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Digital ID deployment playing crucial role in African healthcare delivery

Experts on ID4Africa Livecast explore different models of delivery
Digital ID deployment playing crucial role in African healthcare delivery

Stakeholders in the healthcare sector have agreed that digital ID, no matter what format it takes, can make massive contributions to effective and inclusive healthcare delivery if properly deployed.

The speakers shared their views in Episode 47 of ID4Africa’s Livecast series which aired on February 28. The Livecast, which unfolded in five segments, touched several key areas of digital ID related to healthcare.

Aspects examined included challenges and opportunities in digitalizing healthcare, health ID as a sectoral or universal credential for access to healthcare services, the role of digital ID in facilitating patient identification, authentication platforms and biometrics in health, and how to boost civil registration via health infrastructure mobilization. They also described healthcare as one of the main demand drivers of digital ID, given the enormous benefits it offers.

Speakers during the Livecast included health ministry officials from some African governments like Cameroon, Ethiopia, and Senegal; experts from multilateral development organizations and civil society organizations like UNICEF, JSI, Public Digital and the World Privacy Forum; as well as industry actors like Simprints.

What kind of digital ID is best suited for healthcare delivery?

Three speakers shared thoughts in a policy panel in one segment of the webinar. Bhaskar Mishra, a CRVS and digital ID specialist with UNICEF, shared his experience in some lower-middle-income countries such as Tanzania and Nepal where different IDs exist for different health services.

Al Shiferaw, a technical director at JSI, a global public health organization, shared his experience of many years of work in the domain of digital identity and digital health in Africa. He agrees that many countries don’t have unique health identifiers which health programs can use to identify patients. Such unique IDs, he says, may or may not be dependent on foundational ID systems, depending on how they are designed.

Pam Dixon from the World Privacy Forum said in the Global North, health ID systems “are quite fractured,” although that was less the case about 15 years ago when unique IDs were widely used to identify patients. She cited the case of the United States where the health ID system was eventually fragmented by design, explaining that the government removed a unique identifier for the provision of healthcare, and introduced functional IDs for specific health services.

The speakers also agree that healthcare is a special use case for digital ID although its deployment has to be contextual, given the circumstances of different countries. To them, there is also no universal need to have a specific health ID as countries have different ground realities. The panelists approve of a link between digital ID used for health purposes and foundational or legal ID systems, however.

In any case, the officials emphasize that whichever health ID system is adopted must prioritize the security of patients’ digital data files. “Having all the health data in one location is not actually going to be easy to secure,” says Dixon while making the case for a decentralized health ID system.

For countries seeking to use specific identifiers for healthcare systems, the panelists advise them to first put in place the requisite regulatory and governance frameworks, set up patient registries, sort out logistical issues and put in place mechanisms to protect sensitive data while addressing human rights aspects. Governments should consult with all stakeholders including vulnerable populations, and select a couple of systems that might work and get them tested in pilot projects.

Digital ID for patient identification, other purposes

In another segment, speakers from the Ministries of Health of Ethiopia and an African non-profit organization talked about patient identification using digital ID.

Gemechis Melkamu, an executive officer at Ethiopia’s Ministry of Health, noted that unique identification is a crucial aspect in the implementation of the country’s digital health blueprint. He adds that digital ID is important because it facilitates access to health services, enhances inclusion, aids decision-making, security and trust, and instant verification and enables remote access to digital health services.

Ethiopia, according to Melkamu, has been using manual ID processes for patient identification and records management over the years, but the country is now in the pilot phase of implementing a biometric digital health information system (eCHIS) which already has about 25 million people subscribed to it. They are also working on a health card, he says, which will be used to manage patient information portability and mobility.

With digital ID, he believes patient tracking, health record management, system integration and care coordination will be significantly improved as outlined in the 2021-2030 digital health blueprint of the country.

Beyond patient identification, Melkamu mentions that digital ID can also be important for other health aspects such as AI-based diagnosis, telemedicine, mobile health (mHealth), data analytics, and easy contact with healthcare providers across different locations.

Melkamu also explains how integrating digital ID with a community health insurance scheme (CBHI) is likely to help solve some of the problems Ethiopians currently face.

