Contribution of International Cooperation for Future Healthcare: Progress in Digital Health in Low and Middle Income Countries


2024.10.18
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- Yoshida Tomoya Senior Deputy Director General Human Development Department
In recent years, the challenges in health sector in low and middle income countries have been shifting from maternal and child health and infectious disease control to non-communicable diseases (NCDs) such as lifestyle-related diseases and the NCDs of the elderly. As healthcare costs come under increasing pressure due to non-communicable diseases that require long-term treatment and rehabilitation, utilization of digital technology in health and medical fields are attracting attention, and JICA is also strengthening its efforts in the field of digital health.
For many people in Japan, the image of the challenges facing low and middle income countries in the past may have been poverty, hunger, and poor infrastructure. Of course, there are many countries that still face these challenges, but a growing number of countries are overcoming them. For example, the number of mothers who die during pregnancy and childbirth, and the number of children who do not live to the age of five have been greatly reduced in low and middle income countries over the past quarter century alone.
However, a new challenge that has emerged is the increase of non-communicable diseases, such as lifestyle-related diseases, caused by unbalanced nutrition and lack of exercise. In many low and middle income countries, these non-communicable diseases have become the leading cause of death. Maternal and child health care focuses on a life-stage with highest health risk from pregnancy and birth to the age of five, and infectious diseases such as malaria, which are common in low and middle income countries, can be treated and recovered in a relatively short time. On the other hand, treatment of non-communicable diseases such as diabetes, stroke and myocardial infarction can be financial and time-consuming burdens on for the patients themselves, as in same cases require several years of rehabilitation. In addition, it places a tremendous burden on the providers of medical services. Low and middle income countries have few hospitals and other medical facilities, and the number of health human resources are limited, so it is extremely difficult to meet the ever-increasing healthcare needs by expanding or building new hospitals or increasing the number of healthcare workers. Therefore, the use of digital technology is attracting attention.
The use of digital technology in the field of healthcare is called “digital health” by WHO. “Digital health” is expected to be used in various fields. For example, it is expected to be used for sharing health information and medical data through electronic medical records, improving the quality of medical care through telemedicine, and improving the efficiency of the management and logistics system of medical supplies such as pharmaceuticals, and is actually being introduced.
(Reference: JICA Human Development Department; Digital health will change the future -To create a society where everyone can access to appropriate health services-
video:【Health】Digital health, to achieve Universal Health Coverage: UHC(Full ver.)【UD】)
The following is a specific case study of digital health in Bhutan. Bhutan is a Himalayan kingdom with a population of 780,000 whose national policy is to pursue the happiness of its people, and while JICA has many years of experience in cooperation in areas such as agriculture and infrastructure, the pandemic of COVID-19 has triggered initiatives in healthcare, particularly digital health.
Under the ongoing technical cooperation project, “Project for Strengthening Government Capacity for Using Digital Technology and Data in Bhutan,” four digital databanks and a data sharing platform utilizing the already established digital national ID are being developed (Fig.1). The four digital databanks are: Medical Bank (electronic medical records), Health Bank (health data collected by wearable devices, such as activity levels and sleep), Household Bank (housing conditions, household income and expenses, sanitary conditions, etc.), and Biobank (genome information, blood and other biological materials). Personal health data accumulated in each of these databanks will be called up using national IDs, with the aim of providing better diagnosis and treatment for each patient by referring not only to test results and past medical history, but also the housing environment and daily living conditions. Since data from all hospitals will be consolidated, it will also be possible to provide more efficient health services, such as sharing test results received at other hospitals to avoid the need for repeat tests. It is also planned that by analyzing data from the entire population, the Bhutanese government will be able to make better decisions and optimize resources for health services by region and for specific populations.
Fig.1 Data sharing platform utilizing four digital databanks and the digital national ID
Even more promising is the use of healthcare data to contribute to industrial development. Although Bhutan has recently joined the middle-income countries, the unemployment rate is high, and the development of attractive industries in the country, especially for young people with high levels of education, is an issue. Therefore, the Bhutanese government has a strong desire to have domestic and foreign companies and research institutions utilize the big data to develop industries by pseudonymizing or anonymizing the health and medical data (removing personal information from the individual health and medical data in the data bank). In particular, by using the biomaterials and genome data accumulated in the biobank, it is expected to promote collaboration with Japanese and other foreign companies in the areas such as pharmaceuticals, vaccine development, and research on microbiome. In addition, the vast accumulation of diverse and high-quality data may lead to the development of new health and medical AI.
Bhutan government mission calling for data utilization at a seminar for potential Japanese partners from private sector.
Behind the Bhutanese government's promotion of accumulation and utilization of comprehensive medical and health data, which has been difficult to achieve even in Japan, is the commitment of the Bhutanese people, including his majesty King of Bhutan, to increase the Gross National Happiness, and the government's strong desire to take advantage of a small country that can flexibly tackle things that large countries cannot. These efforts have a potential to spread not only in Bhutan but also to other low and middle income countries. Furthermore, Japan could also develop new technologies and services through these efforts and return them to the domestic healthcare system in Japan. International cooperation brings many benefits not only to low and middle income countries themselves but also to us Japanese. With this future in mind, I would like to continue to take on various challenges together with people in low and middle income countries.
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