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The Future of Virtual Health and Care

The Broadband Commission for Sustainable Development Working Group

on Virtual Health and Care was co-chaired by the Novartis Foundation

and the World Health Organization.

The report was funded by the Novartis Foundation

with in-kind support from Accenture

The COVID-19 pandemic has changed the way health and care are delivered. The past two years in particular have seen a boom in connecting patients and users with health and care providers remotely. The delivery of health and care services remotely through digital means and technologies, commonly known as virtual health and care, has enabled: • proactive and preventive health management for individuals and populations through real-time notifications and reminders to prevent and manage health challenges, • care navigation and support to ensure that patients are able to locate and access appropriate care, • telehealth to streamline patient and provider communication and enable continuous remote monitoring, and • smart diagnostics and digital therapeutics for data-led, evidence-based clinical decisions and actions. The result: Patients and providers are complementing in-person face-to-face interactions with virtual delivery to increase access and take better-informed decisions about health and care. The increasing trend of delivering several aspects of health and care virtually presents a clear opportunity for policymakers globally to act now and reap the benefits of digitization to achieve health and care equity and access for all. The Broadband Commission’s 2021 Working Group on Virtual Health and Care encourages inclusive policymaking that puts the individual at the center of care delivery and planning. The Working Group’s report examines virtual health and care in context of the COVID-19 pandemic: the trends, forecasts, key role of policy in influencing adoption, challenges, and ways of overcoming them. Through a comprehensive analysis of global developments, the report charts a roadmap for countries to integrate virtual delivery in their national health and care systems. It recommends policies as well as key stakeholder actions to ensure virtual health and care solutions increase equitable access and outcomes for those facing the greatest barriers to obtaining services, resulting in improved health and care equity and faster achievement of universal health coverage. Executive Summary 10 Executive Summary Virtual delivery of health and care has gained importance since COVID-19 began Virtual engagement has become common practice today in several walks of life, especially in health and care. Noticeable growth in several public as well as private sector virtual health solutions – which integrate medical, social, and environmental factors to enable holistic well-being – has empowered individuals and societies to efficiently manage health issues. For instance: France: COVIDTracker, a data visualization tool for public health decision-making, gained more than 700,000 users within a span of six months ending January 2021.1 India: Aarogya Setu, a contact tracing app, had 190 million downloads within a year, making it one of the most-downloaded COVID-19 tracing apps in the world as of June 2021.2 China: Health Code, a color-code based tracking system for monitoring access to places, was used in more than 300 cities covering over 900 million people starting February 2020.3 Similarly, virtual care – which focuses heavily on remotely managing medical conditions – has seen impressive growth around the world. For instance: 150+ countries: Ada Health, an algorithm-enabled, clinical literature-driven symptom checker, had 6 million users join in 2020, compared to 5 million in the previous eight years.4, 5 Germany: Hello Better, a digital therapeutic for stress, exhaustion, insomnia, and depression, had more users in the first quarter of 2021 than in 2015–2019 combined.6 Indonesia: HaloDoc, a teleconsultation platform, saw a 101% gain in average daily active users between 2019 and March 2020.7 UAE: vHealth, an international telehealth provider, reported a 500% increase in the usage of its app in the UAE between March–September 2020 and the same period in 2021.8 UK: NHS Pathways, a triage and clinical decision support system, saw a surge of 1 million weekly appointments being attended to by general practitioners between 2020 and 2021.9 This increase in the use of virtual health and care during the early phases of the COVID-19 pandemic was in part driven by national actions to stop the virus’ transmission through physical distancing measures. In its 2021 Global Pulse Survey, the World Health Organization reports that more than 50% of the 95 surveyed countries used telemedicine or home-based care to overcome essential service disruptions and recover quality services.10 As the world begins to reopen, a hybrid mode of life has become the norm. Virtual and inperson events are complementing each other in several walks of life. Thus, it is not surprising that the new levels of virtual health and care use are several times higher than what they were prior to the COVID-19 pandemic. Executive Summary 11 Although the increase and higher levels of use of virtual health and care are encouraging, services are not reaching all in an equitable way. Several forms of digital divides exist: Gender: Women and men have different levels of adoption of the internet and digital technologies. A 2019 global estimate shows this gender gap – only 48% of women use the internet as compared to 55% of men globally.13 Age: Older people are less likely to use digital tools and the internet. A 2021 survey of adults in the USA shows that 25% of people older than 65 years do not use the internet, the highest among all adult age groups.14 Location: Rural areas have less communication connectivity as compared to urban regions. 2020 data from India shows that rural internet access is roughly half that in urban localities.15 Income: Low-income groups have lower internet access and speeds than high-income groups. 2021 data from Colombia shows a positive correlation between income levels and internet connectivity. High-income groups have almost 1.5 times better access and 4 times faster speeds than low-income groups.16 Figure 1. The recent levels of use of virtual health and care are noticeably higher than pre-COVID-19 levels Oct-19 ~5% Currently (New baseline) Telehealth claims as a % of total health claims ~25x higher baseline Jan-20 Apr-20 Jul-20 Oct-20 Jan-21 Apr-21 Jul-21 Oct-21 Jan-22 7% 5.4% 0.2% PreCOVID 0.4% USA patient zero 7.5% First stay-athome order 13% Open-up guidelines USA: The proportion of telehealth claims out of total health claims peaked at 13% (April 2020) and have lately stabilized at ~5%. Doctor-to-patient consul- tations on eSanjeevani (Monthly, in M) Active COVID-19 cases in India (M) Oct-20 Dec-20 Feb-21 Apr-21 Jun-21 Aug-21 Oct-21 Dec-21 Febr-22 0.4 M 0.2 M 0.10 0.20 0.50 0.40 ~4x higher baseline India: Steady rise and stabilization of teleconsultations in India administered through the eSanjeevani platform launched during the COVID-19 pandemic. The percentage of telehealth claims out of total health claims in the USA were around 25 times higher in January 2022 compared to the pre-COVID-19 situation in October 2019.11 The numbers of synchronous teleconsultations on India’s national teleconsultation and e-outpatient service eSanjeevani were roughly 4 times higher in February 2022 than in October 2020.1

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