Digitalization of Human Development Services in Europe and Central Asia Ahmet Levent Yener, Jamexis Denise Christian, Samuel Jacques Chicheportiche, Subhashini Rajasekaran, Parviz Ahmadov and Lucia Solbes Castro Acknowledgements © 2024 International Bank for This human capital review has been prepared by a World Bank team led Reconstruction and Development / by Ahmet Levent Yener and Jamexis Denise Christian, composed of Samuel The World Bank Jacques Chicheportiche, Subhashini Rajasekaran, Parviz Ahmadov, and Lucia Solbes Castro with substantial inputs, contributions, and feedback from 1818 H Street NW, Washington, DC 20433 Indhira Santos, Himmat Singh Sandhu, Kexin Wang, Melis Güven, Renata Telephone: 202-473-1000 Mayer Gukovas, and Charles Hurpy. Richard Crabbe provided editorial ser- Internet: www.worldbank.org vices. Some rights reserved. 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Abbreviations AI Artificial Intelligence CAPI Computer-Assisted Personal Interviewing COVID Coronavirus Disease DPI Digital Public Infrastructure ECA Europe and Central Asia EMIS Education Management Information Systems EU European Union FBB Fixed Broadband GB Gigabyte GNI Growth National Income GPS Global Positioning System G20 Group of Twenty HD Human Development ICT Information and Communication Technology ID Identity ITU International Telecommunication Union LAC Latin America and the Caribbean LTE Long Term Evolution MB Megabyte MBB Mobile Broadband MBPS Megabyte per second MENA Middle East and North Africa OECD Organization for Economic Co-operation and Development PIN Personal Identification Number UNESCO UN Educational, Scientific and Cultural Organization WIMAX Worldwide Interoperability for Microwave Access Regional Classification used in this Report Central Asia Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan, Uzbekistan Central Belarus, Moldova, Ukraine Europe Russia South Armenia, Azerbaijan, Georgia Caucasus Türkiye Western Albania, Bosnia and Herzegovina, Kosovo, Montenegro, Republic of Balkans North Macedonia, Serbia iii Contents Acknowledgements i Abbreviations iii Executive Summary 1 1. Introduction 4 2. Digitalization of Human Development Services 7 2.1 Digital Foundations 7 2.2 Digital Enablers 12 2.2.1 Strategy Development 12 2.2.2 Interoperable and Safe Data Platforms 14 2.2.3 Digital skills 22 2.3 Services at scale 26 3. Key Takeaways and Ways Forward 33 4. References 36 Annex 1. Background Reports and Case Studies 44 Annex 2. Digital Education Readiness Assessments 45 Annex 3. Building Blocks of Digital Health Ecosystem 47 iv List of Figures: Figure 1: Critical Success Factors for Digitalization of Human Development services 7 Figure 2: Individuals using the internet, by gender in 2022 8 Figure 3: Active MBB subscriptions are higher than FBB in ECA 9 Figure 4: ECA is well covered by 3G and 4G network 9 Figure 5: Median Number of Connected Data Centers (per million population) in 2022 9 Figure 6: ID and digital ID availability in ECA countries 15 Figure 7: Digital payments in ECA (%), 2021 15 Figure 8: Estonian Education Information System 16 Figure 9: ITU Global Cybersecurity Index Score (0-100) 20 Figure 10: Percentage of people in ECA mastering two basic digital skills 23 Figure 11: Gender imbalance in IT services, 2021 23 Figure 12: Percentage of STEM graduates in ECA and EU 24 Figure 13: Online Service Index score compared to overall UN-E Government 27 Development Index and rank Figure 14: Moldova Digital Government Architecture. Source: E-Governance Agency 28 of Moldova Figure 15: A sample how a DHP interacts with external applications and users 29 List of Boxes: Box 1: National digital identity system in education sector in Singapore 15 Box 2: Enterprise architecture in Estonia 18 Box 3: Türkiye’s Digital Health Interoperability 19 Box 4: Data Security and Cybersecurity in Estonia 21 Box 5: Putting digital skills at the top of the political agenda in Kazakhstan 24 Box 6: Ukraine’s Electronic Social Protection System 32 v ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Executive Summary This report, “Digitalization of Human Development Ser- In the health sector, digital health applications are cru- vices in Europe and Central Asia,” provides a summary cial for advancing universal health coverage (UHC), of the current state and strategic approach for the digi- enhancing patient experiences, improving clinical care tal transformation of Human Development (HD) services quality, and supporting performance-based payment in the Europe and Central Asia (ECA) region. The report systems. Digital health tools optimize the management was prepared primarily based on a secondary literature of noncommunicable diseases (NCDs), elevate public review and synthesis of World Bank internal documents awareness, promote early intervention, and improve and reports, supplemented by academic publications health planning, resource allocation, and public health and data from international organizations. It mainly surveillance. Telehealth services overcome geograph- draws on three sector-specific reports that accompany ical barriers, making healthcare more accessible and this report and other supporting background documents continuous. presented in Annex 1. Consequently, the findings reflect the state of digitalization as per the available data at the For SPL services, digital platforms streamline applica- time of preparation, while acknowledging the potential tions for social programs, facilitate electronic payments, gaps and biases inherent in relying on secondary data. and enable performance monitoring via dashboards. Digital tools and artificial intelligence improve the tar- Under each subsection, the report presents sector-spe- geting of cash transfers and the efficiency of social cific discussions, enabling stakeholders to focus on the programs. During crises, digital databases and data HD sectors pertinent to their interests. The digitalization exchange significantly expand service reach. of HD services, encompassing education, health, and social protection and labor (SPL), promises significant Tackling the multifaceted challenges in digital access, enhancements in service delivery effectiveness, effi- usage, innovation, skills, and trust requires innovative ciency, and quality. This report illustrates how digital thinking, comprehensive assessment, and coordinated technologies can revolutionize these services, improv- action from various government agencies.1 The digi- ing human development outcomes across the ECA tal transformation of public services, while promising region. At the same time, it clarifies that for these gains enhanced quality, responsiveness, and engagement, to be realized without leaving anyone behind, it is criti- also poses significant risks if not carefully managed. Vul- cal to be explicit about the risks of exclusion that come nerable groups may be excluded due to a lack of digital with digitalization and the need to devise and imple- skills, and digital platforms can exacerbate inequalities. ment remedial measures. Data privacy and security concerns are prevalent, with potential breaches in education, healthcare, and social Digital technology makes it easier for HD benefits protection programs. Extensive digital exposure can and services to be adaptive as they can speed up harm mental health and cognitive development, par- and improve the accuracy of a response in the face ticularly among students and young children. Moreover, of a shock. In the education sector, digital transforma- merely digitizing inefficient processes without redesign- tion involves redesigning operational, organizational, ing workflows can entrench existing inefficiencies. and cultural aspects of the education ecosystem. This requires integrating digital technology and data into The report identifies several critical success factors daily operations and managing the resultant changes for the effective digitalization of HD services in ECA. effectively. Digital transitions in education focus on Achieving large-scale digitalization, characterized by enhancing learning outcomes, promoting inclusion, fos- improved access to higher-quality and human-centered tering innovation, ensuring cost-effectiveness and effi- HD services, requires establishing “digital foundations,” ciency, and maintaining privacy and security. Enhanced followed by “digital enablers.” digital access can improve equitable access to quality education, strengthens teaching effectiveness, and bol- Digital foundations for all sectors rest on high-speed sters the resilience of education systems. internet access and modern data hosting capacity. Reli- World Bank, 2021. 1 1 ◄ Table of Contents Executive Summary able internet connectivity ensures seamless access to efforts and to leverage collective strengths in tech- digital platforms, while advanced data hosting capabili- nology adoption and adaptation. Supportive policy ties support the processing and storage of vast amounts frameworks fostering innovation, interoperability, data of data. Digital enablers are a series of interdepend- privacy, security, and ethical standards are essential. ent gears that should be considered as an integrated These should facilitate collaboration between gov- system. ernment agencies, private sector entities, civil society, and international organizations. Enhanced data shar- Governance and strategic development play vital roles ing capabilities between agencies can improve the in digital transformation. A clear national digital strategy, coordination of services for individuals and families, supported by robust policy frameworks and cross-sec- ensuring that social workers have a comprehensive tor collaboration, is crucial for success. Interoperable understanding of the challenges and resources avail- and Safe Data Platforms focus on deploying interoper- able to their clients. Moldova’s integration of digital able Digital Public Infrastructure (DPI), including digital platforms like MCloud and MPass exemplifies effec- identity, digital payments, and data sharing. They also tive digital governance, enhancing service efficiency involve developing cross-cutting enablers and the safe- and accessibility. Digital case management tools can guards necessary for the collection, management, and enhance the workflow of social workers by provid- utilization of interoperable data, in addition to building ing mobile access to case files and data while in the robust cybersecurity institutions and capacities within field, leading to better-informed decisions and faster regulatory frameworks. Effective DPI fosters innovation, response times. These tools also facilitate the integra- builds trust, and ensures secure and seamless service tion of healthcare, nutrition, and early learning inter- delivery. Regulatory frameworks designed to ensure ventions through unified platforms. For example, dig- data protection and manage cybersecurity challenges itized health and immunization records can be linked are essential to building a trusting environment and mit- with early childhood education enrollment systems, igate risks. This is particularly critical in HD sectors that promoting timely interventions and comprehensive manage sensitive personal information, connect multi- care. Türkiye’s approach to automatically registering ple databases, and cover children. Developing digital newborns demonstrates a clear synergy between the skills and literacy among the workforce and the popu- social protection and education sectors. This seam- lation is also vital for the adoption and effective use of less data sharing across sectors not only boosts effi- digital technologies. ciency but also ensures that benefits are targeted and delivered more effectively. Citizens in ECA, as in many other regions, have high expectations for better public services. This prompts • Strategic Investments in Digital Infrastructure. To the modernization of the public sector through digital leverage digital technologies for human develop- technologies, aiming to enhance service quality, respon- ment, substantial investments in digital infrastructure siveness, and engagement with citizens while reducing are crucial. This includes reliable, high-speed internet costs and improving government trust and transpar- and modern data hosting capacities. Although ECA ency. Digital transformation is crucial for increasing ser- countries benefit from good mobile broadband cov- vice productivity, reducing labor intensity, and fostering erage, the high cost of mobile phones and subscrip- citizen engagement. The shift involves moving from tions necessitate the development of competition in basic digitization of back-office functions to compre- the telecommunications market and to this end, revis- hensive digital government initiatives focused on user- ing regulatory frameworks can help to reduce these driven services and policy outcomes. Governments are costs. The need for robust digital foundations, like encouraged to integrate digital technologies and user high-speed internet access and modern data hosting, preferences into public services and policymaking to are universally necessary for the digital transforma- tackle complex challenges, achieve efficiency, and tion of health, education, and social protection ser- maintain public trust. vices. This shared requirement can foster collabora- tion in building and investing in these critical digital The report outlines several key takeaways for moving infrastructures. forward: • Enhancing Security and Building Trust: As digital • Policy Frameworks and Cross-sector Collaboration. technologies integrate into human development ser- A common theme across the sectors is the necessity vices, enhancing security and building trust are vital. for cohesive national digital strategies supported by Investments in advanced cybersecurity measures, robust policy frameworks. These strategies must facil- comprehensive data protection laws, and transpar- itate cross-sector collaboration to avoid duplication of ent practices are necessary to safeguard user data. 2 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Establishing dedicated cybersecurity agencies and health tools tailored for women, and providing ICT fostering public trust through clear communication skills training to women and girls, can empower them about data use and protection is essential. Countries to fully engage in the digital economy and society. in ECA may benefit from the experiences of Estonia to further strengthen their cybersecurity posture. This • Leveraging Emerging Technologies: Emerging tech- includes protecting citizens’ personal information and nologies like AI, big data analytics, and blockchain sensitive government data by creating cybersecurity offer opportunities to enhance service delivery in centers, implementing training programs for citizens, various sectors. Effectively leveraging these technol- and enforcing strict data protection regulations. ogies requires investment in technical infrastructure and workforce training, as well as implementing regu- • Capacity Building and Digital Literacy: Digital trans- latory mechanisms to mitigate negative impacts such formation requires capacity building and enhancing as increased monopolies, privacy risks, inequality, digital literacy across society. Comprehensive edu- and safety issues. Countries in the ECA region should cational and training programs are needed to equip closely follow the initiatives of member countries of the people with digital skills. Countries like North Mac- Organisation for Economic Co-operation and Devel- edonia, Serbia, and Kazakhstan have achieved high opment (OECD ) regarding the responsible develop- digital literacy through