He adds that they are working to make sure that the healthcare and other sectors are integrated with the Ethiopia national digital ID, Fayda, which is currently being rolled out.

The other speaker in this segment Wayne Naidoo, from Jembi, an African non-profit supporting health systems, shared the organization’s experience in patient identity management. He said patient identification is an integral part of healthcare and monitoring, and there “can be no continuation of care without accurate and accessible patient identification.”

Naidoo also underlined the importance of a Master Patient Index (MPI) which performs patient matching (identifying and linking patient data across various health systems) and stores the links between patients and all their associated records in a centralized database for querying.

He mentions Jembi’s MPI pilots in Kenya and Sri Lanka where they are using patient matching to ensure a data driven continuity of healthcare.

Digital health care delivery progress in Cameroon, Senegal

An earlier segment of the Livecast involved a trio of speakers from the Ministries of Health of Cameroon and Senegal.

The officials explained the efforts being made by their countries to implement universal health coverage schemes, the success and challenges, as well as prospects for the future. They also explained how they are integrating technology into healthcare delivery, something that comes with many challenges.

In Senegal, an official from the health ministry, Ibrahima Dia, said about 18 million people are covered by the country’s Universal Health Coverage (UHC) scheme, corresponding to about 50.3 percent of the population. The ministry is integrating technology into the project to facilitate patient care and monitoring, ensure security and interoperability of information systems in the health and social protection sectors, and improve patient satisfaction and access.

Those efforts notwithstanding, certain challenges remain, and they include issues related to governance, data storage and protection, security, interoperability, regulations, concerns about the national digital ID system, and the issuance of a unique ID number to be linked to a patient’s profile.

The official also mentioned Senegal’s health system digitalization program running between 2023-2027, based on a government-run digital ID masterplan.

In terms of health insurance, Mouhamed Mahi Sy, information systems director of the universal health insurance agency of Senegal, explained that the country has been working towards having a fully digitized patient journey, which begins with the enrollment of beneficiaries, digitization of care records, digital patient file monitoring as well as interaction with providers.

This, he says, is being done progressively, beginning with a pilot that includes the integration of a health ID with a patient insurance ID and the linkage of these with the national digital ID and other systems.

In the case of Cameroon, Charles Yopndoi, an official of the ministry of public health, said since 2020, the country has been implementing its four-year National Strategic Plan for Digital Health which entails optimizing health care delivery through the use of digital technologies at different levels of the healthcare delivery chain.

According to Yopndoi, Cameroon has since April 2023 been implementing the first phase of its UHC scheme, which prioritizes digital access to health. To date, he said, about three million citizens have been enrolled for the program which offers important health care services for pregnant women, children aged 0-5 years, people living with HIV, tuberculosis patients, and haemodialysis patients. Enrollment for the scheme requires a national ID which has been a headache to obtain in the central African country for many years now.

Yopndoi agrees that in meeting the health digitization goals set out in the government digital health plan, digital ID is particularly relevant as it can, among other things, ensure secure access to health data both for patients and for authorized health personnel; facilitate the identification of health providers, patients and other actors involved; as well as smoothen control of services provided.

For now, he says the government is working to strengthen the legal framework when it comes to the protection of personal data, improve the health information and data management system which collects data from 6,148 public and private health facilities, initiate the setting up of an interoperable framework for the sharing of birth and death data with the Integrated Civil Status Management System, and the pursue development of a digital patient file system.

The last two segments of the online event looked at the importance of authentication platforms and the use of biometrics in digital healthcare systems, and how health infrastructure mobilization can drive up civil registration.

In the fourth segment, Chris Fleming, a partner at Public Digital, delivered a presentation on the role of ID in the development of digital services in the UK’s National Health Service (NHS). The presentation, which projected the UK as good example to emulate for digital healthcare system management, demonstrated that a foundational ID is pertinent in rolling out an effective health ID.

Simprints Director of Partnerships Ejemhen Esangbedo later spoke about biometrics and how they can be used to unlock access to healthcare and inclusion, like the organization is helping to do in a number of countries including Ethiopia.

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