Curatio International Fooundation, Tbilisi, Georgia
School of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia.
BMJ Glob Health. 2024 Oct 1;9(10):e015589. doi: 10.1136/bmjgh-2024-015589.
Enhancing digital health governance is critical to healthcare systems in low-income and middle-income countries. However, implementing governance-enhancing reforms in these countries is often challenging due to the multiplicity of external players and insufficient operational guidance that is accessible. Using data from desktop research, in-depth interviews, focus group discussions and three stakeholder workshops, this paper aims to provide insights into Georgia's experience in advancing digital health governance reforms. It reveals how Georgia has progressed on this path by unpacking the general term 'governance' into operational domains, where stakeholders and involved institutions could easily relate their institutional and personal roles and responsibilities with the specific function needed for digital health. Based on this work, the country delineated institutional responsibilities and passed the necessary regulations to establish better governance arrangements for digital health. The Georgia experience provides practical insights into the challenges faced and solutions found for advancing digital health governance in a middle-income country setting. The paper highlights the usefulness of operational definitions for the digital health governance domains that helped (a) increase awareness among stakeholders about the identified domains and their meaning, (b) discuss possible governance and institutional arrangements relevant to a country context, and (c) design the digital health governance architecture that the government decreed. Finally, the paper offers a broad description of domains in which the governance arrangements could be considered and used for other settings where relevant. The paper points to the need for a comprehensive taxonomy for governance domains to better guide digital health governance enhancements in low-middle-income country settings.
加强数字卫生治理对于低收入和中等收入国家的卫生系统至关重要。然而，由于外部参与者的多样性和缺乏可获取的充足操作指导，这些国家实施治理增强改革通常具有挑战性。本文通过桌面研究、深入访谈、焦点小组讨论和三次利益攸关方研讨会提供了有关格鲁吉亚在推进数字卫生治理改革方面的经验。它通过将“治理”这一术语分解为操作领域，揭示了格鲁吉亚在这条道路上的进展，利益攸关方和相关机构可以轻松地将其机构和个人角色与数字卫生所需的特定功能联系起来。基于这项工作，该国明确了机构责任，并通过必要的法规，为数字卫生建立了更好的治理安排。格鲁吉亚的经验为推进中等收入国家数字卫生治理所面临的挑战和找到的解决方案提供了实际的见解。本文强调了针对数字卫生治理领域的操作定义的有用性，这些定义有助于：(a) 提高利益攸关方对已确定领域及其含义的认识；(b) 讨论与国家背景相关的可能的治理和机构安排；(c) 设计政府颁布的数字卫生治理架构。最后，本文对可以考虑并在相关情况下用于其他环境的治理领域进行了广泛描述。本文指出，需要有一个全面的治理领域分类法，以更好地指导中低收入国家数字卫生治理的增强。