targeted educational poli- ment and adoption of AI technologies. For instance, cies. Innovative platforms, such as Armenia’s TUMO the Global Partnership on Artificial Intelligence (GPAI) Center and Azerbaijan’s information and communi- aims to advocate for principles of responsible stew- cation technology (ICT) integration strategy, are cru- ardship and global coordination of national policies cial for fostering continuous learning. The challenge and international cooperation for trustworthy AI. of improving digital literacy is also shared among the workforce in education, health, and social protec- • Sustainability and Environmental Considerations: tion, reflecting a commonality that transcends sec- The digital transformation of services must consider toral boundaries. This calls for unified strategies to sustainability and environmental impacts. Digital enhance digital competencies that can support the infrastructure consumes significant energy, making it digital transformation needs of all sectors. Digital plat- imperative to enhance energy efficiency and transi- forms can also support career transitions by providing tion to renewable energy sources. Cloud computing skills assessments, training modules, and job match- and promoting shared services can reduce energy ing services that consider current market demands. consumption and redundant infrastructure. Using dig- This can be particularly beneficial in regions undergo- ital platforms to promote sustainable practices, such ing economic shifts or post-crisis recovery. as waste reduction and energy-saving techniques, and integrating them into educational curricula and • Addressing Societal Challenges and Ensuring public health campaigns is essential for sustainabil- Equity: Digitalization must ensure equitable access ity. Estonia’s national Digital Agenda for 2030 aims to technology and services. Tailored digital platforms to achieve the greenest digital government in the can provide disadvantaged individuals with easier world. Estonia’s experience in reducing redundant access to social services, healthcare, and community infrastructure and energy consumption through opti- engagement activities, helping to reduce isolation mizing resource use and employing advanced cool- and promote a more inclusive society. For example, ing technologies, which lower the energy needed for digital tools can collect and analyze data on urban data center operations, is strongly recommended as accessibility for people with disabilities, influencing a model for other ECA countries. the planning of more inclusive public spaces and ser- vices. Establishing grievance redress mechanisms The report emphasizes that a successful digital trans- through technology is crucial to offer a platform for formation in the ECA region requires strategic, inclu- beneficiaries and the general public to express their sive, and comprehensive efforts. By integrating tech- opinions and enhance accountability. Initiatives like nology into society, ECA countries can enhance human Ukraine’s DIIA platform demonstrate how digital tools development, equity, and sustainability. Learning from can enhance government responsiveness and inclu- regional successes and global best practices will help sivity. Addressing the digital divide involves providing build resilient, inclusive, and sustainable digital eco- infrastructure and ensuring vulnerable populations systems for current and future generations. However, have the tools and training to benefit from digital it is important to remember that digitalization acts as a advancements. Additionally, digital platforms focus- facilitative tool for broader HD objectives. Digitalization ing on women’s health and empowerment can further should be seen as a means to enhance the achieve- promote equality. Developing and distributing digital ment of HD goals, rather than as a goal in itself. 3 ◄ Table of Contents 1. Introduction 1. Introduction Digital Human Development (HD) services represent a ity, interoperability, and interactivity.3 The digital health comprehensive, interdisciplinary domain that merges ecosystem has the potential to deliver a personalized information technology (IT) with HD service delivery. and integrated experience to patients, enhance health- This integration facilitates the digital transformation of care providers’ productivity, engage formal and informal HD services, encompassing infrastructure, tools, regu- caregivers, and improve outcomes and affordability.4 lations, and implementation methods. Although digital In many countries, technology now plays a large and HD sectors vary, the main components of digital HD growing role in SPL service delivery through new uses systems include: (i) identification systems that assign of data and through the transformation of business pro- unique identifiers for beneficiary verification; (ii) man- cess with novel technological devices and platforms.5 agement information systems (MIS) for data collection, These are just some of the potential gains, but con- processing, and management; (iii) communication plat- stantly evolving technological change promises signif- forms for interacting with users via SMS, email, and icant further transformations. social media; (iv) data analytics and reporting tools to analyze collected data, enhance decision-making, and Digitalization of HD services offers numerous predict trends; (v) mobile applications that provide direct advantages access to information, document submission, and com- munication with service providers via smart devices; (vi) Digital transformation of the education sector refers interoperability frameworks that facilitate data sharing to the redesign of the education ecosystem, including across different government agencies and programs the operational, organizational, and cultural aspects. for a unified approach; and (vii) cybersecurity measures It requires integrating digital technology and data to safeguard sensitive data and ensure the privacy and into daily life and effectively managing the resulting security of user information. changes they bring about. As education races forward to keep pace with accelerating digital transformations, Each HD sector exhibits specific complementary it is critical to lead digital transitions in education with components. In education, digital systems are supple- an unwavering focus on impact on learning, inclusion, mented with digital content, Learning Management Sys- innovation, cost effectiveness and efficiency, and pri- tems, teacher training, assessment tools, and collabora- vacy and security. tive platforms. The digital health sector may encompass mobile health (mHealth) apps, electronic health records Countries in ECA that leverage digital solutions can (EHRs), electronic medical records (EMRs), wearable develop equitable, fit-for-purpose, and resilient edu- technology, telehealth, telemedicine, and personalized cation systems, positively impacting learning out- medicine approaches. Similarly, digital SPL systems comes. This requires that the solutions are designed include integrated beneficiary databases, electronic with both learning principles and digital development payment systems, and case management tools. principles in mind, such as inclusion, scalability, and sus- tainability.6 Digitalization enhances equitable access to Digital technologies hold the potential to revolution- quality education, improving learning outcomes through ize service delivery in HD,2 enhancing the effective- comprehensive learning opportunities. It boosts teach- ness, efficiency, and quality of services. This is the ing effectiveness, cost efficiency, and system resilience. case around the world, and also in ECA where the Research highlights that contextualized technology sig- legacy of existing systems from the predigital era pose nificantly improves learning outcomes across diverse particular challenges and opportunities for digitaliza- levels. Personalized computer-assisted learning, such tion. Digital technologies play a transversal role in edu- as adaptive platforms, proves more effective than cation and skills development by offering an array of merely providing hardware.7 Digital interventions pro- affordances, such as transparency, customer-centricity, mote self-led learning and provide significant benefits adaptability, customizability, replicability, programmabil- to low-income and rural students.8 2 In this report, Human Development encompasses the sectors of education, health, and social protection. 4 3 Rajasekaran et al., 2024. 4 Singhal and Carlton, 2019. 5 Lindert et al., 2020. 6 Kucirkova et al., 2023. 7 Escueta et al., 2017. 8 Bernard et al., 2018; Rodriguez-Segura, 2020. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Digitalization of health services presents several tan- mobile and different web-based applications. It can also gible benefits. By reducing healthcare delivery costs facilitate the work done by staff of social programs in through minimizing the necessity for face-to-face con- outreach through digital tools, undertaking quicker sultations and extensive physical infrastructure, digital assessments using technology and data from different health interventions make healthcare more afforda- administrative data sources, providing benefits through ble. These technologies enhance the quality of care electronic payments, and monitoring program perfor- provided by granting healthcare professionals access mance through dashboards. Digital tools are increas- to contemporary information and sophisticated deci- ingly being used to improve the efficiency of social sion-support tools, leading to superior health outcomes. programs, for example, through the interoperability of Furthermore, the deployment of mobile applications administrative data sources and artificial intelligence to and online patient portals facilitates a continuum of improve the targeting of cash transfers. Similarly, in the care that extends well beyond the walls of healthcare context of employment services, digitalization provides facilities, ensuring sustained patient engagement and ample opportunities to improve the quality and timeli- management. Telehealth services transcend geograph- ness of labor market information and its accessibility for ical limitations, extending their reach to encompass a critical actors such as workers, students, employers and broader demographic, including remote and tradition- policymakers. Moreover, it can increase the efficiency ally underserved communities. Additionally, the inte- and the quality of labor market matching. For example, gration of digital supply chain management systems in Ukraine, an ongoing pilot is testing the use of artificial ensures the timely availability of essential medical com- intelligence to identify critical skills in jobseekers and modities and equipment. Digital education platforms in match them to a wider set of job opportunities those healthcare and remote mentoring systems are instru- identified through more traditional approaches. mental in enhancing the skills of healthcare workers, alleviating resource shortages, and fostering a more Digitalization may also facilitate service expansion in equitable distribution of qualified personnel. The uti- certain time periods, notably in strengthening access lization of virtual visits and digital scheduling systems during times of crisis. Cross-country analysis from the acts as a conduit, eliminating physical and geographic COVID-19 response suggests that where governments barriers to healthcare access. Also, comprehensive dig- relied on digital databases and data exchange to iden- ital health records and patient tracking systems signifi- tify the population, their emergency social protection cantly improve accountability and the efficacy of patient programming reached on average 51 percent of their follow-up procedures. Thus, the digitalization of health population, while countries that had to undertake new services is a multifaceted advancement that not only data collection to identify participants typically reached makes healthcare more affordable and accessible but only 16 percent of the population.9 also enhances its quality and continuity. The deployment of digital solutions in HD service Given the escalating prevalence of NCDs in ECA, the delivery faces several challenges integration of digital health tools and applications is timely and critical. They present opportunities to These challenges include substantial initial capi- optimize screening and diagnosis for NCDs, integrate tal expenditures, and unsustainable funding. The and educate non-traditional health players – digital assumed cost savings of digital approaches are often apps focused on wellness, fitness, nutrition, community challenged by hidden expenses that can surpass the health workers, and technology companies developing benefits. These include significant costs related to sup- health-related applications or devices – into the health- porting users with digital platforms, such as training, care system. Digitalization also spurs health-seeking troubleshooting, and providing technical assistance.10 In behavior, particularly for chronic conditions that are the long run, the sustainability challenges may increase often asymptomatic, by elevating public awareness as digitalized systems will require continuous invest- about symptoms and early intervention benefits. Real- ments for improvement. The rush towards technologi- time data collection and analysis afforded by digital cal solutions and the lack of thorough long-term plan- tools lead to more efficient health planning, better ning can compromise the sustainability of digital social resource allocation, and improved public health surveil- protection systems, which includes a global shortage of lance and research. skilled digital service professionals, exacerbated in low- er-income countries by salary disparities.11 If effective Digitalization of SPL benefits and services can bring collaboration cannot be established between the human multiple gains related to access, efficiency and qual- development and ICT sectors, it may lead to uncoor- ity. Digital platforms can make it easier for individuals to dinated digital projects, resulting in fragmentation, apply for social programs and receive benefits through unnecessary duplication, and the creation of data silos. 9 World Bank, 2022a. 5 10 Wright, 2021. Barca and Chirchir, 2019. 