Leveraging digital solutions for gender-responsive and inclusive health systems
In the context of a global health crisis or emergency, digital solutions can build more equitable and effective health systems. Emerging findings from IDRC-funded COVID-19 projects are demonstrating that many digital solutions, such as data analysis tools, geospatial maps, mobile applications and machine learning-enabled processes, may lead to better health system responses. Successful digital solutions with transformative impact are designed with local needs, users and contexts in mind.
In the early months of the COVID-19 pandemic, government response and recovery efforts across the globe, including in low- and middle-income countries, failed to consider marginalized populations and their unique healthcare needs. Intersectional factors such as gender, race and socio-economic status left women, gender minorities and other equity-seeking groups behind.
As the world marks the third anniversary of the WHO declaring the COVID-19 pandemic in March 2020, we explore innovative IDRC-supported research projects. Each developed and used transformative and inclusive digital solutions to help women, gender minorities and marginalized groups recover from the immediate and long-term effects of the global pandemic. Early evidence demonstrates that digital technology can offer new solutions to promote equity and equality in healthcare, while also strengthening health systems.
- New digital health tools are allowing health systems planners to respond to health crises, analyze data and achieve better, more inclusive outcomes.
- Digital tools and gender-responsive processes can protect, support and improve the skills of healthcare workers and create more flexible, resilient health systems that can withstand future pandemics.
- Health crisis responses that are designed to connect with hard-to-reach or marginalized audiences yield better responses by taking their concerns and unique needs into consideration.
The gendered and exclusionary impacts of COVID-19 on health systems
The COVID-19 pandemic affected women, gender minorities and groups such as refugees and informal workers at all levels of the healthcare system — from planners involved in the pandemic response to healthcare workers and the communities they serve.
In low- and middle-income countries, governments prioritized efforts to limit the spread of the virus and manage the burden on health systems. They also redirected healthcare resources and imposed movement restriction policies in an effort to save lives. Movement restrictions and closing places of work, for example, had unintended and undesirable effects that deepened inequalities and made living conditions worse for women and other populations already living in vulnerable situations.
From a planning perspective, many countries adopted a one-size-fits-all approach that failed to consider the specific needs of women, gender minorities and LGBTQI2+ communities. For example, health officials redirected health resources to COVID-19 priorities, which worsened already limited funding for sexual and reproductive health and HIV prevention services.
COVID-19 also weakened overstretched health system capacities in the Global South. Healthcare workers, 70% of whom are women, faced more working hours at the same time as their caregiving demands increased with children or elderly parents under lockdown at home. This additional workload compounded existing staff shortages, leading to burnout, illness and leave. Healthcare workers also faced a greater risk of infection, and many did not have the knowledge or protective measures to manage COVID-19 cases.
At the community level, Indigenous groups, refugees, LGBTQI2+ populations and primarily female informal workers faced bigger barriers to access health services because of limited capacity, fear, discrimination or mistreatment in healthcare facilities. In some cases, COVID-19 response efforts could not successfully reach remote, Indigenous or migrant populations. In others, response efforts failed to address their specific concerns about the virus, vaccinations and the government’s response. This deepened mistrust in healthcare systems led many to ignore safety recommendations such as social distancing and handwashing, or to reject the vaccine altogether.
Going digital: Using tech to promote equality
IDRC-funded researchers have identified gender inequalities and related gaps in services at each stage of the healthcare process. Their COVID-19 research is exploring the potential and feasibility of using innovative digital health solutions to address these gaps and to build more equitable, inclusive health systems that can withstand future pandemics and health emergencies.
Developing gender-inclusive planning tools
Funded by IDRC and led by Colombia’s Universidad de los Andes and Pontificia Universidad Javeriana, together with data.org, the Epiverse TRACE LAC project is building digital analysis tools using gender-disaggregated data. The data is collected by community health workers and government health information systems to strengthen epidemic response in Latin America.
TRACE LAC’s tools use inclusive, relevant data and a human-centered approach. The project introduced processes to explore the challenges of gender inclusion in data science and to integrate gender into each stage of health systems planning and implementation.
Another project, led by Colombia’s Universidad de los Andes and funded by IDRC and the Swedish International Development Agency, worked collaboratively across sectors to use artificial intelligence (AI) to deepen understanding of the social and gender dynamics of the spread of COVID-19 and vaccination uptake. The project generated sex-disaggregated data on the national vaccination plan, provided specific data on migrant populations and how COVID has impacted them, and analyzed social media activity related to the gender identity of the account holder.
“We need solutions built on the knowledge and capabilities of those most at-risk of bearing the burden of inequities in global health,” says Catalina Gonzalez Uribe, Director of Internationalization for the Vice Presidency of Research and Creation, and Associate Professor at the Universidad de los Andes.
Using mobile apps to prepare and protect health professionals
In other regions of the world, IDRC-funded research teams are working to identify service gaps and address knowledge needs among healthcare workers. Through the COVID-19 Innovation and Research Project, they are developing training tools and finding new ways to connect with hard-to-reach audiences.
Led by the Aga Khan Foundation and funded by IDRC, researchers are developing and scaling up three digital tools to strengthen health systems and improve care for at-risk populations in Afghanistan, Kenya, Pakistan, Syria, Tajikistan and Tanzania. The mobile applications are designed to monitor high-risk populations, serve hard-to-reach populations and share proven practices to create awareness among healthcare workers. The applications include:
- CoronaCheck, which aims to reach high-risk populations such as women, girls, refugees and internally displaced communities. CoronaCheck assesses their risk of infection, raises awareness about social distancing and provides resources to combat gender-based violence.
- VirtualDoc offers non-urgent medical teleconsultations to people who face barriers to accessing health services such as the elderly, people with physical impairments and women and girls.
- PPE mobile application provides education and best practices on personal protective equipment (PPE) for healthcare workers.
Connecting directly with marginalized communities
The IDRC-funded project #SafeHandsSafeHearts is serving a critical need for gender minorities and racialized groups. This digital health project is connecting with LGBTQI2+ and racialized populations in Thailand, India and Canada to study the specific challenges and social barriers they face within the context of the COVID-19 pandemic.
Professor Peter Newman of the University of Toronto says the study will help community organizations in all three countries to “develop their capacity to work with marginalized people” and inform how governments address the needs and experiences of LGBTQI2+ people. “Before the next crisis strikes, we must ask ourselves how to avoid a situation in which [health] measures only take into account the reality of straight couples with 2.4 children,” he explains.
This innovative, culturally situated digital health intervention tested three online peer counselling sessions held over three consecutive weeks to help LGBTQI2+ communities learn about COVID-19, discuss how to access HIV prevention and sexual and reproductive health services, and reduce anxiety, depression and alcohol use.
Digital solutions can build better, more inclusive health systems today, and lay foundations for improved health equity tomorrow. Advances in technology, including artificial intelligence innovations, can provide accurate, robust, location specific and contextually appropriate data that can inform equity-based planning and decision-making, build capacity among healthcare workers and improve access to health systems for women and vulnerable populations.
This potential cannot be achieved in a vacuum. Success hinges on local expertise, contextual understanding and sustained leadership. It also involves addressing biases within the design of digital solutions to ensure the proposed solution avoids exacerbating existing biases and mitigates potential new biases being introduced. Achieving equitable health systems requires a concerted effort by governments to collect, share and use data that offers a full picture of the population with a particular focus on women, gender minorities and other equity-seeking groups. The use of digital tools to collect and analyze information efficiently and effectively provides knowledge that can be used by policymakers to push for more inclusive health systems and improved health outcomes for the world’s most vulnerable populations.