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Saturday, July 20, 2024

Unintended Consequences of COVID-19: Dying children and Digital Health

As Covid-19 continues to wreak havoc, it is imperative that the health of children, who are the most vulnerable members of society, be a priority. The authors explore how digital health played an important role during these trying times.

By: Shelina Bhamani, Ibrahim Sajid, and Zen Tharani |

The third sustainable development goal (SDG) sought for healthy lives and well-being of all individuals, irrespective of age. In line with this goal, mother and child health has seen significant improvement, with the World Health Organization (WHO) reporting a successful decline in maternal and child morbidity and mortality around the globe.

Over the last decade and a half, childhood deaths across the world have been cut in half.  This trend is no different in Pakistan, a country declared as the world’s most dangerous country for a newborn. This reputation is based on the highest rates of post-natal complications and lowest infant survival rates.

The trend comes amidst a scarcity of skilled midwives and a systemic approach to increasing health-seeking behaviour with access to quality healthcare, especially in the rural sectors of the country.

The new normal?

Hanging over the ongoing situation is a large shadow cast by the COVID-19 pandemic which is creating additional challenges and further exasperating the maternal and child morbidity and mortality situation in the country.

Globally, COVID-19 has interrupted the usual health care delivery and that has caused a reduction in access to health care services across all levels of care. Health care access has already been an ongoing challenge in Low & Middle-Income Countries (LMIC’s) like Pakistan; the added pressure of the pandemic has created a situation that is leading to a worsening of conditions in areas of maternal and child health services.

The rise of pediatric malnutrition, reduced access to routine vaccinations, delayed health care assessments for children are just some of the unintended consequences of the ongoing public health efforts.

Read more: Pakistan’s health care system in a crisis

As the global population continues to look forward to the vaccines with hope, experts are already indicating that ongoing public health measures will need to continue to ensure a sustainable victory over the virus and the emerging variants. There is this underlying hope that the focus on the piling health care issues will be resolved once we are back to normal; once we are able to pay more attention to all things non-COVID.

The reality is that this is our new normal and it is an ever-evolving one. There is no returning back to a pre-COVID world. So, if we are in our ever-evolving normal, our work to minimize and rectify the unintended consequences due to COVID-19 should be a priority now, not after we have all been jabbed in the arms.

There may be cause for pessimism here thinking about the sheer number of issues that need to be resolved.  If we were in a bygone era, that pessimism may be warranted and justified.  The reality is that we, the human race, has seen an unprecedented advancement over the course of this pandemic that is unparalleled. Health care has been no exception.

Read more: COVID-19: Militaristic response and the crumbling healthcare system

COVID-19: Innovation Accelerator of the century

Digital Health has made its way into the vernacular of a large portion of the population worldwide. With an injection of innovation seen through machine learning, artificial intelligence, mobile health (m-health/mHealth), and eHealth mainly being driven due to increased demand by the patients is now a normal trend across countries regardless of its socio-economic status.

This integration has been made possible due to a significantly higher percentage of the global population shifting to smart-devices, high-speed broadband internet services, and widespread media coverage about digital health advancements.

Read more: Apple & Google decide to fight COVID-19 with smartphone technology

The prevalence of the digital divide has also become more apparent as citizens of low-income countries still have accessibility issues such as access to the internet, access to affordable eHealth services, including lack of programs to name a few. However, due to COVID-19, there has been an increased effort towards developing digital health capacity through both government and private initiatives.

In Pakistan, there are many models of digital health in practice including short message service (SMS) based interventions to serve as reminders for medication compliance and medical appointment reminders and telehealth clinics for all patients.

Innovative models such as the development of applications like e-Doctor and Sehat Kahani enable female doctors to continue practising medicine irrespective of their household and childcare responsibilities; Teeku- which aims at keeping records of childhood immunizations is also gaining momentum.

Technology has also been deployed in conducting investigations and coordinating a national response to outbreaks. During the current COVID-19 outbreak, the Government of Pakistan developed a mobile-based application to track the number of cases, death, recoveries, and provide real-time information with respect to the availability of beds and ventilators in various hospitals across the country.

Read more: WHO Telemedicine: Right step to sustain Health Care System in Pakistan

The government also developed a mobile-based application in 2011 to track the cases of suspected and confirmed cases of Dengue- which helped in defining hotspots for the outbreak, allowing focal interventions.

