I was recently afforded the opportunity to lead the development and advancement of Rwanda’s national digital health strategy in an engagement funded by Global Affairs Canada through Alinea International, as well as the World Health Organization. As with all good strategies, it was important to articulate the benefits of the strategy, in this case, for public health. The easy way was to be clinical and technical about the benefits, such as presented in Figure 1.
Figure 1: The benefits of the National Digital Health Strategy
Important aspects of the patient-centric strategy are the level of benchmarking performed to determine best-in-class approaches to digital health, especially in Africa, enhanced patient experiences, alignment with human rights principles and the UN’s SDGs, operational excellence, and the special impact on children and youth and enhanced financial efficiency. These are the outcomes of enhanced digital literacy, health education, healthcare access, and of data integration and interoperability.
A much more impactful way to relate the strategy to the average citizen would be to relate the public health benefits of the strategy to the country in a story using local references to places and names – a story that any member of the population could easily relate to and understand. This was the story:
Introduction
In the small but picturesque village of Karabo, nestled amidst one of the thousand rolling hills in Rwanda, there lived a wise old woman named Kayitesi. Her life's journey was intricately intertwined with the ever-evolving landscape of digital healthcare, and it was a testament to the transformative power of interoperability, digital literacy, health education, and personal health empowerment.
Childhood and Early Life:
Kayitesi's journey with healthcare began in her early years. She vividly remembered visiting the local health centre - Kirarambogo HC - a cheerful and welcoming place where a friendly health worker, Mbabazi, administered her vaccinations and provided annual check-ups. What made this experience truly remarkable was the meticulous “only once” record-keeping by Mbabazi and other healthcare workers. They diligently tracked her health history, ensuring that every vaccine and medical event was documented in digital form. This attention to detail and accuracy by the healthcare workers became invaluable as Kayitesi grew up.
Teenage Years:
As Kayitesi entered her teenage years, she found herself in the midst of various digital health education programs at her school. These programs, led by healthcare professionals but also accessible on her phone, made use of Kayitesi's health history – with her parent’s consent – to provide her with tailored health advice. Digital literacy became her superpower, as she learned to navigate health apps and platforms that enabled her to monitor and enrich her own health and well-being.
Early Adulthood:
Moving to Kigali to pursue her career was a breeze for Kayitesi's healthcare continuity. Her digital health records – all continuous – were as accessible there as anywhere else in Rwanda. Her personal health empowerment grew as she used more digital tools to book appointments, access her medical records, examine test results, and communicate with her healthcare workers to learn even more about her health.
Starting a Family:
The power of interoperability became even more evident as Kayitesi embarked on motherhood. Ngabo, her obstetrician, used her now comprehensive digital health history to offer personalized prenatal care with due consideration for her full health history. Kayitesi was also empowered not only to monitor her own health, but to actively engage in her baby's well-being by means of various, fit-for-purpose digital health resources and telehealth services.
Chronic Illness and Middle Age:
In middle age, Kayitesi faced a chronic illness diagnosis. With interoperable data, her healthcare team could trace her history back to her earliest health records. With her health history in hand, they were empowered to craft precise treatment plans and gave her access to remote health monitoring tools so she wouldn’t need to travel. Kayitesi was no longer just a patient; she was an active participant in her own healthcare, empowered by her digital literacy and her growing health knowledge facilitated by a growing number of online personal health resources.
Retirement:
Returning to Karabo in retirement, Kayitesi continued her healthcare journey at the local health center. Interoperability remained at the core of her healthcare experience. The transparent and secure messaging systems she had grown to trust after years of reliable use allowed her to communicate with healthcare providers easily and safely. She embraced the role of a proactive patient, continuing to leverage her digital literacy to monitor her health and well-being.
Golden Years:
Later, Kayitesi often marveled at her healthcare journey. It was a journey marked by the power of interoperable systems, digital literacy, health education, remote monitoring, and personal empowerment. Her health data had become a lifeline, and her ability to actively manage her health was a source of pride for her.
Kayitesi's story is a testament to the importance of having embraced the vibrant eHealth ecosystem in Rwanda that empowers individuals to take charge of their health and well-being while being supported by various health professionals. It is more than a story; it is a celebration of the transformative potential of healthcare systems designed around the patient. In other words, it is the material and meaningful realization of the benefits of patient-centric digital healthcare.
By means of the story, the hope was to convey what the digital health strategy would do in everyday terms as would be experienced by a patient. Key to the realization of the strategy is the technical concept of data integration and interoperability, much of which is covered in my ISACA Journal Volume 2 2024 article, “Data Interoperability: Addressing the Challenges Placing Quality Healthcare at Risk.”