11 ◄ Table of Contents 1. Introduction Across all sectors, the challenges related to digitali- works, creating gaps in oversight and challenges zation underscore the critical need for improved dig- related to data protection and privacy, again high- ital literacy. In-depth training for both staff and users is lighting the need for effective data protection. Social essential for proficiently navigating new technologies. protection programs involve collecting and storing This challenge is intensified in scenarios where direct sensitive personal information, which can be sus- interaction is limited or when there is increased demand ceptible to breaches and identity fraud. for services. It highlights the importance of adaptability and continuous learning in the digital age. • Extensive Exposure to Digital Tools: Extensive exposure to digital media can lead to harmful con- The digital transitions also create risks that need to tent encounters and cyber threats, raising concerns be managed early on about cognitive and emotional well-being. Students face risks like hateful material, scams, and misinfor- Unless carefully designed and implemented with inclu- mation, impacting their safety and mental health. sive intentions and robust mitigating measures, digitali- High social media use is linked to reduced reading zation may inadvertently cause more harm than good in skills, shorter attention spans, and susceptibility to the provision of HD services. fake news. It can also diminish working memory, cause psychological issues, and affect sleep pat- • Exclusion of Vulnerable Groups: Those with no terns. Intensive use correlates with lower happi- digital skills or other barriers to accessing technol- ness, especially among girls, and can lead to poorer ogy may be excluded, despite potentially benefiting memory, increased impulsivity, and anxiety. Early the most from improved services. Service providers screen use in preschoolers affects language devel- and platform entities wield significant influence, yet opment, and cyberbullying can cause severe mental their pursuit of user engagement may exacerbate health issues.13 exclusionary practices and widen the digital gap. For example, in education, while artificial intelligence • Digitalizing Suboptimal Processes: Digitaliza- (AI) holds promise, its deployment can engender tion can make structural reforms more difficult by disparities, discrimination, and biases, challenging embedding existing inefficiencies into new digital institutional autonomy and educators’ professional systems. For example, in healthcare, if providers discretion. Digitalization in healthcare exposes a simply digitize existing inefficient paper records digital divide, worsening disparities in access and without rethinking workflow and data integration, outcomes. This divide is even more significant for the result can be fragmented systems that do not beneficiaries of social programs, such as margin- communicate effectively, leading to continued alized groups or the elderly, who lack digital skills administrative burdens and potential risks to patient and face greater barriers to accessing technologies. safety. In the social protection sector, the lack of inte- These vulnerable groups are often missed during gration between different systems may exacerbate data collection processes, complicating the formu- delays and exclusion of eligible beneficiaries. There- lation and design of relevant policies. Digitalization fore it is critical to reengineer and optimize current may negatively affect service user outcomes; for processes to align with SPL objectives and broader instance, the shift to remote social care support digital transformation goals to avoid merely digitiz- instead of in-person visits reduces social workers’ ing existing inefficiencies. Instead, emphasis should ability to detect potential changes and needs in a be placed on streamlining and enhancing processes service user’s situation or home surroundings.12 prior to initiating digitization efforts. • Data Privacy, Protection, and Online Security: Challenges in education include breaches of data privacy, online safety concerns, cyber threats, and the commercialization of educational endeavors. The healthcare sector faces vulnerabilities in its supply chain, particularly when reliant on external providers like cloud services, which may lead to data breaches. The rise in remote work has also increased the vulnerability to security breaches, underscoring the necessity for effective data protec- tion strategies. Rapid technological advancements can outpace existing legal and regulatory frame- Eurofound, 2020. 12 6 Zhu et al., 2021. 13 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia 2. Digitalization of Human Development Services The pathway for digital transition in a country depends transforming economic and social activities by increas- on important digital and nondigital contextual precon- ing reach, improving efficiency, and strengthening value ditions. International best practices demonstrate that propositions, which is built on digital foundations and various contextual conditions need to be in place for enablers to unlock opportunities for digitalizing high-im- individuals, communities, and societies to realize the pact HD services. potential benefits of incorporating digital solutions to improve human development outcomes. The state of readiness of these contextual conditions has predictive 2.1 Digital Foundations power, especially during periods of heightened uncer- tainty. Assessing the digital maturity level is important Digital foundations for all sectors rest on high-speed to helping governments and organizations determine a internet access and modern data hosting capacity. system’s state and capabilities in effectively managing The first brick of the digital foundation is the availabil- and guiding digital transformation efforts.14 ity of dependable, high-speed fiber-optic internet for individuals, organizations, and businesses. For maxi- To successfully digitalize HD sectors, several prereq- mum effectiveness, internet accessibility must be uni- uisites must be met. Annexes 2 and 3 provide exam- versal, spanning both urban and rural regions, offering ples of existing tools to assess the readiness and key high-quality connections devoid of network disruptions building blocks needed for the successful digitalization and delivering rapid speeds essential for utilizing digital of education and health services, respectively. Achiev- platforms and services. Another crucial element in this ing large-scale digitalization, characterized by improved digital framework is the modernization of data hosting access to higher-quality and human-centered HD ser- capabilities. Scaling digital services in sectors such as vices, requires establishing “digital foundations” fol- Edtech, Healthtech, and GovTech necessitates the col- lowed by “digital enablers” – see Figure 1. High-Impact lection and processing of vast amounts of personal data, digital services focus on fundamentally or incrementally often reliant on modern Cloud computing for storage. Figure 1: Critical Success Factors for Digitalization of Human Development services 3 Services at scale Enablers Strategy • Strategy Development: Strategic leadership and governance for citizen-centered Development service delivery Interoperable and safe • Interoperable and Safe Data Platforms: Interoperable Digital Public Infrastructure Data platforms and regulatory frameworks for cybersecurity Digital Skills and human capacity • Digital Skills: from basic digital literacy to high-level digital skills 2 Digital foundations Modern data hosting capacity • Modern data hosting capacity: Data centers and Cloud infrastructure Broadband access • Broadband access: Reliable, powerful and a ordable last mile connectivity (fixed and mobile broadband) 1 Source: World Bank. Cullinan et al., 2021. 14 7 ◄ Table of Contents 2. Digitalization of Human Development Services Figure 2: Individuals using the internet, by gender in 2022 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ia n on tio us a e a a vo a e ia n ia an ic an an an in ov i i n iy ja bl an rb en rg a ar ov d so st ist ist ist ai er rk ai pu ce d Se eo lb kr rm eg l kh rb Ko Be Tu jik en ek ol a d A Re U rz fe G za M ze A Ta zb m M He an Ka A th rk yz U d i or Tu ss an rg Ru Ky N ia sn Bo Female Male Source: ITU, (No disintegrated data were available for Moldova, Kyrgyz Republic, Tajikistan and Turkmenistan). Regarding digital foundations, internet use in ECA is the cost amounts to approximately 168 percent of the almost universal. The share of people using the inter- average monthly income.22 net in ECA has increased steadily over the past few years, by 25 million from 2019 to 2022. In 2022, 84 per- Compared to mobile phones, computer ownership is cent of the population in ECA used the internet, which not universal and especially scarce in rural areas in is higher than the Latin America and Caribbean (LAC) ECA region. Almost two thirds of households in urban region (77 percent) and the Middle East and North Africa areas possess at least one computer (approximately 67 (MENA) region (73 percent),15 but still below the level of percent) with Serbia and Kazakhstan (respectively 82 the EU (91.5 percent)16 and high-income countries (92 percent and 84 percent in 2022) near EU levels (86 per- percent).17 While most ECA countries have now reached cent in 2017).23 Urban-rural gaps are particularly high in universal internet use (90 percent), Turkmenistan, Tajik- Ukraine, Moldova, and Georgia. Central Asian countries, istan, and Moldova especially have significant room for including Uzbekistan and the Kyrgyz Republic (respec- improvement, with respective usage rates of 21 percent, tively 43 percent and 10 percent) stand out for their low 36 percent, and 61 percent.18 Internet use is also pretty computer ownership rates. inclusive, with a slight gap between women and men or across age groups. Except in Armenia and Belarus, men Mobile broadband subscription is high in ECA where use the internet more than women – see Figure 2. The the mobile network coverage is better than in other gender difference in internet usage in the ECA region regions. Except for six countries – Albania, Bosnia Her- is small, with men being 2.47 percentage points more zegovina, North Macedonia, Azerbaijan, Tajikistan, and likely than women to be using the internet. However, Turkmenistan – more than 80 percent of the population when compared to the EU in 2020, this gap is slightly in ECA subscribed to a mobile broadband (MBB) plan larger. In the EU, the gender gap was smaller (1 percent- (Figure 3).24 In contrast, the highest level of fixed broad- age point).19 The gap deepens when it comes to digital band (FBB) subscription barely reaches 41 percent in competencies and especially high-level digital skills, as the Kyrgyz Republic. Mobile network coverage is rela- discussed below in the section on digital skills. tively high in ECA. 90 percent of the population is cov- ered by 3G and more than 80 percent of the population In terms of usage, the population of ECA has wide- is covered by 4G Long-Term Evolution (LTE) networks spread access to the internet via mobile phones, (Figure 4). However, the region is lagging in terms of although the costs are high in most countries. In 2022, 5G network roll-out with only three percent of the pop- the mobile cellular subscription rate in ECA reached 117 ulation enjoying coverage. In North Macedonia and percent. This is much higher than the proportion of ECA Belarus for instance, 5G recently entered in commercial households, mostly located in urban areas, that possess deployment. While 4G LTE technologies provide speed a computer—67 percent of households in urban areas.20 ranging from 5 to 100 Mbps, 5G provides up to 1 Gbps However, smartphone prices are high in ECA, close to and enables the connection of multiple devices using high-income country levels,21 and represent approxi- ultrafast internet at the same time. The LAC and EAP mately 18 percent of monthly Gross National Income regions are ahead of ECA in terms of 5G coverage with (GNI). In some countries, the cost of mobile phones can 17 percent and 61 percent, respectively. reach extremely high levels, like in Azerbaijan, where 15 World Bank, 2024a, Digital Progress and Trends report 2023. mobile phone subscription. 8 16 Eurostat, 2023. 21 World Bank, 2024, Digital Progress and Trends report. 17 World Bank, 2024a. 22 ITU, A4AI, 2022. 18 ITU Datahub. 23 Eurostat, 2017, Households located in cities, Annual, Households having access to, via 19 Statista, internet usage per gender in EU 27, 2020. one of its members, a computer, Percentage of households. 20 World Bank, 2024a; ITU Datahub. 117% means that some people may have more than one 24 ITU, Datahub. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Figure 3: Active MBB subscriptions are higher than FBB in ECA 180% 50% 160% 45% 140% 40% 120% 35% 100% 30% 25% 80% 20% 60% 15% 40% 10% 20% 5% 0% 0% an an s va ne ia na vo ia ia n e ia n a n ic an ru gi iy tio ja ta bl an on rb en do ist ist vi so ist ai rk ai or la s pu Se ra go lb kr rm ed kh rb Ko Be Tu jik en ek ol Ge de A Re U ze za M ac ze A Ta zb m fe Ka er A M rk yz U H n Tu rg th ia d Ky or ss an N Ru ia sn Bo Active MBB subscriptions Active FBB subscription (Right axis) Source: ITU. Figure 4: ECA is well covered by 3G and 4G networks 100% 99.8% 90% 80% 70% 60% 50% 40% 30% 20% 12% 10% 5% 0% a in s va ia vo ia ia n e ia n a an ic an an v ru gi iy tio ja bl an on rb en go do so st ist ist rk ai or la pu Se ra lb rm ed kh ze rb Ko Be Tu jik ek ol Ge de A Re er za M ac ze A Ta zb fe Ka A H M yz U d n rg th an ia Ky or ss ia N Ru sn Bo EU average for 4G 3G 4G 5G Source: ITU. The FBB subscription rate in ECA is low and nega- percent of FBB subscription rate in 2021. Generally, FBB tively correlated to prices that are higher than MBB subscriptions are less developed than mobile broad- plans. In 2022, median fixed and mobile broadband band, potentially due to lower infrastructure demand plans were relatively affordable and accounted respec- and flexibility. This situation is particularly massive in tively for 1.9 percent and 0.9 percent of monthly GNI per the landlocked countries of Central Asia (less than 20 capita except for Tajikistan (5 percent), Turkmenistan, percent subscription) that remain far from submarine and Albania (2 percent).25 Despite the affordability of cables. This lack of penetration makes it challenging fixed broadband plans, ECA countries had less than 30 to provide at-scale services, particularly in critical areas such as schools and health centers, as variable latency Figure 5: Median Number of Connected Data Centers and limited bandwidth can cause performance issues. (per million population) in 2022 3.35 Regarding modern data hosting capacity, data centers in the ECA region lag far behind those in high-income countries (Figure 5). ECA countries, and especially landlocked countries in Central Asia, exhibit low levels of high-capacity data storage. In 2021, only five ECA countries – Belarus, Moldova, the Russian Federation, Serbia, Türkiye – had more than five secure internet 0.85 servers per million people.26 Access to seas and oceans 0.39 0.38 provide broader access to international submarine net- 0.14 0.14 0.13 0.13 works, which are integral to modern data hosting as they enable the high-capacity, high-speed data trans- AFE AFW EAP ECA LAC MNA SAR HIC mission required for the global reach and reliability of Source: World Bank, Digital Progress and Trends Report, 2023. cloud services and content delivery. ITU, Datahub. 