The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting

Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT’s stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries. Author summary While functional health information systems are central to effective and efficient service delivery, many low- and middle-income countries lack the information communication technology infrastructure required for the digital collection and exchange of health data. This issue is particularly relevant to Small Island Developing States where geography, small population sizes, reliance on extra-national expertise, and supply-chain limitations are barriers to digital health adoption. This paper explores the impact installation of very small aperture terminal (VSAT) technology at health facilities across the remote South Pacific Island nation of Tuvalu has had on the delivery of primary health care and on efforts to achieve universal health coverage. We found that VSAT has enabled regular peer-to-peer communication between health workers on outlying islands and the county’s only hospital enhancing clinical decision-making and reducing the number of domestic and overseas medical referrals required. It has also led to increased formal and informal staff supervision and training opportunities and aided networking with colleagues overseas. We found that successful adoption of new technology requires systems to be reliable and convenient for end-users. We suggest simple solutions harnessing ubiquitous technology (such as smartphones coupled with commercial communication apps, such as Zoom) may be more readily adopted by healthcare workers than dedicated platforms. While the introduction of VSAT in Tuvalu has overcome some long-standing challenges, stakeholders stressed that technology is not a panacea for all the problems they face