Similarly, in Sindh, geospatial mapping helped delineate the root causes of drug-resistant typhoid and HIV outbreak and understanding the course of spread.

Impact of digital health

The digital health ecosystem is at a turning point in Pakistan. The convergence of consumer demand, innovation acceleration due to COVID-19, and the increased focus of government and private funding create a concoction that can enable the country pivot its health care delivery model to meet the needs of its population while demonstrating fiscal resilience and sustainability.

It is important to be clear that digital health is not a silver bullet solution, neither is it a “one and done” model. The value proposition of digital health can only be realized when the focus of the health care system puts the patient in the centre of care backed by the commitment across the country at all levels of government, industry, and professional bodies to make this a reality.

When we design a health care system that revolves around the diverse needs of the patient (and their caregivers), there is a synergy that is attainable to deliver the best care for the people through collaboration and smart investments.

Read more: Read more: Understanding ‘Human Trauma’ in COVID-19 Times

Within the myriad of tools in the toolbox, digital health is one of those tools that can help in designing and delivering a health care system that is patient-focused and built around providing the best experience for both the health care recipients and providers.

With the formalization and release of the Digital Pakistan Policy by the Government of Pakistan, the public sector has already shown its commitment to moving in the right direction. The vision of the policy is to “become a strategic enabler for an accelerated digitization ecosystem to expand the knowledge-based economy and spur socio-economic growth”.

The government, within this policy, has shown further commitment to e-Health to directly support none other than the third sustainable development goal. The seed has been sown and is germinating. Now is the time to be bold and make some strategic and sustainable moves through ecosystem alignment.

Focus on securing the well-being of the future of Pakistan

Every life matters. The lives that matter the most are those of the most vulnerable members of our society, and in Pakistan’s case, one of the most vulnerable segments of the population are children. They are literally the future of the nation.

According to a study by UNICEF in 2019 (pre-COVID), kids in Pakistan were 50 times more likely to die during the first month than newborns in Japan or Iceland.  Let’s forget Japan and Iceland and focus on a country in proximity to us, for example, neighbouring India’s mortality rate of children under the age of 5 is half that of Pakistan.

The mortality rate in Afghanistan is even better than that experienced in Pakistan.  This shouldn’t be a surprise seeing that Pakistan only spends 1% of its GDP on health.  Why wouldn’t we want to mobilize our efforts to make it possible for these newborns to live happy and healthy lives?

Read more: Are Pakistan’s health systems prepared for a COVID-19 vaccine?

The 1000-day strategy

It is irrefutable that the “first 1,000 days of life – the time spanning roughly between conception and one’s second birthday – is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established”  according to UNICEF.

This concrete correlation provides a clear sphere of focus to integrate the right policies and investments to create space for new and innovative digital health technologies and programs to develop sustainable accessibility and availability of health care services.

This requires a bold step by the public sector leadership to provide a national focus to enhance the alignment of efforts across the nation. A good example of this is Australia where the government has created the National Children’s Digital Health Collaborative with a vision of harness the power of digital technology to make the country the best place to raise healthy children irrespective of their location, socioeconomic status or cultural background.

Read more: UNFP urges to prioritize women’s health globally to avoid ‘dire consequences’

A bold step that has created the momentum of innovation and investments in the areas of a longitudinal digital health record for children and pregnant women, elimination of paper records to track a baby’s progress together with sunsetting the collection of pregnancy data on paper.

These are basic and very initial steps by the public sector that play a key role in signalling to the sector players that there is a commitment, focus, and investment possibilities to move the needle in the maternal and child health arena.

The tacit portion of this move is the simple assumption that the provision of health care and utilizing digital technologies cannot be viewed and are two separate paths. A health care provision strategy, in this era, cannot deliver on its promise without a robust, achievable, and democratized digital health strategy.

Therefore, lets start small by taking care of the small and vulnerable amongst the nation and by ensuring that that our immediate hyper-focus becomes looking after the 1000 days of both the mothers and the babies. Let’s step forward to ensure a strong sustainable future for the future of the country.

Dr Shelina Bhamani & Ibrahim Sajid work at the Aga Khan University, Karachi Pakistan & Zen Tharani is a management professional having expertise in Digital Health from Canada and currently, he is the CEO, Xenex, Consulting Inc. For correspondence connect with Shelina.bhamani@aku.edu or zen.tharani@gmail.com

The views expressed in this article are the author’s own and do not necessarily reflect Global Village Space’s editorial policy.