25 9 26 World Bank, World Development Indicators. ◄ Table of Contents 2. Digitalization of Human Development Services Education Management Information Systems (EMIS). Innovations in real-time data collection tools enhance the moni- The availability and adequacy of the fundamental toring of educational activities and progress, which is building blocks of electricity, telecommunications crucial for informed adjustments.31 Effective dashboard infrastructure including equipment and digital devices, designs can distribute data to diverse groups, such as and meaningful internet connectivity are essential to educators, equipping them with the resources needed form the ICT backbone for education. Once these foun- for enhancements.32 dational infrastructural barriers are overcome, access to high-speed internet in schools, availability of devices for Adequate data hosting capacity and cloud comput- teachers and students, and appropriate software and ing technologies facilitate the real-time application learning platforms are necessary.27 For example, with of administrative and student assessment data, ena- government investments in infrastructure in Denmark, bling dynamic responses to student needs and the over 97 percent of households have internet access.28 enhancement of learning outcomes. Learning man- These investments have allowed Danish schools to agement systems use real-time data collection and successfully integrate digital learning into their curric- analytics to improve decision-making across various ula. Similar government investments in infrastructure learning modalities, including blended, in-person, and have led to high home internet access rates in Türkiye remote learning. For example, the Turkish Education (96% in 2023) and Albania (97% in 2022), according to Management Information System (EMIS) features sev- ITU. In Türkiye, the Ministry of National Education has eral modules for efficient student data management, enhanced digital access for vulnerable students by dis- covering administration, school processes, student tributing nearly 600,000 learning devices with internet information, enrollment, examination, and reporting. packages, partnering with mobile network operators for The enrollment module utilizes data from the Ministry of discounted data, and establishing 150 Education Infor- the Interior to automatically identify out-of-school chil- mation Network mobile centers to support distance dren. Initially including e-Okul for formal education and learning. In Albania, multistakeholder partnerships have e-Yaygin for nonformal education, the EMIS expanded boosted school connectivity. In collaboration with inter- in 2014 to include Syrian students under temporary pro- national organizations, Albania have provided modern tection. This expansion monitors their attendance and facilities, ICT training for teachers, and internet connec- performance, streamlines enrollment for students with- tivity.29 By 2025, Albania aims for 100% of schools to out valid ID numbers, and integrates their information have high-speed broadband connectivity of 1 Gbit/s. with e-Okul for efficient data sharing, supporting pro- grams like conditional cash transfer for education. The evident relationship between population density and internet quality underscores the necessity for The imperative expansion of broadband networks investment in less developed regions to foster equity. plays a pivotal role in fostering educational equity. A In Georgia, for example, an estimated 13 percent of dependable, affordable, and good quality broadband schools, or 295 educational institutions, are believed connection is indispensable for students accessing var- to be grappling with inadequate or nonexistent internet ious online educational resources, including interactive services. This implies that about nine percent of stu- learning platforms, virtual tutoring, and e-books. These dents are deprived of internet access at their educa- resources enrich learning experiences and complement tional establishments.30 In response, Georgia’s National traditional classroom teaching, empowering students to Broadband Network Development Strategy for 2020- delve into subjects beyond their textbooks. Particularly 2025 has mandated that internet access and its speed during crises, as exemplified by the recent COVID-19 be aligned with both EU and Georgia’s 5G development pandemic, the necessity of remote learning becomes plans. imperative. Expanding broadband networks facilitates students’ engagement in virtual classrooms, online Digitalization underpins an education system that lectures, and collaboration with peers and educators empowers students, educators, parents, and admin- through videoconferencing platforms. This ensures the istrators to adopt a data-oriented approach. The uninterrupted continuity of education, irrespective of incorporation of technology, data, and human skills physical barriers. In the contemporary digital era, profi- into the system’s architecture maximizes the impact ciency in technology and digital literacy are imperative of these investments. Technologies like real-time data for preparing students for the future workforce. The collection, cloud storage, and dashboards support the expansion of broadband networks serves as a catalyst adaptive management of education systems, providing in fostering these skills, providing students with essen- vital information to various stakeholders and facilitating tial tools for online research, communication, critical improved data utilization and storage within Education thinking, and problem-solving. 27 OECD, 2015. 10 28 OECD, 2019. 29 UNICEF, 2021a; ITU & UNICEF, 2021. 30 World Bank, 2024c. 31 Gustafsson-Wright et al., 2022. 32 Admin RISE and Pritchett, 2018. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia During the COVID-19 pandemic, Albania and Kosovo enhance care coordination and enable seamless transi- established digital learning platforms to ensure edu- tions between different levels of care. cational continuity, leveraging expanded broadband networks. Albania’s Akademi.al platform which offers Social Protection and Labor over 17,000 video lessons by teachers, including 7,000 from RTSH – Albanian Radio and Television – facilitated Strong networks providing internet coverage empow- 190,000 virtual lessons, benefiting over 462,000 stu- ers service providers to effectively deliver social pro- dents and involving more than 33,000 teachers. The tection and employment services. For example, in platform continues to enhance accessibility by adding Estonia, full coverage of digital mobile phone networks subtitles, voice-overs, and sign language for students was a core prerequisite for the country’s digital transfor- with disabilities, along with virtual classrooms for live mation over the last two decades in the social protec- sessions.33 Similarly, Kosovo developed shkollat.org, tion sector.38 providing teachers and students access to a wide range of educational software and materials through unique Having an internet connection and a cell phone are user profiles. The platform supports easy registration via basic needs that make outreach and awareness cam- email and mobile phone, and offers multilanguage sup- paigns easier, especially in less accessible areas. port. Shkollat.org can accommodate up to 115,000 simul- Internet access through mobile phones and computers, taneous users, serving both formal education students for instance, offers alternative information sources for and those seeking skill development opportunities.34 social protection programs, supports remote commu- nication, and aids in targeted campaign prioritization. Health It also enables data collection and analysis by social services through digital tools such as surveys, sen- Electronic health records (EHRs) can improve effi- sors, Global Positioning System (GPS), and biometric ciency, enhance data collection, improve diagnosis, technologies. These tools enable service providers to and treatment.35 Digitizing patient records eliminates accurately and promptly gather essential data, enabling the need for paper documentation, reduces error the effective monitoring, evaluation, and improvement risks, and facilitates seamless information exchange of services. Internet access extends to social services across healthcare settings. Digital technologies pres- communication, where digital channels facilitate rapid ent unparalleled opportunities to fortify health systems information dissemination by offering convenient by ensuring timely access to accurate information for access to information and targeting specific populations the right individuals.36 Online registration portals and for outreach.39 The COVID-19 pandemic accelerated the mobile applications enable patients to complete regis- use of digital channels for socially distanced communi- tration forms remotely, saving time and improving the cation, with social protection agencies leveraging tech- overall patient experience. Automated data validation nologies like SMS, messaging apps, and social media mechanisms can also help to ensure the accuracy and for outreach.40 Data sources such as satellite imagery completeness of patient information, minimizing data and mobile phone records also assist in identifying pri- entry errors. In addition to streamlining data collection ority areas for targeted campaigns.41 and registration, digitalization can improve the assess- ment of healthcare outcomes and performance metrics. The fundamental architecture of social information Advanced analytics tools and data visualization plat- systems comprises data intake and exchange mecha- forms enable healthcare organizations to analyze large nisms, software applications supporting both front-of- datasets and identify trends, patterns, and areas for fice and back-office functions, database management improvement.37 Real-time dashboards and performance systems and, in some instances, interoperability solu- indicators provide valuable insights into the effective- tions for ICT infrastructure. Governments are increas- ness of healthcare interventions, allowing stakehold- ingly using shared data centers for social protection ers to make informed decisions and allocate resources purposes to achieve economies of scale in the procure- more efficiently. ment, investments, and operations of information sys- tems for multiple programs.42 Moreover, countries are Digital technologies facilitate the integration of data increasingly shifting to cloud technologies for cost-ef- from multiple sources, including wearable devices, fectiveness and flexibility in accessibility. For instance, remote monitoring sensors, and population health after Russia’s invasion of Ukraine, as a preventive meas- surveys. This comprehensive approach to data collec- ure against potential destructions of data centers, the tion enables healthcare providers to gain a holistic view Government of Ukraine created a working copy of the of patients’ health status and tailor interventions to indi- State and Me (DIIA) system and its data in cloud infra- vidual needs. Additionally, interoperable data systems structure.43 While Cloud technologies come with multi- 33 ITU and UNICEF, 2021. 38 OECD, 2019b. 11 34 UNICEF, 2021b. 39 Li et al., 2021. 35 Li et al., 2021. 40 ETF, 2021. 36 Socha-Dietrich, 2020. 41 Aiken and Ohlenburg, 2023. 37 Paul et al, 2023. 42 Karippacherile et al., 2024. 43 World Bank, 2023a. ◄ Table of Contents 2. Digitalization of Human Development Services ple benefits, some governments still prefer to keep data are united in their commitment to leveraging digital ini- centers in their countries to ensure complete control tiatives for socio-economic advancement and digital over data and hardware. inclusion, reflecting the diverse pathways countries can pursue in their digital transformation journeys.44 2.2 Digital Enablers The strategy must acknowledge that digitalizing HD systems does not equate to providing digital services Digital enablers function as a series of interdepend- to all users in all aspects of service delivery. Despite ent gears that drive the development of digital public targeted efforts to enhance digital access and literacy, goods, facilitate data integration, and promote safe some service users may remain unable to utilize digi- and innovative usage. These enablers are categorized tal methods, necessitating the continued availability of under interoperable and secure data platforms, as well manual or in-person alternatives. Additionally, certain as digital skills. To eliminate siloed government sys- aspects of service delivery cannot replace the human tems, establish unified and interoperable frameworks, interaction, support, or discretion provided by person- and scale up digital solutions cost-effectively, it is es- nel. For example, digitalization efforts in employment sential for governments to develop a clear vision and services, even in advanced economies such as Aus- strategy for digitally-enabled HD systems. tria or Sweden, have been calibrated to complement counselors rather than replace them, particularly when 2.2.1 Strategy Development serving more vulnerable populations that need more hands-on support. In advancing digital government, Governments must come up with a clear vision and particularly in digitalizing HD service delivery, technol- strategy for digitally-enabled HD systems. But, it is ogy should serve as a tool to improve service provision, crucial to recognize that the benefits of strategic leader- not as a goal in itself. ship and governance for citizen-centered service deliv- ery depend on meeting certain preconditions, such as Education adequate and sustainable financing and procurement mechanisms. Without fulfilling these preconditions, the There is an evident need for an agile and adaptive potential gains may not be realized. approach for developing national digital strategies and action plans in education. Countries with a strat- Developing national digital strategies for HD sectors egy and plan were more resilient in digital learning is a crucial initial step in identifying, prioritizing, and during the COVID-19 pandemic.45 Countries are increas- addressing gaps and barriers within key digital ena- ingly recognizing that their education strategies need blers. A thorough assessment of the current state of to evolve in a changing digital landscape while being the sector’s digital ecosystem is vital for crafting a long- grounded in the contextual realities. They must be term national strategy. Furthermore, collaboration with cross-cutting as they traverse and penetrate all parts of other sectors across digitalization areas is essential. the education system as well as overlap with other sec- Such collaboration can drive pivotal changes by foster- tors. For example, this could include focusing on health, ing an enabling environment and coordinated actions, employment; being an enabler to the end goal, rather such as consensus-building on policy, improved utiliza- than the end goal itself; and ensuring that they are not tion of shared resources, and enhanced private sector a one-off investment but need adaptive management involvement, along with investments in digital skills and as digital solutions require more skilled support and infrastructure. For instance, the cross-sectoral national maintenance to ensure systems are functioning and digital strategies in Kosovo and Albania underscore the relevant.46 Estonia exemplifies this approach through a pivotal role of digital strategies in shaping each nation’s rigorous process involving conferences and meetings digital evolution. While sharing the overarching goal of with key stakeholders from both the public and private utilizing digital technologies to bolster economic growth sectors to develop its digital strategies in education. and improve citizen services, they diverge in their stra- The country’s Education Strategy 2021-2035 prioritizes tegic emphases. In Kosovo, the Digital Agenda 2030 digital inclusion, fostering digital literacy, and leveraging prioritizes establishing secure digital infrastructure, driv- digital tools to enhance education accessibility and effi- ing business digitization, enhancing public services, fos- ciency. It emphasizes the adoption of digital pedagogy tering digital skills and innovation, and ensuring cyber- to enhance teaching methods and encourages inno- security. Albania’s Digital Agenda 2015-2020 focuses vation driven by digital technologies in education. The on expanding electronic public services, enhancing Digital Agenda 2030 outlines the country’s vision and ICT in education, and upgrading national broadband action plans for harnessing digital technologies across infrastructure. Despite these variations, both agendas various sectors, emphasizing the integration of digital Ministry of Economy, Republic of Kosovo, 2023; Republic of Albania, 2019. 44 12 UNICEF, 2022. 45 46 Coflan et al., 2022. