How digital can catalyse good governance in healthcare

New study shows mobile phone technology can improve healthcare governance.

Human-centred design is vital for ensuring that digital approaches align with the real problems underpinning poor governance. Increasing transparency is not enough; driving reform also requires actionable accountability and effective citizen-government feedback loops.

Isaac Holeman

Mobile phone technology offers opportunities for improving governance in the healthcare sector, particularly in low and middle income countries, according to a new study co-authored by two Gates Cambridge Scholars.

Corruption, fraud, inefficiency and discrimination are significant barriers to the delivery of sustainable and equitable healthcare in many developing countries. The new report published in The Journal of Global Health shows how digital, often mobile, innovations are offering new opportunities to combat these challenges.

In their scoping review of research and practice, for USAID, the authors, Gates Cambridge Scholars Isaac Holeman [2013] and Tara Cookson [2011] and Claudia Pagliari from the University of Edinburgh identified a wide range of technology-enabled ‘good-governance’ initiatives aimed at increasing healthcare quality by:

– Gathering and verifying information about services for transparency and auditability

– Supporting decision-making through data aggregation and visualisation

– Mobilising citizens to report weak or corrupt practices

– Automating processes to combat fraud.

Examples include patients using apps to report bribe-taking or to verify the provenance of dispensed drugs; health leaders analysing data patterns to detect absenteeism or false accounting; hospitals introducing electronic cash registers to combat temporary measures used to address billing problems; and governments using mobile payments to ensure salaries reach their intended recipients.

According to Dr Pagliari; Director of Global eHealth at the University of Edinburgh and the senior academic on the project: “While all countries are affected by these problems to some extent, the health sector in low and middle-income regions has been particularly susceptible, due to factors such as low and inconsistent salaries, entrenched norms favoring informal payments and weak systems of oversight and accountability. As digital technologies penetrate these regions innovative approaches are emerging to tackle these challenges, both from the ground up and as part of designed projects, although the complexity of the underlying issues typically demands more than technological solutions.”

First author Isaac Holeman, who is doing a PhD in Management Studies at the University of Cambridge and is a tutor on Edinburgh University’s Global eHealth MSc programme, points to the need for a greater focus on involving stakeholders in the design process. He says: “Human-centred design is vital for ensuring that digital approaches align with the real problems underpinning poor governance. Increasing transparency is not enough; driving reform also requires actionable accountability and effective citizen-government feedback loops.”

With new solutions continuously being sought to meet United Nations Sustainable Development Goal 16 – to strengthen institutions, increase public participation and eliminate corruption – and Goal 17 encouraging greater utilisation of technology and information, the use of digital good governance methods in healthcare will almost certainly grow, say the researchers. By analysing a wide range of examples, with reference to governance theories, global development priorities and design principles, they add that their review provides insights and recommendations to inform future interventions and the research needed to understand and evaluate them.

Picture credit of mHealth app via Wiki Commons