Health ICT governance architecture framework developed by ADB together with partners
A new paper from the Asian Development Bank (ADB) highlights efforts to develop a health ICT governance architecture framework through consultations and close collaboration with experts.
The paper notes that a range of solutions, such as digital disease surveillance systems, electronic medical records, and social health insurance payment processes, are being implemented in different countries. However, good governance for successful implementation and sustainability throughout the health system requires a holistic approach which is often missing. The health sector lags behind other sectors and industries in the development and adoption of ICT governance frameworks.
To fill this gap, ADB developed a health ICT governance architecture framework (HIGAF). The framework was further refined through consultations with health sector ICT experts in the region further refined the framework, leading to the creation of HIGAF 2.0. HIGAF 2.0 is designed specifically to meet the evolving needs of developing member countries in the region.
The Asia eHealth Information Network (AeHIN), a peer-led network of digital health experts from government, civil society, the private sector, developed countries, development partners, and academia in more than 25 countries and ADB can assist countries to develop and implement HIGAF 2.0.
HIGAF 2.0 simplifies key elements of the COBIT 5 framework for the governance and management of enterprise IT and combines them with digital health resources, including the WHO and International Telecommunication Union National (ITU) eHealth Strategy Toolkit and the Broadband Commission report Digital Health: A Call for Government Leadership and Cooperation between ICT and Health. The framework also takes into account a global repository of digital health standards, policies and architecture artefacts, stakeholder mapping and the principles of good governance.
In HIGAF 2.0, the seven components of the WHO/ITU eHealth Strategy Toolkit have been expanded to include information and architecture and divided into: what to govern and how to govern.
Three tiers encircling the framework, represent three digital health components from the WHO/ITU eHealth Strategy Toolkit, which describe how to govern. The first tier is leadership, governance and multisector engagement to enable the taking of system-wide decisions.
The second tier covers the governance process - legislation, policy, and compliance - to create the enabling environment to ensure law enforcement and alignment of IT policies nationwide and across sectors. It includes laws and policies on data standards, privacy and security, which are key to establishing trust and protection for the public as well as the health sector workforce.
The third tier of strategy and investment ensures that financing priorities are aligned across governments, donor agencies, and the private sector.
The framework requires a national digital health strategy, defined by the national health strategy, policies, and plans.
At the center of the framework, there are six digital health components to be governed: Services and application, Standards and interoperability, Architecture, Infrastructure, Information and Workforce.
The framework classifies the components of governance into three main categories: process, structure, and stakeholders.
Stakeholders in digital health include government ministries, decentralised levels of government, civil society organisations, the private sector, and service providers. Stakeholders extend beyond the health sector. Examples would be civil society organisations, private vendors, and non-health ministries such as the ministry of ICT and ministry of finance.
A three-step process is presented for stakeholder mapping: (i) identify stakeholders with roles in policy- and decision-making and implementation in and beyond the health sector; (ii) identify those who will use and will be affected by digital health solutions; and (iii) identify those who bring in key resources (human, financial, and technological).
The WHO and International Telecommunication Union National eHealth Strategy Toolkit provides guidance on how to map, engage, and consult different stakeholder groups in creating an eHealth vision.
The paper highlights that a governance framework must take into account the main stakeholders in health service delivery, and in health care financing, consider public spending, out-of-pocket expenditure, and donor funding, as well as health insurance mechanisms. Feedback should be sought from frontline health workers and patients in planning and implementing digital health.
Nationwide implementation of digital health with exchange of patient-centric data would require polycentric and diffused forms of patient-centered governance, as opposed to traditional hierarchical, forms. But even in diffused forms of governance, the health enterprise, with the MOH at its core, would need to maintain a central role in regulatory functions such as policy making, coordination, and standard-setting.
When implemented, a digital health governance framework has to reflect the power relations and lines of accountability between the different stakeholders. For example, having a central actor responsible for defining standards hierarchically lower than other stakeholders might make it difficult to implement the digital health standards. Establishing a governance structure is one of the first steps to be taken in COBIT 5.
The Broadband Commission has proposed three different possible governance models. Digital health can be driven from within the MOH, which then mobilises technical capacity and skills from other ministries. Alternatively, the MOH drives digital health, but a government-wide agency provides ICT infrastructure capacity. In a third model, the MOH leads health strategy, but ICT is designed by a third-party agency.
Governance processes encompass policy and decision making, planning, resource allocation, coordination, and monitoring and evaluation. These are usually driven by the digital health enterprise with the MOH at its core.
HIGAF 2.0 draws from COBIT 5 from governance processes. In COBIT 5, processes are defined as “a set of practices and activities to achieve certain objectives and produce a set of outputs in support of achieving overall IT-related goals.” These processes can be divided into those concerning governance and those pertaining to enterprise management. The former includes practices and activities aimed at evaluating strategic options, providing direction to IT, and monitoring the outcome. The latter processes cover responsibility for planning, building, running, and monitoring.
Access the paper “Transforming Health Systems through Good Digital Health Governance” here.