Executive summary
Improving population health is an essential goal of public policy. Health systems must improve the overall health of every person, ensure its equitable distribution and guarantee financial protection in healthcare. Strengthening health systems is, and must be, a strategic priority to achieve these objectives. In this context, Information and Communication Technologies (ICT) are a key tool to enhance efficiency in health services, optimise available resources and improve both the access to and the quality of medical care.
Digital transformation in the healthcare sector
For this to happen it is necessary to foster a digital transformation in the sector –a deep technological, cultural and organisational shift that leads to more effective and efficient health systems–. Advancing this process requires enabling environments and the participation of key stakeholders, as well as strategic planning, governance structures and context-specific analyses to support implementation.
The use of ICT, particularly in the health sector, accelerated significantly during the COVID-19 pandemic. In Latin America and the Caribbean those years saw major progress in the digitisation of processes. Also, regulatory frameworks for telemedicine were strengthened in some countries and the use of digital health services reached unprecedented levels. These developments provided valuable experience and evidence that health systems’ digital transformation can help build resilient systems and contribute to achieving universal health coverage.
However, the process also revealed systemic gaps in the region, such as unequal access to technology, concerns about data security and insufficient regulatory frameworks.
A study to reimagine Latin American health systems in the digital era
The primary goal of the Reimagining Latin American Health Systems in the Digital Era study was to generate evidence on the barriers and enabling factors to implementing public policies for the digital transformation of the health sector in four countries: Uruguay, Argentina, Chile and Mexico.
The case studies and their analysis were conducted knowing that the selected countries share some common elements but also exhibit important differences in their political systems and economies. For instance, while all four countries can be considered full democracies, Chile and Uruguay have centralised political systems, whereas Mexico and Argentina are federal states. Economically, Uruguay and Chile are classified as high-income countries, while Argentina and Mexico are considered middle-income countries. These and other factors influenced the design and implementation of the analysed public policies and strategies.
The study was carried out with the conviction that digital transformation can significantly advance the health sector’s goals achieving them more quickly, efficiently and with greater impact. At the same time, it acknowledged the limited information available on how to guide this transformation through public policy in ways that strengthen health systems.
Moreover, the study did not begin with a fixed policy definition of the digital transformation. Instead, it sought to select cases that incorporated aspects and factors that could be considered part of such a policy. This flexible approach helped clarify the key characteristics of digital transformation, offering insights that may provide valuable guidance for future research projects.
Qualitative methodology with a participatory approach
The research was conducted using a qualitative method with a participatory approach. This involved the creation of a regional network of subject-matter experts. The network co-created four case studiesto identify enablers and barriers in the implementation of public policies. After selecting the cases, each country team conducted semi-structured interviews guided by the following research questions, which were adapted to each country’s context:
- How were the public policy implementation processes developed and executed?
- How did technical, political, cultural, organisational and financial factors influence the implementation of public policies?
- What enablers and barriers emerged during the implementation of these public policies?
The information obtained from the interview process was analysed using an implementation analysis framework. Such a framework considers: the objectives of the public policies; financial, technical, cultural, organisational and political factors; the characteristics of the implementing teams; implementation strategies; and approaches for managing key stakeholders.
Research focus: the ‘how’ of public policy implementation
The focus of our study was on the implementation processes of public policies. This emphasis stems from the recognition that, even when a policy is well designed, various factors during its implementation can either facilitate or hinder its execution. It is important to note that the project does not aim to evaluate the policies themselves or quantify their impact. Instead, it focuses on examining the processes, actors, structures and contextual factors that shape implementation, including any deviations from the original policy intent.
In each country, case selection was guided by the identification of experiences whose characteristics, scope, strategies and implementation processes could provide valuable insights into both lessons learned and challenges faced.
Rather than comparing the design or implementation of the selected cases, the study aimed to offer a broad perspective to identify key factors that influence the implementation of public policies in the health sector.
