Healthcare systems in low- and middle-income countries often struggle to provide affordable, high-quality, and universally accessible care. The inability to achieve health targets set out by the Sustainable Development Goals, combined with increasing consumer demand for health services, have forced health planners to seek innovative solutions. One such solution has been to integrate information and communication technologies in the health sector to digitize service provision by creating e-health platforms.

The global COVID-19 outbreak has highlighted the urgent need to innovate health systems, particularly in developing countries that lack the necessary surge capacity and adequate healthcare resources to effectively combat the spread of the virus. As a result, the COVID-19 pandemic has accelerated the implementation of e-health systems as a low-cost and highly effective healthcare solution. 

In response to the COVID-19 crisis, countries across the world have implemented a combination of social distancing measures and lockdown procedures in order to slow the spread of the virus, or “flatten the curve.” At the same time, countries in the G20 have attempted to stockpile critical medical supplies, such as personal protective equipment (PPE) and ventilators. However, developing countries are at a significant disadvantage in responding to the crisis, as factors such as population density, limited economic resources, variable state capacity, and strained healthcare infrastructure impede the effectiveness of preventative measures. As a result, developing countries are likely to be the hardest hit by the pandemic, in terms of both health and economic impacts. For example, income losses as a result of COVID-19 are expected to top 220 billion dollars in developing countries – a devastating consequence given that millions of the people affected by these shocks live in extreme poverty and have limited or no access to social safety nets.

Given the prevailing institutional and resource constraints, some developing countries are rapidly moving towards the adoption of e-health systems as a way of managing the COVID-19 crisis. E-health can improve health outcomes in developing countries by expanding geographic access to healthcare, improving diagnosis and treatment, enhancing patient communication, improving data management, and streamlining financial transactions. 

E-health platforms can expand geographic access of health coverage by overcoming the distance between patients and physicians through telemedicine. This is made possible through technologies such as videoconferencing, instant messaging, and telephone helplines. Furthermore, these e-health platforms have enhanced patient communication by improving general health education, encouraging patient care, and enabling emergency care. They can also greatly assist healthcare professionals by digitizing medical record systems that can be accessed from anywhere, and by facilitating remote professional networks.

A recent study published in The Lancet shows that COVID-19 has been a watershed moment in developing countries as the pandemic has shattered longstanding resistance towards adopting digital health measures. China’s healthcare system, for example, was transformed overnight when the country’s national health insurance agency decided to pay for all virtual care consultations as hospitals and other healthcare facilities approached full capacity and fears of overcrowding increased. China partnered with local conglomerates such as Baidu and Tencent to overhaul existing infrastructure to make way for new e-health services in order to combat COVID-19.

India, which has long resisted wide-scale e-health adoption, has followed in China’s footsteps by releasing a new suite of applications that enable e-health services. These applications leverage existing instant messaging platforms, such as WhatsApp, to carry out epidemiological tracing, facilitate mass public health communication, and expand access to virtual healthcare providers. Telemedicine programs in India have used a three-pronged approach to facilitate patient mobility that includes mutual recognition and registration of medical credentials with partner regions, reciprocity arrangements that enable licensed doctors to engage in e-health practice across various regions, and  physician registration which protects patients from medical negligence and enforces malpractice legislation. As such, these telemedicine measures have greatly increased the efficiency of healthcare delivery in India. 

Although countries in Sub-Saharan Africa have generally been slower to adopt e-health practices, these innovations are beginning to be implemented rapidly in response to COVID-19 in countries such as South Africa. COVID-19 is removing some of the regulatory barriers which had previously held back the full adoption of e-health technologies in many parts of Africa, and it is only a matter of time before countries begin to pursue and implement more comprehensive digital health strategies. In particular, the ubiquity of mobile phones and the abundance of cellular infrastructure in Africa presents a unique opportunity for governments to scale up successful pilot programs at a low cost. Professor Alex Jadad, the founder of the Centre for Global eHealth Innovation at the University Health Network in Toronto, claims that challenges related to implementing e-health systems are easily surmountable even in the most “resource-scarce settings.”

The digitization of healthcare delivery has been made easy by rising numbers of cellphone and Internet users, along with the progressive decline in the prices of these technologies. Identifying and scaling programs that leverage targeted data form the foundation of comprehensive e-health policies in developing countries, and can allow healthcare workers to do more with less. In the context of the COVID-19 pandemic, e-health technologies can allow developing countries to minimize mortality rates, protect front line healthcare workers, and help to contain the spread of the virus until a vaccine is developed.