COVID-19 has pulled back the curtain on health system fragility to expose persistent and deepening inequities worldwide. The limited capacity of low- and lower-middle income countries (LMICs) to respond to the pandemic and its impact on the health of populations – particularly the most vulnerable – presents a marked challenge. In this context, countries face the enormous task of rethinking the way essential services will be delivered. A critical and essential part of solving these challenges will be using information and communication technology and digital health to enhance direct communication with the public; scale proven and innovative service delivery models; and empower the frontlines. However, if the deployment, adaptation, or expansion of these innovations are not user-centered for the most marginalized or do not learn from past lessons, it could be highly wasteful at best. At worst, such shortcomings could exacerbate pre-existing weaknesses in the health care system such as exclusion of peripheral populations, disempowerment of health workers, and proliferation of unregulated private providers. We provide recommendations of which innovations should be prioritized and implementation principles to address the current challenges while responding to the need to fundamentally change service delivery for accelerated impact.

中文翻译：

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低收入和中等收入国家应对 COVID-19 的数字健康：机遇与挑战

COVID-19 拉开了卫生系统脆弱性的帷幕，暴露了世界范围内持续和加深的不平等现象。低收入和中低收入国家 (LMIC) 应对这一流行病及其对人群健康的影响（尤其是最脆弱人群）的能力有限，这是一个显着的挑战。在这种情况下，各国面临着重新思考基本服务提供方式的艰巨任务。解决这些挑战的关键和必要部分将是使用信息和通信技术以及数字医疗来加强与公众的直接沟通；扩展经过验证的创新服务交付模型；并赋能前线。然而，如果这些创新的部署、改编或扩展不是以用户为中心的最边缘化群体，或者没有吸取过去的教训，它充其量可能是非常浪费的。在最坏的情况下，这些缺陷可能会加剧医疗保健系统中先前存在的弱点，例如边缘人群的排斥、卫生工作者的权力被剥夺以及不受监管的私人提供者的激增。我们提供了应优先考虑哪些创新的建议和实施原则，以应对当前的挑战，同时响应从根本上改变服务提供以加速影响的需要。