It’s 2025, and in a rural area where health care workers are in short supply, a woman with diabetes must manage her disease. What can she do? Who do you turn to…? To her smartphone. Just two years from now, health care—and many other services—could look very different than it does today. Technologies like artificial intelligence and the internet could allow this woman to receive health care with the push of a few buttons. An adhesive could use her sweat to measure blood glucose levels. A microchip in his phone would send that data to his electronic health record in the cloud and he could then place an order for insulin, which would be delivered to his door by a drone, or ask the local pharmacy to 3D print his metformin pills and verify their identity through a text message.
A comprehensive digital primary health care system could mitigate or even overcome systemic problems such as absenteeism (…) low quality and non-responsiveness and structural inefficiencies
To detect diabetic retinopathy, which if left untreated can damage the eyes and cause blindness, you could also use your smartphone to get an image of the retina, much like taking a selfie. An artificial intelligence algorithm would analyze it and if it found anything abnormal, it would schedule an appointment with the doctor. She could even order a taxi to take her and deduct the cost of transportation from her mobile wallet. Before the woman arrives at the office, the doctor may try laser therapy on her digital twin to assess the best treatment.
It may sound like science fiction, but all those solutions already exist separately. And given the likelihood of exponential growth in computing power, further deep learning of neural networks, and revolutionary advances in smart machines, robotics, and 3D printing, these systems will become more prevalent and powerful.
If it is technically possible to build a complete digital primary health care system tailored to the needs of low-resource settings, why hasn’t anyone put those elements together? There are no financial incentives for private companies to link independent technologies and neither are national health systems, which are often under-resourced.
Realizing the potential of this digital transformation requires looking outside of healthcare. Specifically, in digital payment systems which, given their wide adoption, could herald a new era for healthcare. Redesigning health systems to integrate data and digital technologies is no longer simply a job for government ministries. It is increasingly carried out by financial institutions, organizations experimenting with new technologies, and online retailers.
During the three years that I held the position of president of Ehsaas, Pakistan’s largest social security and anti-poverty program, I saw the infrastructure needed to facilitate digital payments. Gateways and switches make up the backbone of those systems, but so do policies, standards, and regulatory frameworks. Ehsaas himself is currently developing a unique digital ecosystem that could benefit millions of families. It includes the Ehsaas Savings Wallets initiative, implemented in accordance with the “A Bank Account for Every Woman” policy, and enables beneficiaries of the Ehsaas Kafaalat Program, which provides monthly cash stipends to the country’s poorest women, to withdraw or save your money. The new ecosystem also includes the Ehsaas Rashan Riayat Program, a technology initiative for grant disbursements. With the rashan appqualifying families receive discounts on select foods at kiryanas or small stores. Coupled with the right tax incentives, such initiatives could increase financial inclusion and accelerate the transition from cash to digital payments.
Even in the most remote parts of the world, fast food chains and taxi companies harness the power of mobile technologies to deliver goods and services. Theoretically, these same technological capabilities could form the basis of innovative public sector digital ecosystems that are transparent, accountable and responsive. The Ehsaas ecosystem is a step in the right direction.
A comprehensive digital primary health care system could mitigate or even overcome systemic problems such as absenteeism, supply chain losses, institutionalized theft, low quality and non-responsiveness, parasitic rent-seeking behaviors, informal payments and structural inefficiencies. Just using the blockchain or blockchain — a multi-purpose technology — can safeguard security, increase transparency, and has the potential to prevent fraud and minimize losses in healthcare systems.
Covid-19, the inflationary crisis and climate changes highlight the need to reform public institutions and health care. In order to realize a future in which that woman with diabetes can be treated through a constellation of medical technologies, both intensive investment in the digitalization and modernization of payment systems, as well as the development of regulatory and policy frameworks, are essential. The technology already exists, now we have to put it at the service of everyone.
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