Bridging the digital divide in health: "from trade to telemedicine, from education to environmental protection, we have in our hands, on our desktops, and in the skies above, the ability to improve standards of living for millions upon millions of people. ... ".

• Author: Dzenowagis, Joan

With these words, in an opening address to the World Summit on the Information Society in 2003, former United Nations Secretary-General Kofi Annan captured the promise of information and communication technology. Building on the Millennium Development Goals (MDGs), this compelling vision opened the door to new commitment, new investment and, most of all, to creativity and the drive to push the boundaries of technology far beyond anything ever dreamed. Today, it is thanks to those pioneers determined lo experiment with new technologies in new settings--often a challenging and risky enterprise--that many can take for granted the benefits that ICT brings to health. For too many others, that promise is still unfulfilled.

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A fundamental change in the years since the MDGs were agreed upon is the appreciation of the role that ICT can play in meeting health targets. It was not so long ago that health decision makers were questioning the utility of adopting ICT in health services and systems--that is, "e-health"---particularly in developing countries. At that time, e-health projects were few in number, disconnected, small, and costly. They were driven not by countries, but by funders. 'Their planning and implementation usually relied on technical assistance provided by aid agencies and the international private sector, as there was little local expertise to draw on. The aim of these initiatives was most often technology proof-of-concept or exploration of new markets, rather than strengthening local health care processes. Not surprisingly, decision makers remained unconvinced of the value of ICT for health as projects distracted staff from regular duties, applications and infrastructure were unsuitable and unreliable, and in the end there was no definitive way to measure the impact on health outcomes.

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Nor was there a consensus on priorities for investment. Some may remember the energetic debate as to whether development aid should be spent on computers or vaccines^--a debate that goes on to this day. Particularly in the poorest countries, where daily survival is the goal for a large part of the population, it can be hard to justify any expenditure beyond meeting basic human needs. The debate was also fueled in part by high-profile initiatives that, while breaking new ground, were nonetheless unsustainable and therefore used as examples of the failure of technology in these settings. However, even in richer...