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia skills as a fundamental component of the curriculum at front of the digital health movement is critical for all educational levels in the education sector.47 advancing strategic goals. Their sustained support and advocacy provide the impetus and visibility Government strategies, policies, regulations, and needed to drive the strategy forward. Concurrently, commitment to digitally-enabled education are sig- their commitment to secure and allocate funding not nificant determinants of digital readiness. These help only kickstarts the initiative but ensures its vitality promote the safe, ethical, and equitable use of digital and continuity, addressing both current and future technologies in education.48 Many LICs, LMICs, and financial demands. This dual approach of strong MICs49 face challenges related to collaborative leader- leadership and financial investment is critical to ship, alignment of policy frameworks and action plans maintaining momentum and achieving long-term complemented with adequate financing to support digi- goals. tally-enabled education.50 Addressing these challenges requires identifying champions at different levels of 2. Effective governance mechanisms are the compass government, strengthening institutional capacity, and that guides the digital health strategy, ensuring setting performance standards for critical business pro- that it remains on course and true to its objectives. cesses to establish accountability. Key areas for change By engaging a broad spectrum of stakeholders, the management support must be considered, including strategy benefits from diverse perspectives, gaining regulatory structures beyond the Ministry of Education richness and depth. Such inclusive governance cul- to ensure safety, security, and interlinkages to national tivates a fertile ground for innovative ideas and col- digital infrastructure such as cloud computing, and digi- laborative problem-solving, bolstering the strategy’s tal government services. resilience and adaptability. Ensuring that all voices are heard and considered is key to creating a strat- Health egy that is both comprehensive and dynamic. The development of national health priorities marks 3. A robust national ICT framework acts as the cen- the initial step in healthcare’s digital transformation. tral nervous system of the digital health strat- These priorities, derived from an analysis of a country’s egy, ensuring seamless communication and data principal health challenges and needs, guide policy exchange across different platforms and services. making, strategic planning, and resource allocation, By establishing and upholding standards for inter- focusing on disease prevention, healthcare access, operability, the framework guarantees that digital equity, and service quality. health solutions are not only compatible with one another but also scalable and secure. This future- Once national health priorities are established, the proofs the healthcare system, allowing it to evolve next crucial step is to develop a national digital health with technological advancements while maintaining vision. This vision, while informed by the identified pri- integrity and reliability. orities, sets forth a comprehensive plan that leverages digital technologies to achieve improved health out- These elements represent a recipe for success, pro- comes. A cogent digital health vision provides a strate- viding the structural support necessary to transform gic framework for the development and implementation the envisioned digital health strategy into an opera- of digital health tools and applications, underscoring the tional reality. Together, they form the bedrock of a sus- transformative potential of technology in healthcare. As tainable and effective digital health ecosystem that can a beacon for progress, the vision statement should be withstand the test of time and evolve with technological a rallying call that health sector leaders can advocate advancements. By focusing on leadership and finan- for and propagate, ensuring that it resonates clearly cial commitment, robust governance and stakeholder with stakeholders and paves the way for unified action involvement, and a strong ICT framework, nations can towards a digitally-enabled healthcare system. build a resilient and adaptable digital health infrastruc- ture capable of meeting both current and future health- With a comprehensive digital health strategy in place, care challenges. the subsequent step is to solidify the pillars that will uphold and ensure its success. These pillars deline- Social Protection and Labor ate three crucial elements necessary for the practical implementation and sustainability of the national digital As in other sectors, governance and strategy play a health strategy. crucial role as enablers in the digitalization of SPL ser- vices. Governments need a clear vision and strategy for 1. Having senior government officials at the fore- digitally-enabled SPL systems as the starting point in the 47 OECD, 2023a. 13 48 Resta and Laferrière, 2015. 49 LIC – Low-income country; LMIC – Lower-middle-income country; MIC – Middle-income country. 50 Unwin et al., 2020. ◄ Table of Contents 2. Digitalization of Human Development Services digitalization pathway is the traditional “analog” system, and middle-income countries’ combined GDP to $19.2 historically used for SPL delivery, which often consists trillion, achieving this goal two to three years faster of fragmented paper-based, manual, and in-person than otherwise possible. Its ability to connect sectors mechanisms. SPL agencies typically transition from this also makes it possible to capture spillover effects, ulti- analog system through stages of e-government and mately advancing sustainable development in sectors digital government, eventually creating a consolidated not directly targeted by DPI.53 Countries that had ele- digital system for social protection. ments of DPI in place before the pandemic were more resilient, reaching three times more beneficiaries with Moving into the “digital government” phase requires emergency cash transfers. Countries with good DPI in alignment with broader government digitalization place could also keep government services, commerce, strategies. Ukraine’s experience in digitalizing its core hospitals, schools, and other operations functioning SPL architecture exemplifies the implementation of a through online channels.54 broader government digitalization strategy. Ukraine inherited a large and diverse social protection system Digital Identity and Payments from the former Soviet Union, which relied solely on paper. This required individuals to submit physical appli- Digital identity enables people to securely access ser- cations with numerous supporting documents, often vices and transact over the Internet. Digital identity is necessitating multiple in-person visits. Over the years, a pivotal element in ensuring the safety and security of the Ukrainian government has made significant strides digital transactions. It serves as a digital proof of identity, in digitalizing this system. The transition began with allowing individuals to access online services, conduct moving from an analog setup to an e-government system, electronic transactions, and interact with government digitizing databases and archives, and eventually push- platforms with a higher level of trust. An eID system ing towards a whole-of-government transformation.51 verifies a person’s identity, ensuring that services are delivered to the rightful individual, particularly in sen- 2.2.2 Interoperable and Safe Data sitive areas like banking. The challenge lies in creat- Platforms ing a system that functions seamlessly across borders, agencies, and industries. Credentials to underpin such Interoperable and Safe Data Platforms focus on an “official” digital identity and enable remote authenti- deploying interoperable Digital Public Infrastructure cation can take many forms, including ID (identity) cards (DPI) that provides common core and reusable digital with a chip and mobile IDs containing a cryptographi- building blocks to enhance efficiencies in both public cally protected digital certificate in a secure element, and private sectors. They also develop cross-cutting combined with the use of personal identification num- enablers and safeguards needed for the collection, bers (PINs), passwords, and biometrics to offer multifac- management, and utilization of interoperable data, and tor authentication. build robust cybersecurity institutions and capacities within regulatory frameworks. Despite a lack of government-issued ID in some coun- tries, digital identity is widely adopted in ECA. Most Digital Public Infrastructure ECA countries feature online digital identity systems, with Tajikistan and Turkmenistan as the exceptions DPI encompasses digital identity, digital payments, (Figure 6). It is important to note that while countries and data sharing. While DPI is an evolving concept, the may have adopted digital identities, that does not mean G20 New Delhi Leaders’ Declaration defines it as “a set that everyone within the country has one. In Armenia, of shared digital systems that are secure and interop- for example, a quarter of the population has no digital erable, built on open technologies, to deliver equitable or physical ID; in Tajikistan, it is 15 percent. access to public and/or private services at a societal scale and are governed by applicable legal frameworks Concerning digital payments, ECA is ahead of other and enabling rules to drive development, inclusion, regions, but lags behind high-income countries. innovation, trust, and competition, and also respect for Less than 20 percent of adults made digital merchant human rights and fundamental freedoms.”52 payments in Albania, Armenia, Kyrgyz Republic, and Tajikistan in 202156 (Figure 7). Conversely, digital pay- Good DPI can also foster innovation, build trust ments are widespread in Bulgaria, Kazakhstan, Russia, between people and governments, and create data and Ukraine. In 2021, digital payments made through ownership for citizens. For example, a study by the online shopping were 30 percent less than those made United Nations Development Program (UNDP) and Dal- in high-income countries, and 39 percent less for pay- berg revealed that by 2030, DPI could increase low- ments made through digital merchant payments. 51 Lowe et al., 2023. 14 52 World Economic Forum, 2024. 53 Center for Strategic and International Studies, 2023. 54 World Bank, 2024d. 55 How to read this chart: The blue bar chart refers to the left axis and is showing whether (1) or not (0) a country is issuing online digital identity; the orange dot chart refers to the right axis and shows the percentage of that population not having an ID. 56 World Bank, Findex Database 2021, 2022c. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Figure 6: ID and digital ID availability in ECA Figure 7: Digital payments in ECA (%), 2021 countries55 100% 1 30% 25.4 90% 80% Online digital identity 25% 71 Pop without ID (%) 70% 20% 59 57 14.4 60% 46 49 15% 50% 42 45 45 45 39 38 38 38 40% 33 33 7.7 10% 31 31 30 29 31 6.4 30% 25 4.8 4.9 22 2.1 3.0 3.8 5% 20% 17 1616 15 0.7 0.7 1.0 1.1 1.2 1.3 1.6 12 1011 10% 6 0 0% 1 4 0% Ko iye yz eo o U epu ia ek lic jik an rm n ia Se ria Ka k ia Tu sia M hs e m e ld n N is er a M (2 n ed 7) A nia Tü nia en d ov za rain A ista ta th an tio rg G sov ra an U ion Ka ulg e kh ia an th eg ia ed a Tü nia Ko iye ol o A va rm a rg G nia U pu a ek lic jik n an en R rg rb ac 01 zb b Ta ist a ac in A ani Re rgi B in Ta ista M ov rk o a za ar b zb b lg do or t a d e ssi st ist lb rk M ov o e a or rz e t s yz eo o Bu k lb kr S U Fe Ru F e rk n H Ky d Ky s an Ru N ia sn Bo Online digital identity No ID Shopped online Digital merchant payment Source: World Bank, Digital Progress and Trends Report, 2023. Source: World Bank, Digital Progress and Trends Report, 2023. Education ID ecosystem, including Digi-ID (in the form of a smart A unique digital ID can play a big role in education card), Mobile ID (via a special SIM to be inserted in a systems. Although from outside the ECA region, the smartphone), and Smart ID (an application for smart- use of Singpass, the national digital identity system in phones and tablets that does not require a special SIM), Singapore, can be a useful model as it is utilized for individuals can access an array of services and digitally course registration, reviewing national examination sign documents effortlessly. Embracing this technol- results, managing education fees, and facilitating com- ogy, the education sector has streamlined processes to munication between schools and parents (Box 1). enhance efficiency in learning and teaching, effectively monitor the education system, and provide one consol- Within the ECA region, the integration of digital IDs idated point to access digital learning materials. Digi- in education in Estonia has transformed the learning tal ID holders can easily communicate with students, landscape, leveraging the mandatory national eID teachers, and parents; access basic, general, and voca- card possessed by nearly 1.3 million citizens to estab- tional education learning materials; and access detailed lish a robust digital identification system. With various information about educational institutions, students, forms of identification available in the Estonian Digital teachers, and curricula. Box 1: National digital identity system in education sector in Singapore57 Singapore successfully established and implemented a national digital identity system–Singpass. The system allows users to access various public and private sector services online with the same level of trust as a face-to-face interaction. Singpass relies on the API Exchange (APEX), a digital public infrastructure that allows a seamless, secure, and transparent exchange of data across government agencies. Complementarily, Singaporeans and residents use the MyInfo platform to provide consent to share the data held in government databases. Singpass has been adopted by 4.5 million users (97 percent of eligible users) and facilitated appli- cation processes that otherwise would require physical documents and in-person verification. Singpass has been widely applied in the education sector. Starting in 2021, students applying for the Joint Admissions Exercise – for example, courses in Junior Colleges, Millenia Institute – can use Sing- pass to register for the course choices and view the results. Citizens with Singpass can also view their past national examination results. Post-Secondary Education Account (PSEA) is part of a scheme that helps to pay for post-secondary education. Through Singpass, holders of PSEA can check their balance and withdraw funds to pay education fees. The Ministry of Education rolled out “Parents Gateway,” an ini- tiative to facilitate the interaction between schools and parents with a Singpass on administrative mat- ters, ranging from information on extracurricular classes to changes on the timetable on a given day. 57 Qiang and Chan, 2022. 