The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting

Kaye Borgelt; Taniela Kepa Siose; Isaia V Taape; Michael Nunan; Kristen Beek; Adam T Craig

doi:10.1371/journal.pdig.0000109

The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting

PLOS Digit Health. 2022 Oct 7;1(10):e0000109. doi: 10.1371/journal.pdig.0000109. eCollection 2022 Oct.

Authors

Kaye Borgelt¹, Taniela Kepa Siose², Isaia V Taape², Michael Nunan³, Kristen Beek⁴, Adam T Craig⁴

Affiliations

¹ Digital health consultant, Melbourne, Victoria, Australia.
² Ministry of Health Social Welfare and Gender Affairs, Tuvalu.
³ Beyond Essential Systems, Melbourne, Victoria, Australia.
⁴ School of Population Health, University of New South Wales, New South Wales, Australia.

Abstract

Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT's stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries.

Copyright: © 2022 Borgelt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by a grant to ATC from the Asia Pacific Observatory for Health Systems and Policies (Grant reference: 2020/1002187-0). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.