The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions (¹1. G20 Brasil 2024: building a just world and a sustainable planet [Internet]. Brasilia: G20; 2024 [cited 2024 Apr 9]. Available from: https://www.g20.org/en
https://www.g20.org/en... ). As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (²2. WHO Secretariat. Global Initiative on Digital Health [Internet]. Geneva: World Health Organization; 2024 [cited 2024 Apr 9]. Available from: https://www.who.int/initiatives/gidh
https://www.who.int/initiatives/gidh... ), aligned with the Pan American Health Organization´s (PAHO) eight guiding principles for the digital transformation of the health sector (³3. Pan American Health Organization. Eight guiding principles of digital transformation of the health sector: a call to Pan American action. Washington, D.C.: PAHO; 2021 [cited 2024 Apr 9]. Available from: https://iris.paho.org/handle/10665.2/54256
https://iris.paho.org/handle/10665.2/542... ), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understanding that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services.

In envisioning the future of global health, the fourth pillar of the vision of PAHO’s Director emerges with critical importance: the construction of resilient national health systems is firmly rooted in the implementation of the PHC strategy. This vision is not just an aspiration but a necessary evolution, with PAHO standing ready to guide countries towards achieving this goal. PAHO’s commitment involves supporting countries in the organization of health services networks based on PHC, targeting public financing to foster universal access and coverage, and bolstering governance in health under the leadership of health ministries. Moreover, it calls for the rapid deployment of technological innovations such as telehealth and also broader digital transformation initiatives (⁴4. Silva Jr JB. Dr. Jarbas Barbosa’s vision [Internet]. Washington, D.C.: Pan American Health Organization; 2024 [cited 2024 Apr 9]. Available from: https://www.paho.org/en/dr-jarbas-barbosas-vision
https://www.paho.org/en/dr-jarbas-barbos... ). Digital transformation, emerging as a key innovative strategy, offers significant improvements to the strengthening of PHC. Through the adoption of inclusive digital health solutions, it is possible to enhance the delivery of health services, ensuring they become more accessible, efficient and equitable for everyone, everywhere (⁵5. Pan American Health Organization. Inclusive digital health: eight guiding principles for the digital transformation of the health sector. Digital transformation toolbox. Washington, D.C.: PAHO; 2023 [cited 2024 Apr 14]. Available from: https://iris.paho.org/handle/10665.2/58409
https://iris.paho.org/handle/10665.2/584... , ⁶6. Pan American Health Organization. Digital public goods: eight guiding principles for the digital transformation of the health sector. Digital transformation toolbox. Washington, D.C.: PAHO; 2023 [cited 2024 Apr 14]. Available from: https://iris.paho.org/handle/10665.2/58406
https://iris.paho.org/handle/10665.2/584... ). Among the priorities leading this transformation, telehealth emerged at the G20 as a key opportunity in the mission to leave no one behind and as a cornerstone of the digital transformation of the health sector. Telehealth improves access to care and health information, thereby empowering individuals and communities (⁷7. da Silva JB, Espinal M, Garcia-Saiso S, Fitzgerald J, Marti M, Bascolo E, et al. A digital transformation for primary health care. Bull World Health Organ. 2024 Jan 1;102(1):2-2A. doi: https://doi.org/10.2471/BLT.23.290726.
https://doi.org/10.2471/BLT.23.290726... ). It effectively extends health services to underserved populations, encourages collaborative practices among health professionals, and broadens access to health for the wider community. It can support reduced waiting times and costs through efficiencies in care management. Through telehealth, the transition to a new era of PHC can be accelerated through technological advancements that drive us towards a more inclusive and accessible health care system for all.

Concrete efforts should be focused on modernizing normative and legislative frameworks, investment in digital infrastructure, prioritizing the development of robust digital health infrastructures while ensuring that reliable internet access and digital tools are available across urban and rural areas alike. Enhancing digital literacy and telehealth competencies among health professionals and the population will maximize the utilization and effectiveness of digital health services. However, the lack of standardized policies and frameworks for telehealth is a significant barrier to its global adoption and, therefore, G20 nations can lead by example, working towards (a) developing international telehealth guidelines that consider ethical, privacy and security standards for telehealth services to facilitate cross-border healthcare delivery and secure data exchange; and (b) promoting interoperable telehealth platforms that can seamlessly exchange information, thus enhancing the continuity and quality of care.

The G20’s leadership and commitment to integrating telehealth into the global health agenda can set an unprecedented opportunity for international cooperation in digital health. G20 countries can significantly impact global health outcomes by integrating telehealth at all levels of care and health service delivery networks, impacting the lives of billions around the world. Equity must remain central to our efforts as telehealth services are integrated into the model of care. This means ensuring the adoption of differentiated approaches in digital health based on (a) the characteristics of a territory (geographical dispersion, status of infrastructure), (b) the beneficiary population to be served (their health needs, and cultural, racial and ethnic considerations) and (c) the health system capacities and organization (the health services network, coverage capacity and availability of multiprofessional teams). Health outcomes can be significantly positively impacted by undertaking bottom-up planning processes that take into account the latter considerations and by adapting the model of care to leverage the capacity of digital health.

Embracing the Regional Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas is imperative for countries aiming to develop expansive, resilient and inclusive health systems based on PHC (⁸8. Saisó SG, Marti MC, Medina FM, Pascha VM, Nelson J, Tejerina L, et al. La transformación digital para una salud pública más equitativa y sostenible en la era de la interdependencia digital [Digital transformation for more equitable and sustainable public health in the age of digital interdependence]. Rev Panam Salud Publica. 2022;46:e1. doi: https://doi.org/10.26633/RPSP.2022.1. Spanish.
https://doi.org/10.26633/RPSP.2022.1... ,⁹9. Pan American Health Organization. CD59/6: Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas. 73rd session of the Regional Committee of WHO for the Americas. Washington, D.C.: PAHO; 2021 [cited 2024 Apr 9]. Available from: https://www.paho.org/en/documents/cd596-roadmap-digital-transformation-health-sector-region-americas
https://www.paho.org/en/documents/cd596-... ). This comprehensive framework, backed by lessons learned and successful experiences, underscores the significant potential that digital transformation holds for improving health outcomes. Brazil's commitment to the consolidation of the Unified Health System (the Sistema Único de Saúde, or SUS) and its well-established Family Health Strategy as the foundation for the health and well-being of its population is being expressed through the rapid deployment of telehealth, and serves as a model of innovation and effectiveness, showcasing the transformative impact of digital health solutions on accessibility, efficiency and quality of care (¹⁰10. Belber GS, Vasconcelos RO, Agreli HLF, Haddad AE, Peduzzi M, Leonello VM. Telehealth use in primary healthcare collaborative interprofessional practice: protocol for a scoping review. BMJ Open. 2023;13(3):e069163.). This editorial, jointly prepared by representatives of the government of Brazil and PAHO advocates for global standardization of telehealth practices that ensures the scalability and sustainability of health interventions while addressing the core determinants of health equity.

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