Specifically, four public policy experiences and strategies targeting the digital transformation of the health sector were analysed:
| Country | Public policy / Strategy |
| Uruguay | Mi Historia Clínica Digital (My Digital Health Record) |
| Argentina | Estrategia Nacional de Salud Digital (National Digital Health Strategy) |
| Chile | Sistema de Información de la Red Asistencial (SIDRA, Assistance Network Information System) |
| Mexico | Sistema de Información Básica en Salud (SINBA, Basic Health Information System) |
The case study analysis facilitated the identification of lessons learned for each country. Additionally, it enabled the examination of public policy implementation for digital transformation across different contexts and approaches, including centralised versus decentralised strategies, bottom-up versus top-down implementation and reliance on national funds versus international financial resources to sustain the process. Together, these factors provided a broader perspective for a comprehensive analysis.
Among the main recommendations, the following stand out:
1. Essential elements:
- Objectives must be clear and address a specific health problem: there must be a clear understanding of the specific health issue that the digital transformation policy aims to address –it is not about digitising for the sake of digitising–. To this end, objectives should always be aligned with multisectoral national digital transformation processes and focus on improving population health. From this perspective, digital and technological solutions serve as tools to achieve broader health goals, such as more efficient and faster systems with greater coverage and higher quality of services.
- Implementation team: public policy implementation for digital transformation requires teams with well-defined roles, legitimacy to perform their work, flexibility, diverse profiles and the ability to communicate the usefulness and benefits of the policy to various stakeholders.
- Conduct diagnostics on the digital transformation maturity status at the subnational level: to develop implementation strategies that respond to local contexts, digital transformation policies must be based on a clear understanding of the current state of digital transformation at both the national and subnational levels.
2. Decision points for the team –or person– responsible for implementation to consider:
- Implementation strategies: the way policies are implemented can vary depending on the context and needs. In some cases, implementation may follow a top-down approach, while in others it is better –or sometimes the only option– to proceed through negotiation and consensus-building processes. Although these strategies should have a clear structure, they must also maintain flexibility.
- Engaging key stakeholders: Identifying and involving key actors in the implementation process can provide multiple benefits and foster a diverse, multidisciplinary perspective. However, this must always be done without compromising the policy’s objectives. Identifying allied individuals or ‘champions’ within the implementation process is often an effective strategy to ensure the policy permeates health service practices.
- Differentiated benefits: in public policy implementation there will always be groups and individuals who benefit –either directly or indirectly– and others who are ‘left out’. Having clear objectives helps guide decision-making and ensures that the groups targeted by the strategies receive benefits. At the same time, technological solutions must be capable of addressing the needs of different actors, which may not always occur simultaneously.
- Decisions on tools and products: digital transformation is a paradigm shift that must go beyond mere ‘digitisation’. Decisions should be made with the goal of driving changes in processes, governance structures, workforce training and alignment with health system objectives.
3. Enablers:
- Progress and achievements must be showcased at all stages: to ensure the sustainability of implementation over time, it is important to identify and communicate achievements and benefits in strategic spaces to key stakeholders. Additionally, it is essential to always maintain clarity on who is benefiting from the public policy and how it must be maintained.
- Governance structures: public policies for the digital transformation of health systems must be supported by structures and regulations that clearly define levels of responsibility and ownership of processes. This ensures proper implementation and establishes monitoring, evaluation and accountability mechanisms.
- Flexibility for digital transformation: digital transformation is inherently uncertain. Public policies must remain flexible and be capable of adapting to dynamic processes and contexts without losing sight of their core objectives and the populations they aim to benefit.
Based on the case analysis and findings, we have gained a deeper understanding of both the potential and the ‘hows’ of implementing public policies for the digital transformation of health systems. We trust that these findings, presented as public policy recommendations, will be useful in guiding the implementation of more efficient and sustainable strategies that contribute to achieving universal health coverage.
Image: Latin America as seen from space on planet Earth. Photo: inkoly / Getty Images.