15 ◄ Table of Contents 2. Digitalization of Human Development Services Health Together, digital identity systems and the MPI create a supportive and dynamic ecosystem that enhances Digital identity is a crucial enabler in digital health sys- the implementation, scalability, and sustainability of tems, ensuring that each individual can be uniquely digital health systems. They ensure that these systems and accurately identified across various platforms and are capable of delivering on their promise to transform services. It involves creating secure, verifiable identities healthcare delivery, improve patient outcomes, and for patients, healthcare providers, and institutions. Digi- facilitate more efficient healthcare management. tal identity systems facilitate seamless access to health records, enable efficient and accurate patient matching, Social Protection and Labor and support the secure sharing of health information. By ensuring that all parties can be reliably identified, The availability and quality of digital public infrastruc- digital identity systems help build trust and integrity ture, including ID systems, government-to-person within digital health ecosystems. payment systems, and platforms for data exchange, are crucial in determining the feasibility and effective- A fundamental component of digital identity in the ness of digital social protection initiatives. Countries health sector is the Master Patient Index (MPI). The like India and Singapore have successfully integrated MPI is a comprehensive database that maintains unique these components of public infrastructure at scale identifiers for patients, ensuring accurate record match- through “digital stacks.” These comprehensive digital ing and integration across different healthcare systems. systems, encompassing digital ID, payments, and data The MPI enables seamless data sharing among differ- exchange, have significantly facilitated the delivery of ek lic jik an rm n ia Ko iye yz eo o U epu ia Se ria Ka k ia Tu sia M hs e m Fe old n N is er a M (2 n ed 7) A nia Tü nia ent healthcare providers, ensuring consistent access to social protection services.58 en d ov za rain A ista ta th an tio rg G sov en R rg rb ac 01 zb b Ta ist a rk o a lg or t a lb Bu k patient information. For example, a prescription from a U specialist is automatically updated in the primary care Unique IDs are essential for building a fully interop- rk n Ky s physician’s records and the pharmacy’s system, facili- erable and integrated social protection management Ru tated by the patient’s unique digital ID. system architecture within digital public infrastructure. Figure 8: Estonian Education Information System e-Schoolbag Source: Centre for Internet and Society, 2019 World Bank, 2024c. 58 16 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Unique identification systems enable single authentica- a set of standards and guidelines to ensure communi- tion of individuals applying to social programs; digital cation between the information systems of central and payments across all sectors, including conditional cash local enterprise architecture in Estonia. transfer programs; and evidence-based monitoring for policy decision. Education Without widespread and inclusive access to ID sys- Interoperability is essential for fostering effective and tems and civil registration, countries face challenges seamless digital learning environments.61 It ensures in rolling out digital registration or data-driven iden- that applications, devices, and equipment can exchange tification of social protection participants, and in and interpret data consistently and accurately through accurately implementing and monitoring benefit established standards. At the heart of achieving such and service delivery. Türkiye is a good example, with interoperability lies a digitally ready regulatory frame- near-universal ID numbers and birth registration data work that supports the development of flexible, sec- being key factors enabling the development of digital tor-specific legislation and regulations. These are social protection information systems.59 Similarly, in crucial to keep pace with the rapid evolution of tech- Armenia, unique identification numbers are assigned at nologies, services, and markets.62 The lack of common birth and used to identify individuals in all sectors. data standards, terminologies, and structures in educa- tion data is a significant barrier to progress, as seen in Digital identification methods, often incorporating Moldova, where education metadata lacks standardiza- biometric data collected at the point of registra- tion and is not fully integrated into all public informa- tion, ensure the uniqueness of each entry, facilitate tional systems. Although there are some fragmented cross-database matching for eligibility verification, efforts, no systematic approach exists to ensure inter- and secure identity authentication for future access. operability between education and other departments, Additionally, technology facilitates various aspects of such as labor. This lack of data standards is likely to the intake, registration, and assessment processes. hinder integration efforts.63 In contrast, the European Tools such as Computer-Assisted Personal Interviewing Commission established CLARIN, an open and distrib- (CAPI) and video tutorials for survey staff simplify the uted digital infrastructure in 2012 that offers an inter- collection of registration data, making it easier whether operable language technology platform for multidisci- in-office or through field visits. Digital methods for reg- plinary research to advance digital linguistics. The EU’s istration and assessment, including immediate online General Data Protection Regulation (GDPR) provides registration and administrator-led verification, are a framework for data governance in digitally-enabled increasingly adopted to improve access to programs education, balancing the need for data to improve and streamline participant assessment learning with the need to protect personal data.64 Simi- larly, the U.S. Department of Education has made signif- Digital payment methods proved useful during the icant strides toward enhancing interoperability with the pandemic, facilitating widespread adoption even introduction of the Ed-Fi Data Standard and Technology in areas with limited formal banking infrastructure. Suite. This initiative provides comprehensive guidelines Countries that had made relevant investments during for the collection, management, and organization of the COVID-19 pandemic were able to respond more rap- educational data, enabling seamless exchanges across idly and more effectively through their social protection different systems. This serves as a model for how data system. They used digital payment methods and had a standardization can support more effective integration higher penetration of ATMs, commercial bank branches and use of educational data. and agents per capita.60 But even where formal bank systems were limited, many countries were able to lev- To leverage the full potential of these interoperable erage mobile money payments if they had advanced systems, governance and robust security measures mobile money agent networks. are imperative. These systems must not only provide timely and actionable insights but also safeguard sen- Interoperability sitive information. Establishing a coherent information system that supports the effectiveness of data pipe- Interoperability standards between applications, lines is vital. This system should align with an educa- devices, and equipment enable consistent and accu- tional enterprise architecture and implementation plan rate information collection and exchange between focused on the core objectives of education and skills systems. Box 2 presents Estonia’s interoperability development, ensuring that all tools and systems are framework that plays a role similar to an enterprise archi- interoperable while protecting user data. tecture. The Estonian IT Interoperability Framework is 59 DCI, 2022. 17 60 World Bank, 2022a. 61 Freitas et al., 2020. 62 ITU, 2019. 63 World Bank, 2023a. 64 General Data Protection Regulation (GDPR) – Official Legal Text. Retrieved March 19, 2024, from https://gdpr-info.eu/. ◄ Table of Contents 2. Digitalization of Human Development Services Box 2: Enterprise architecture in Estonia65 Enterprise Architecture (EA) is the active mechanism response to transformation and has been adopted as a framework for all tiers of the organization to deliver effective IT services and management in Estonia. EA ensures governance and a standard of sharing and integration across the entire enterprise, including busi- ness, data, service, and technology throughout the country. EA provides a holistic view covering IT and non-IT systems, where the IT system is compatible nationwide and supports non-IT (business) in decision-making and centralization. The e-Estonia Council facilitates cooperation among departments, universities, local gov- ernments, banks, and organizations. Meta-Architecture, which serves as the EA framework, is technologically uniform and uses electronic identity for authentication with legal significance across all enterprises, despite having individual information systems. “X-Road” is established as the integration infrastructure for central service portals and public administration, enabling secure Internet-oriented data exchange among digitally maintained state databases and secure peer-to-peer and intra-agency data communication. The Ministry of Economic Affairs and Communications designed the Estonian Interoperability Framework that plays a similar role to EA, applied in the public sector institution and its information system. The Estonian IT Interoperability Framework is a set of standards and guidelines to ensure communication between the infor- mation systems of central and local government agencies, defining interoperability in five dimensions. The political context dimension describes the general context of the organization and information system and links with the surroundings, common visions, priorities, and objectives. The other four dimensions pro- vide overviews of legal regulations, organizational processes, semantic assets, and technical infrastructure, respectively. In line with the Framework, public institutions develop the document of interoperability archi- tecture to founding the information system. Through the developed documents, the Management System of the State Information System (RIHA) manages the coordination and registration procedure of the information system, allowing decentralized public and private databases to be interoperable at a national level. For exam- ple, when the birth of a child is registered on the Estonian State Portal, eesti.ee, the child is automatically registered for benefits and enrolled in school. This is possible only because of the interoperability between the Population Registry, the IT system of the education department, and the IT system of the Social Insurance Board. The Interoperability Framework is not written in the law but regulated by the legal agreements among government agencies, the private sector, third-sector organizations, and private persons who can submit proposals for data access. The Estonian Interoperability Framework aims to ensure that state information systems are citizen-focused and service-based. Estonia applies open standards and open-source-based solutions in information systems to ensure interoperability. The Ministry of Economic Affairs and Communications leads efforts to map out IT-re- lated standard needs of the public sector and promotes the implementation of the standardization, ensuring public sector’s IT infrastructure meets high standards of quality and interoperability, both domestically and internationally. Institutions are required to follow the most recent open standards while communicating with one another or the public, on web sites and in public registers. Over 150 public sector institutions are con- nected to X-road; it is used daily by more than 1,000 organizations and is calculated to save more than 820 years of working time for the state and citizens annually. However, these savings result from only 5 percent of queries done via the X-Road, as it does not consider all the savings that occur because of the automatic machine-to-machine data exchange, which amounts to 95 percent of the queries. In all, the Estonian govern- ment estimates that its digital infrastructure has led to annual savings of about 2 percent of GDP. Health seamless health data exchange without human inter- action, improving care quality, health system manage- Effective digitalization of the health sector requires ment, and resource planning. establishing interoperability among all participants, including healthcare providers, financing institutions, Standardization is essential for data structuring, clini- regulatory authorities, research centers, and others. cal coding, medical terminology, messaging, and soft- System-wide digital health interoperability allows for ware accreditation, ensuring effective communication Mayakul et al, 2019. 65 18 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia and reliable data sharing across platforms. To enable Social Protection and Labor the exchange of health data, several prerequisites must be met: predetermined data types, formats, and codifi- In more developed instances of digital data man- cation, structured lists or registries like provider directo- agement, there’s seamless and regular updating of ries and national drug lists, and standardized methods participants’ social protection records, facilitated by for data sharing, such as messaging and data exchange high levels of interoperability among government protocols. databases. For example, Estonia’s digital Population Register, which covers over 900 organizations with Governments must adopt internationally recognized an integration layer and e-ID system, ensures efficient interoperability standards for effective digital health data updates.66 Enhanced database interoperability and systems. Key measures include establishing user regis- automation are revolutionizing how participant monitor- try standards for identifying users and maintaining a MPI ing is conducted. Now, data necessary for monitoring integrated into the e-government system. Healthcare compliance with conditional cash transfers (CCTs) can provider standards should regulate health facilities, be electronically gathered and communicated to the medical staff, pharmacies, and suppliers, supported by social protection agency.67 Relying on Estonia’s expe- real-time directories of healthcare providers and pro- riences, Ukraine developed a system for implementing fessionals. Healthcare service and product standards data exchange between digital registries of the different involve using unified terminologies for services and state institutions. In Greece, the process for applying for interventions; and developing health services directo- Social Solidarity Income is automated to use preexisting ries, national drug lists, and medical technology directo- data for application completion and intelligent chatbots ries. The process includes adopting standards like Log- in Estonia assist applicants through the application pro- ical Observation Identifiers Names and Codes (LOINC) cess,68 while in Finland and Belgium, AI-based image for laboratory services and the Anatomical Therapeutic recognition technologies are deployed to process Chemical (ATC) classification system for pharmaceuti- application documents, albeit with varying degrees of cals, forming a comprehensive Health Data Dictionary success due to challenges in handling paper forms. (HDD). Common terminologies should be updated to The EU’s Electronic Exchange of Social Security Infor- include classifications like the International Classifica- mation (EESSI) system allows for secure data exchange tion of Diseases (ICD), International Classification of Pri- between social security institutions.69 mary Care (ICPC), and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), with a gradual In Türkiye, the Integrated Social Assistance System introduction of ICD-11. Communication standards must (ISAS) swiftly verifies CCT participants’ compliance be established to secure health data exchange, using by automatically retrieving data from the education standards like Health Level Seven International (HL7) and health ministries, cutting down the compliance and Digital Imaging and Communications in Medicine verification period from months to mere hours.70 Fur- (DICOM) for effective communication among users. thermore, digital channels and innovations are now Implementing these interoperability standards ensures employed in grievance redress mechanisms, allowing seamless data exchange, enhancing care quality, health users to submit complaints or appeals through online system management efficiency, and resource utilization. platforms, email, phone, apps, SMS, and other messag- In Türkiye, the development and adoption of national ing systems. For instance, Türkiye’s toll-free hotline, and international digital health standards have been which addresses inquiries related to any social assis- pivotal in addressing interoperability challenges (Box 3). tance program, receives over a million calls annually. Box 3: Türkiye’s Digital Health Interoperability Through the Health System Strengthening and Support Project, the Turkish government successfully devel- oped and deployed the National Health Information Management System. This system serves as the foun- dation for Turkey’s Personal Health System (eNabız) and its Decision Support System (SINA), both of which are now utilized by 99.6 percent of public, private, and university hospitals across the country. As a result, Türkiye has adopted and/or developed 20 administrative, technical, and clinical standards and guidelines. These include international disease categorization systems such as ICD-10, ICD-O, and LOINC; standardized outpatient records (O-EMRAM); a National Healthcare System Dictionary; a Ministry of Health Data Dictionary; SPICE II (a global standard for software development); and Hardware Procurement Standards. With the adop- tion of these standards, Türkiye has achieved a synchronization rate of 82.5 percent, aligning its healthcare indicators internally and with international benchmarks. 66 World Bank, 2018b. 19 67 Lindert et al., 2020. 68 Lindert et al., 2020. 69 European Commission, 2022. 70 Lindert et al., 2020. ◄ Table of Contents 2. Digitalization of Human Development Services the expansion of large-scale services at an affordable Policies and Regulations cost for the end user.74 Additionally, some countries are adapting their regulatory frameworks to accommo- Regulatory frameworks designed to ensure data pro- date AI. For instance, Serbia has adopted the “Ethical tection and manage cybersecurity challenges are Guidelines for the Development and Use of Reliable essential to build a trusting environment and miti- and Responsible AI.” These guidelines include detailed gate risks. This is particularly critical in HD sectors that questions for AI developers and public servants to manage sensitive personal information, connect multi- answer, serving as a self-assessment tool to ensure ple databases, and cover children. Cybersecurity and responsible development and use of AI systems. Simi- data protection can be effectively managed through the larly, Ukraine has unveiled a roadmap for AI regulation, implementation of a robust regulatory framework, such designed to prepare local companies for the implemen- as a national cybersecurity strategy. Additionally, the tation of legislation akin to the European Union’s AI Act. establishment of specialized institutions like a cyber- security agency, along with the formation of national, Education regional, and local incident response teams, plays a cru- cial role. It is also essential to continually update crim- In the education sector’s digital transition, data pro- inal laws and enhance law enforcement capabilities to tection and privacy are paramount in a digitally-ena- address evolving cyber threats. bled ecosystem. While data-driven learning tools hold promise for improving student outcomes, the effective In ECA, data protection and cybersecurity frameworks use of student data in K-12 schools is still evolving. The are being increasingly adopted. Only Armenia and tension between safeguarding data and facilitating its Uzbekistan do not have a clear regulatory framework sharing for constructive feedback is a dynamic chal- regarding cybersecurity.71 Six ECA countries are ranked lenge that requires ongoing attention and improve- above 90/100 on the ITU Global Cybersecurity Index ment. Significant obstacles, such as risks associated Score (Figure 9). This index measures cybersecurity with data-driven methods and privacy concerns, hinder across five pillars (measures): legal, technical, organiza- widespread adoption of data and analytics in schools, tional, capacity development, and cooperation. Govern- particularly due to limited budgets, especially in public ment efforts to improve cybersecurity can only succeed schools. Using student data raises valid concerns about if they are underpinned by a strong and dynamic ecosys- privacy and unauthorized access, prompting the need tem. Hence, in market-based systems of many national for robust security measures and compliance with data economies, responsibility for cybersecurity falls largely protection frameworks. Addressing these issues can on public and private companies, giving rise to effective enhance the interoperability of educational technol- public-private partnerships.72 Estonia is a good model ogies, thereby enriching the learning experience and for successful data security and cybersecurity (Box 4). educational outcomes. Policy makers need to support education institutions by guiding investment decisions ECA countries are progressively adopting policies in digitally-enabled infrastructure, ensuring adherence and regulations that also encourage the development to security protocols, and promoting interoperability of cutting-edge innovations. Through tailored regula- frameworks to foster compatibility among digital learn- tions that protect the final consumer, the development ing environments.75 of a competitive economic environment can foster Figure 9: ITU Global Cybersecurity Index Score (0-100)73 100 90 80 70 60 50 40 30 20 10 0 s va e ia a ia a n e ia n a an ic an an an ru in i gi n iy tio ja bl an on rb en do st ist ist ist ai ov rk ai or la pu Se ra lb kr rm ed kh rb Be Tu jik en ek ol Ge g de A Re U ze za M ac ze A Ta zb m fe er Ka A M rk yz U H n Tu rg th ia d Ky or an ss N Ru ia sn Bo Source: ITU, Global Cybersecurity Index, 2020. 71 ITU, Cybersecurity framework and mandates. Accessible at link for each country of ECA: maps 82 questions and 20 indicators across five pillars: legal measures, technical measures, 20 https://datahub.itu.int/data/?e=ARM&Connectivity=Universal+access&i=100103. organizational measures, capacity development measures, and cooperation measures. 72 UNCDF, 2022. 74 World Bank, 2017. 73 The Global Cybersecurity Index Score, developed by the International Telecommunication 75 OECD, 2023b. Union (ITU), measures the commitment of 193 ITU Member States to cybersecurity. The index ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Box 4: Data Security and Cybersecurity in Estonia76 Estonia is an internationally recognized leader in data security and cybersecurity with advanced strat- egy. To further strengthen its cybersecurity objective to protect citizens’ personal information and sensitive government data, Estonia implemented a third and comprehensive National Cyber Security Strategy (2019- 2022) in 2018, including the creation of a cybersecurity center, training programs for citizens, and strict data protection regulations such as the General Data Protection Regulation (GDPR). The strategy focuses on four objectives: (i) creating a sustainable digital society; (ii) promoting the cybersecurity industry, research, and development, (iii) positioning the country as a leader in cybersecurity across areas of policy, defense, and technological solutions; and (iv) promoting a cyber-literate society. This strategy also sets out a blueprint for continuing active engagement with the world through cyber exercises and new forms of diplomacy based on Estonia’s experience, and recognizes Estonia’s important role within key global institutions such as the EU and NATO. The government agencies in Estonia coordinated and managed the planning and implementation of cybersecurity strategy systematically. The Cybersecurity Council of the government’s security committee oversees the strategy’s objectives through the responsible government institutions’ planning documents and programs. The council ensures the implementation of the cyber sector policy in different government institu- tions. The Ministry of Economic Affairs and Communications manages the strategy implementation and works with the State Information System Authority (RIA) for technological resilience, incident handling, and research development. The Ministry of Education and Research designs lifelong learning activities in line with the strat- egy’s priorities and supports the acquisition of basic knowledge for graduates at all educational levels to cope with cyber threats. The Information Technology Foundation for Education (HITSA) coordinates the “Staying Smart Online” program and the IT Academy program, which trains cybersecurity specialists in the field. Competence centers, think tanks, universities, research institutions, and private sector partners are also actively involved ensuring the cybersecurity in Estonia. For instance, the E-Governance Academy acts as a consultation and think tank center, promoting the international adoption of Estonia’s digital (including cyber- security) solutions. The TalTech Centre for Digital Forensics and Cybersecurity enhances Estonia’s cyber- security expertise and capability through education and R&D. RIA collaborates with ethical hackers to find potential security vulnerabilities with rewarding. Education infrastructure is undeniably critical infra- pandemic have highlighted significant privacy concerns structure, and in the digital age, the need to prioritize and the necessity for stronger data privacy regulations. cybersecurity has become more apparent than ever. Just as providing physical infrastructure for schools Education institutions are prime targets for cyberat- that is safe, healthy, and supportive for all students is tacks, as they host a wealth of data, including per- a must, it is also essential that digital infrastructure is sonal information and sensitive research, and lack equally safe, accessible, resilient, sustainable, and strong cybersecurity measures. Attacks on educational future proof.77 institutions are growing faster than in any other sector. A recent report found that 60 percent of all education Escalating data privacy breaches have become a sig- institutions globally were targeted by ransomware nificant concern in education sector. These breaches attacks in 2021.79 The attacks were largely successful, are categorized into data shared voluntarily, derived affecting their ability to operate. The report indicated from online activities, and produced by algorithms. The that educational institutions suffered from the highest limited capabilities of parents and teachers to monitor rate of data encryption (73 percent) compared to other and comprehend digital behaviors, compounded by a sectors, paid the highest ransomware amounts, and widespread lack of fundamental digital literacy skills took the longest time to recover their data. Digital ser- and an increase in cyber threats, make educational vice providers have also experienced damaging public institutions particularly vulnerable due to substantial relations fallout from cyberattacks—for example, from data repositories and often insufficient cybersecurity zoom bombing. Since it is almost impossible to protect defenses.78 Furthermore, the commercialization of edu- fully against a cyberattack, having robust and defen- cation and the swift shift to digital platforms during the sible processes in place should help protect against 76 Romaniuk and Manjikian, 2021; Ministry of Economic Affairs and Communication, 2018. 21 77 U.S. Department of Education, 2023. 78 Sophos, 2022. 79 Sophos, 2022. ◄ Table of Contents 2. Digitalization of Human Development Services cyberattacks on critical infrastructure and data systems Additionally, data retention regulations must specify and trigger disaster recovery and business continuity periods, destruction guidelines, and documentation plans in the event of a major incident. processes. Implementing these measures ensures dig- ital health systems operate securely, efficiently, and Limited budgets, particularly in public schools, chal- effectively. lenge prioritizing investment in data-driven tools and technologies. Using student data raises concerns The healthcare sector also faces challenges in han- about privacy, the risk of unauthorized access or sale of dling, analyzing, managing, and monitoring data, personal information to third parties, and the broader with particular emphasis on maintaining data privacy considerations of data collection and usage within and and safeguarding against cyber threats as more dig- outside the school system.80 The Netherlands’ pro- ital technologies are adopted. Healthcare entities are active stance on data privacy with Google Classroom also vulnerable to supply chain risks, especially with showcases the importance of robust regulations to pro- increased reliance on external providers like cloud ser- tect student data. Through rigorous negotiations and vices. The rise in remote work has further increased regulatory leverage, the Dutch government compelled vulnerabilities to security breaches, underscoring the Google to adopt new privacy measures, ensuring com- necessity for effective data protection strategies. More- pliance with European regulations and safeguarding over, digitalization in healthcare has highlighted the students’ privacy rights.81 Concurrently, the European digital divide, with disparities in access and outcomes Parliament’s approval of the Artificial Intelligence Act exacerbated by data privacy and security concerns.83 represents a significant step in AI governance. The Act The fast pace of technological change can outstrip exist- aims to protect fundamental rights and ensure safety ing legal and regulatory frameworks, leading to gaps while fostering innovation. It bans certain AI applica- in oversight, which may result in challenges related to tions, sets obligations for high-risk systems, mandates data protection and privacy. transparency, and supports innovation and SMEs through regulatory sandboxes.82 Social Protection and Labor Health The robustness of legal and regulatory frameworks is crucial for effectively protecting users from the poten- Digital health demands strict adherence to ethical tial harms and risks associated with the digitalization standards, enforcement of data protection laws, infor- of social protection. Globally, the level of development mation security, and legal validation of digital health in data protection regulations and frameworks varies.84 records. Unlike paper-based data, digital health data While the situation in ECA is comparatively better, some are easily generated, used, shared, and prone to hack- laws and regulations were often developed after major ing, necessitating robust privacy, confidentiality, and digitalization projects were undertaken, sometimes security regulations. as a response to violations during the project rollout. In some cases, regulations may exist, but guidance on Effective regulation is crucial for digital health systems their implementation may not keep pace with the rapid to operate, collect, use, and transmit data, aiming to evolution of new technologies being piloted or used standardize electronic data transmission and acceler- in the social protection sector. For example, in the UK, ate healthcare digitalization. A comprehensive Digital social workers have expressed concern about the lack Health Law is vital to provide legal certainty across all of guidance on protecting users’ data when providing system components, emphasizing the need for availa- them with new AI-based home care devices, such as bility, integrity, and confidentiality. Health information Amazon’s Alexa.85 must be accessible, accurate, promptly recorded, and securely managed. Regulations must validate the legal- 2.2.3 Digital skills ity of electronic records for various medical uses and outline the transition from paper-based to digital sys- Digital Skills are important. tems, ensuring that new digital documents are legally recognized. They should also specify individual consent While 84 percent of ECA’s global population was rights, restrict personal health data disclosure to neces- online in 2022,86 basic digital literacy remains under- sary medical use, and define security and accountability developed. In 2022, approximately 38 percent of the measures for data sharing. Authentication protocols are population in ECA was proficient in “using copy and needed to verify information accuracy and user iden- paste tools within a document”(Figure 10).87 Internet tity through electronic signatures and possibly digital usage in the region is primarily for messaging appli- stamps, supplemented by audit logs for traceability. cations and social network participation. However, 80 Chui and Sarakatsannis, 2015. 84 Wagner and Ferro, 2020. 22 81 NYTimes, 2023. https://www.nytimes.com/2023/01/18/technology/dutch-school-priva- 85 Wright, 2021. cy-google-microsoft-zoom.html. 86 World Bank, 2024a. 82 EU, 2024. https://www.europarl.europa.eu/news/en/press-room/20240308IPR19015/arti- 87 ITU, Datahub. Accessible at link for each country of ECA: https://datahub.itu.int/data ficial-intelligence-act-meps-adopt-landmark-law. /?e=ALB&Connectivity=Universal+access&i=100082. No data were available for Armenia, 83 Johnson, 2021. Kyrgyz Republic, Moldova, Tajikistan, and Turkmenistan. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Figure 10: Percentage of people in ECA mastering two basic digital skills 100% 80% 60% 40% 20% 0% us ne ia na vo ia ia n e n ia n n iy tio ja a ta an on rb rg ar vi so st ai rk ai is Se eo ra go lb kr ed el kh rb Ko Tu ek de B A U G ze za ac ze zb fe Ka er A M U H n th a d si or an us N R a ni os B using copy and paste tool within a document sending e-mail with attached files Source: ITU, 2020. the advanced use of ICT, particularly in education and ECA countries stand out with higher rates of STEM health, is on the rise. In 2022, for instance, 67 percent (Science, Technology, Engineering, Mathematics) of individuals in Serbia used the internet for health infor- graduates than EU27 countries. Compared to the mation, and 62.2 percent of individuals in Türkiye used EU27, ECA countries globally have more STEM gradu- it to schedule appointments with health practitioners. ates (Figure 12). However, the ability to attract and retain digital talent is an issue for ECA countries especially Moreover, advanced digital skills are necessary to North Macedonia, Albania and Kosovo that suffers from innovate and generate adoption of ICT devices and brain drain.88 Despite that situation, some countries like services. In ECA, IT services has been the fastest grow- Uzbekistan, Serbia, Belarus, Russia, and Kazakhstan, ing segment over the past two decades. ECA recorded record the highest rate of digital skills in ECA. These a 14 percent and 11 percent annual growth in IT services countries have prioritized digital skills in their political value added and employment during 2015-2022, out- agendas, as illustrated in Box 5 below. pacing global growth. In ECA, women make up half of the population and 40 percent of the workforce, but in HD services face challenges, including the need for 2022 had only 29 percent of the employment in IT ser- in-depth training for staff and users to navigate new vices. While the female to male ratio in IT services lies technologies efficiently, especially under conditions below 0.5 in most countries, the ratio exceeds 0.75 in of limited direct interaction or increased demand for the Kyrgyz Republic and Albania, as rising exports of IT services. The successful implementation of digital ser- services offered well-paid and flexible jobs for women. vices is highly dependent on the digital literacy levels of The gender gap remains large in Bosnia and Herzego- both the service providers and the recipients as well. As vina and Türkiye, where the female to male ratio remains such, it is crucial to strengthen the capabilities of gov- below 0.3, as depicted in Figure 11. ernment institutions tasked with program administra- Figure 11: Gender imbalance in IT services, 2021 1.5 Female:male employment ratio 1 in IT services KGZ ALB 0.5 MKD BGRARM BLR SRB GEO TUR BIH 0 0.2 0.4 0.6 0.8 1 1.2 Female:male employment ratio economy-wide Source: World Bank, 2024a. 88 OECD, 2023c. 23 ◄ Table of Contents 2. Digitalization of Human Development Services Figure 12: Percentage of STEM graduates in ECA and EU 50% 40% 30% 20% 10% 0% s va ne H osn ia ia ia n e ia n a an ic an an 27 go nd na ru tio gi iy ja bl on an rb en do EU st ist ist ai vi ze a rk ai or la pu ra Se lb kr rm ed kh er ia rb Be Tu jik ek ol Ge de A Re U ac za M ze A Ta zb Fe M Ka A yz U B ian th rg ss or Ky Ru N Sources: WIPO; Global Innovation Index, 2023; Eurostat, 2021. tion. This includes frontline workers who are essential Education as client-facing officials in service delivery. Their profi- ciency is fundamentally vital to the success of service Leveraging digital technology has become a key tool delivery, regardless of a country’s digital progress—see for ensuring better learning and it is important to Box 5 for Kazakhstan’s efforts in this regard. Inadequate explore how digital technology can be integrated in training and insufficient digital literacy among these key education effectively. Through digitalization, educa- personnel can impede the adoption of digital services, tional institutions can leverage various technological thereby constraining their effectiveness and overall solutions to improve teaching and learning practices, an ic an an an n ey ia n a va ne H n ia go d Ko a vo ia ia s ru gi n tio ja ze an bl en Bo an on rb do rk st ist ist ist vi so ai reach.89 Cultural perceptions about digital technology promote inclusive education, and foster lifelong learning ai or la pu Se ra lb rm kr ed Tu er ia kh rb Be jik en ek ol Ge de A Re U za M ze ac A Ta zb s m can also affect its adoption. In some communities, there opportunities for individuals of all ages.92 Armenia has Fe Ka A M rk yz U Tu rg n th ia might be resistance to adopting digital tools due to dis- been developing its IT sector through a combination of Ky or ss N Ru trust of technology or preference for traditional meth- public and private initiatives. The government is spear- ods of service delivery. heading reforms in STEM education through an itera- tively designed and evidence-based process, allowing Digital transformation in HD sectors necessitates for continuous learning and improvement throughout adaptive changes in attitudes, upskilling, and change implementation. Additionally, private initiatives such as management. Beyond overcoming infrastructure limita- the TUMO Center for Creative Technologies93 provide tions, enhancing communication, improving cross-sec- free education in programming, graphics, and anima- toral coordination, and bridging the knowledge gap tion to teenagers, thereby complementing the govern- between HD and ICT stakeholders are essential for ment’s efforts and fostering a well-rounded tech educa- laying the groundwork for effective digital HD service tion ecosystem. This approach helps to cultivate early delivery. interest and skills in the digital fields, providing a foun- dation for future professionals who are more likely to stay and work in their home country.94 Azerbaijan has prioritized increasing knowledge and skills in the ICT sector and applying ICT in the education system by the Box 5: Putting digital skills at the top of the political agenda in Kazakhstan90 In Kazakhstan, the national digitalization agenda had been a priority even before the COVID-19 pandemic, with the launch of the “Digital Kazakhstan” program in 2017. Since 2020, Kazakhstan has been at the fore- front of UNICEF’s global school connectivity initiative, GIGA, in Central Asia, aiming to provide broadband internet access to every school. The adoption of Information and Communication Technologies (ICT) has been a key driver in enhancing human capital. A recent partnership with Coursera91 has enabled registration for 450,000 individuals. As reported by Coursera’s CEO in the first quarter of 2023, the most sought-after courses among Kazakh citizens are in cybersecurity, programming, and English language. Notably, women constitute 56 percent of the learners, and approximately 57 percent of learners utilize mobile devices for their courses. 89 UNICEF, 2022. 24 90 Astana Times, 2023. 91 Coursera and the Kazakh government worked out a program under which the Ministry of Science and Higher Education bought 20,000 licenses for 25 universities in Kazakhstan. 92 Sarker et al., 2019. 93 https://tumo.org/. 94 TUMO, 2023. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia end of 2025. By appropriate use of ICT in its education itories of learning resources should be more tailored systems at all levels and efforts to increase digital lit- to the needs of general-education students and offer eracy, Azerbaijan could reduce learning poverty, espe- digital affordances such as networking, flexibility, and cially between regions and income groups, increase interactivity to make the materials more engaging and access to e-learning, and equip the students and adults interesting.102 with the new skills required by the labor market. The country’s Socioeconomic Development Strategy 2022- Digital platforms are another instrument that can 2026 aims to integrate new Science, Technology, Engi- enable learners to access educational materials at neering, the Arts and Mathematics (STEAM) based pro- any time and place, allowing them to further develop grams in the national curriculum for guiding student their skills. The degree to which education leverages inquiry, dialogue, and critical thinking.95 ICT entails the creation of a system framework that combines technology, data, and human skills to maxi- Digital skills of the education workforce and public mize the advantages of these investments on a broad education administrators are crucial for effective dig- scale. Countries like Estonia, South Korea, and Uru- ital learning.96 Teachers need to be digitally literate to guay have actively invested in and developed these integrate technology into their lessons, while public capabilities within their education systems, spanning education administrators at school and system levels national, regional, and local levels. As a result, they pos- need digital skills to understand and make informed sess greater overall capacity to be resilient, adaptive, decisions on digital learning technologies.97 Socioec- and responsive to learning needs in normal times and onomic inequalities, parental involvement, and cultural during crises. attitudes toward technology influence digital readi- ness.98 In Finland, for example, a culture of trust in tech- Health nology, a strong belief in equity in education, and active parental involvement contribute to successful digital Successful digital transformation in healthcare learning integration.99 Finland promotes digital literacy requires profound adaptive changes in professional by integrating ICT competence into national curricula attitudes towards technology and enhanced techni- without mandating specific skills. Municipalities incentiv- cal skills, emphasizing that while digital technologies ize teachers’ ICT professional development, guided by are crucial, they alone cannot transform healthcare. a comprehensive framework from the Finnish National These technologies need to be effectively utilized by Agency for Education covering media literacy, computa- health workers and patients. Developing digital skills tional thinking, and digital skills. Since 2012, the Finnish across all levels—from foundational to specialized—is National Audiovisual Institute has strengthened media essential not only for enhancing the value of these tech- education, supporting educators in digital teaching.100 nologies but also for ensuring their widespread adop- In Estonia, the Digital Accelerator program enhances tion and effective use. educators’ digital competencies through personalized training over six months, adapting innovative teaching Capacity building is critical across various healthcare methods to school needs. Insights from this program roles, including personnel, medical institutions, and are compiled into the Digital Accelerator Collection, consumers. The COVID-19 pandemic notably increased sharing best practices for future educators.101 the demand for digitally skilled healthcare profession- als, underscoring the need for continuous professional Greater emphasis is needed on identifying students’ development to ensure efficient and secure health- digital and data literacy skills gaps, and the digital care delivery. The healthcare ecosystem must develop pedagogy and leadership skills gaps among teachers robust capabilities to operate, maintain, and sustain dig- and school administrators. Addressing these gaps is ital services, systems, and infrastructures. crucial for the development of digital education action plans and the implementation of competency-based In-depth training is necessary to fully leverage digital curriculum reforms. In a system where digital skills and solutions, covering their features, functionalities, and data literacy are not systematically assessed, the lack data management aspects such as importing, export- of these skills decreases teachers’ ability to integrate ing, and analytics. Mobile-based learning platforms, technology into teaching and student learning. For which offer flexible access to educational content and example, in Georgia, the Portal of the National Curric- specialized training, have become increasingly vital. ulum outlines student requirements for digital skills, These platforms support peer-to-peer and mentorship the educational use of computers in schools—whether programs, enhancing learning opportunities and fos- by teachers enhancing instruction or students finding tering better patient–healthcare professional relation- information or building skills. However, Georgian repos- ships. 95 World Bank, 2022b. 99 Salmi, J., 2020. 25 96 Fraillon et al., 2014. 100 OECD, 2023a. 97 Tondeur et al (2017) 101 ISSU 98 Ritzhaupt and Hohlfeld, 2018. 102 World Bank, 2023. ◄ Table of Contents 2. Digitalization of Human Development Services The development and deployment of digital health At the sector level, the presence of teams with the services necessitate a workforce equipped with spe- necessary skills and expertise significantly affects cialized skills to effectively digitalize healthcare. It is how digitalization initiatives are developed and imple- essential to have a workforce proficient in health ser- mented or outsourced. For instance, in Canada, the vice delivery, management, and the nuanced use of deployment of an AI-based model to identify recipients digital technologies. