether a digital health bottlenecks reduction 7 7 Cost strategies
intervention can be used to address
bottlenecks. This approach should identify
1) where on the life course digital tools
will be applied; 2) what public health programme engages stakeholders (health Figure 6 provides examples of how
intervention will be enhanced; 3) which system managers, providers or clients).38 digital health interventions can be used
health constraint the intervention is to address key gaps along the maternal
seeking to overcome; 4) how digital and child health continuum. Annex 2
health is applied (function, technology also provides several toolkits that can be
and purpose); and 5) where the digital 38 Mehl, G., ‘The Digital Health Atlas for Inventories and used to further plan and operationalize
Routine Registration of Digital Health Investments’,
2017; World Health Organization, ‘Classification of digital interventions. Finally, to build stronger
health interventions v.1.0: A shared language to describe evidence for investments in digital
37 United Nations Children’s Fund, ‘The UNICEF Health the uses of digital technology for health’, WHO, 2018,
Systems Strengthening Approach: A synopsis’, UNICEF, < http://www.who.int/reproductivehealth/publications/
tools and systems, efforts to measure
, the impact of investing in digital health
Final_10Mar16.pdf>, accessed 17 August 2018. accessed August 17, 2018.
18 UNICEF’s Approach to Digital HealthFigure 6: UNICEF and Frog Design (2012)
Birth & Maternal
MOTHER Pregnancy postpartum health
2nd and 3rd
CHILD 1st Trimester Trimesters Birth & postnatal Infancy Childhood
LEVERAGING Register Track pregnancy Record birth Track child and mother
MOBILE pregnancy
• Create unique • Provide reminders • Record birth/death • Support community case management
identification for ANC of malaria diarrhea, pneumonia, and
• Prompt newborn
number undernutrition
• Monitor critical home visits
• Record age, weight info • Support early infant diagnosis
• Record danger signs
and last birth
• Support home • ncrease postnatal visits on other child
• and undernutrition
visits survival interventions
• Report on danger • Support infant and young child feeding
signs and opportunities for micronutrients
• Support eMTCT • Support immunization
interventions should focus on health Lives Saved Tool,39 to ensure that metrics
outcomes and the cost effectiveness are designed based on the impact on
of digital health tools versus other health, rather than measured by monetary
approaches. For example, the UNICEF investments alone.
East Asia and the Pacific Regional Office,
in partnership with the Asian Development
Bank and AeHIN, is developing a digital
health costing tool that links with the
39 The Lives Saved Tool, ,
accessed 24 August 2018.
UNICEF’s Approach to Digital Health 19v. Digital health contributions to support health strategy actions
UNICEF supports countries to deploy commodities, supply of equipment and Example contributions:
digital health interventions that help them quality of commodities; and
• Digital decision trees to support health
achieve the following health sector results • Policy-makers are informed about
workers’ treatment of childhood illness
from the UNICEF Strategic Plan:40 the functionality of components
(i.e. efficiency, timeliness of care)
of the health system (planning
1. Strategic Plan result one: Newborns and coordination). With the launch of the UNICEF Strategy for
and mothers receive an essential package
Health, 2016–2030, the organization has
of quality maternal and newborn care 2. Strategic Plan result two: Achieve and
renewed its commitment to the value of
services at scale, and improve the country- sustain immunization coverage at national
leveraging digital technologies to support
level evidence and action for the health, and district levels.
key actions, including:
nutrition and well-being of adolescent girls
and boys. Example contributions: 1. Advocating for every child’s right
to health;
• Monitor progress towards immunization
Example contributions:
coverage at the individual or aggregate 2. Influencing government policies;
• Client feedback on the quality and/ level, for example individual-level
3. Strengthening service delivery; and
or availability of health services tracking of infants and children
and commodities (linked to client- throughout the immunization schedule 4. Empowering communities.
side expenses, alignment with and aggregate-level tracking of mass
The following list of key areas in which digital
local norms, diversity of treatment vaccination campaigns to assess reach
health can contribute to Strategy for Health
options, health worker competence, and identify bottlenecks (i.e., supply
actions were identified through UNICEF
quality of commodities, geographic of services, addressing individual
staff interviews, workshop consultations
inaccessibility, unnecessary referrals beliefs and practices, stigma, demand
and task force inputs. This list is not
and transportation) for increased for services, loss to follow up and
exhaustive. Rather, it provides examples for
accountability and transparency; workflow management)
consideration after accounting for factors
• Providers report on relevant stock and
3. Strategic Plan result three: Children such as country context, situation analysis,
notifiable diseases, addressing supply of
under 5 years receive preventive and curative programmatic/health system constraints and
40 United Nations Children’s Fund, ‘UNICEF Strategic Plan, services for pneumonia, diarrhoea, malaria evidence of the efficacy/suitability of the
2018–2021: Executive Summary, 2018, , accessed
24 August 2018.
20 UNICEF’s Approach to Digital HealthHealth strategy action 1: Figure 7: UNICEF Health Strategy (2016-2030) Summary
Strengthen service delivery
UNICEF Health Strategy for 2016-2030
• Build capacity of management and
Guided by the Convention on the Rights of the Child (CRC) & the Convention on the Elimination of
health providers. All Forms of Discrimination Against Women (CEDAW), and in line with the Sustainable Development Goals (SDGs)
• Support programmes, particularly at the and Evert Women, Every Child (EWEC)
community level and in emergencies.
• Strengthen supply chain systems.
Vision
A world where no child dies from a preventable cause,
and all children reach their full potential in health and well-being
Digital health contributions:
End preventable maternal,
Goals
Promote the health and
• Facilitate health worker training newborn & child deaths development of all children
using eHealth and mHealth learning
Address inequities in health outcomes
Approaches
for in-service training, local pre-
service education, and post-training Strengthen health systems, including emergency preparedness and resilience
reinforcement of key concepts to
Achieve results through partnership
Promote integrated, multi-sectoral policies and programs
address health worker competence,
while supporting the management Advocate for every Influence government Strengthen service Empower
child’s rights to health policies delivery communities
of the health workforce, including
performance management and • Support data • Support evidence- • Build capacity of • Engage for social
capture evidence based policymaking management and and behavior
accountability, incentives and generation, and use and financing health providers change
optimization that addresses motivation, • Engage with • Promote scale- • Support • Generate demand
Actions
partners up of effective programmes,
supervision and coordination. interventions/ including service
• Strengthen
• Expand available accountability
• Support community and front-line health resources
innovation provision in
particular at
workers to offer high quality services, • Share knowledge
community level
& promote south-
and in emergency
through digital solutions for diagnosis, south exchange
• Strengthen supply
clinical decision support, supportive chain systems
supervision, referral coordination,
client identification and registration and
Programme areas
Maternal, newborn, and child health (focus on Older child and adolescent health (focus on
supply management. equitable access to quality primary health care) public policies and supportive environments)
• Use mobile communication tools to Proposed actions and program areas represent global “menu” to be tailored
to country context by country offices
support communication roadblocks
UNICEF’s Approach to Digital Health 21between and among health workers, • Form multi-sectoral public and private Digital health contributions:
supervisors, programme managers, partnerships to support all relevant
Assist countries to design, scale and
clients and communities. For example, ministries to adopt child and adolescent-
sustain digital health interventions
health workers have used their mobile focused digital data collection
that facilitate:
phones to systematically coordinate approaches that are interoperable
emergency transport for patients with national HIS architectures and • Targeting communication to mothers,
in distress. frameworks, conform to national caregivers, adolescents and their
eHealth policies, and improve the families to reduce loss to follow up and
capture of real-time data to identify low treatment adherence.
Health strategy action 2: and deliver services to the most • Engaging citizens and communities
Advocate for every child’s right marginalized children and adolescents. with behaviour change communication
to health • Work with governments and partners to to reduce stigma, promote healthy
support investment cases; sustainable behaviours, generate demand for
• Support data capture, evidence services, and collect feedback on the
funding for workforce capacity, training,
generation and use. availability and quality of services
maintenance and upkeep; establishment
• Engage with partners. and commodities.
of and alignment with national eHealth
• Expand available resources for children.
strategies and policies; and strong
Digital health contributions: government leadership and coordination Health strategy action 4:
to reduce fragmentation of systems,
• Leverage digital tools to reduce Influence government policy
duplication and data silos for digital
reporting delays, improve the quality
health investments. • Support evidence-based policy-making
of data, management and use, and
and financing.
increase the accessibility of data
• Promote the scale-up of effective
for faster data collection and trend Health strategy action 3:
interventions and innovations.
analysis to facilitate evidence-based Empower communities • Share knowledge and promote South-to-
decision-making.
• Engage for social and behaviour change. South exchange.
• Use digital tools to generate evidence
and promote community engagement • Generate demand.
Digital health contributions:
and transparency, increase government • Strengthen accountability.
• Make use of planning and analysis tools
accountability and ensure that
that track costs, highlight inequities
every child and adolescent survives
and support analysis of high-impact
and thrives.
22 UNICEF’s Approach to Digital Healthinterventions and HSS strategies that
foster equitable results for children and
adolescents in a cost-effective manner
and support evidence-based policy-
making and financing.
• Generate evidence from child- and
adolescent-focused digital health
interventions that consider national
health and ICT strategies, the enabling
environment and HSS bottlenecks to
reaching children and adolescents; are
designed to scale from the start; and
can be used to generate evidence and
influence policy.
• Use digital collaboration tools that
promote coordination and lesson sharing
across borders to maximize the impact
of digital health investments on child and
adolescent health outcomes.
UNICEF’s Approach to Digital Health 23III. UNICEF’s two-year internal roadmap for
digital health
To support governments to design, During the development of UNICEF’s • Strategic partnerships and multi-
enhance and scale digital health Approach to Digital Health, staff reflected sectoral and multi-division
interventions across country and regional on internal opportunities for aligning and collaboration within UNICEF are
contexts, UNICEF will need to do business coordinating investments in digital health strengthened to effectively support
differently. The organization will need to to better support countries to adopt child- ministries to collaborate in the design,
be open to successes as well as failures, and adolescent-focused digital health enhancement, deployment and scale-up
and continue to expand its public and strategies. UNICEF is committed to of child- and adolescent-focused digital
private sector partnerships. Engaging supporting countries to invest in digital health interventions.
the right ministries and operating in line health interventions that are rooted in HSS, • Digital health knowledge
with the appropriate national frameworks equity-driven and supportive of national management and communities
and priorities will be key to building on and regional health and ICT priorities. By of practice are strengthened
and improving the organization’s current aligning internally, UNICEF can invest in within UNICEF to promote open
approaches to working across sectors. the capacity and infrastructure necessary communication, inventorying of digital
Given the multi-sectoral nature of ICT to successfully guide regions and countries health initiatives, documentation of use
and health programming, UNICEF must to design, scale and sustain child and cases, sharing of lessons learned, and
view digital health interventions as routine adolescent health investments. UNICEF the adaptation of successful approaches
aspects its work with national health is therefore committed to investing across countries and regions.
systems, rather than as innovations institutional resources, capacity and • Implementation research and
or unique pilot projects. There is also fundraising efforts to ensure that: monitoring and evaluation
potential to leverage private sector • UNICEF staff is competent and
approaches focus on digital health
partners, including emerging digital health conversant in digital health and able
investments for children and
stakeholders, such as local developers, adolescents, particularly those that
to support countries to utilize national
local mobile network operators and banks support governments to document
and subnational investments in digital
in the case of mobile money. impacts on child and adolescent
health to advance child health and rights.
health outcomes.
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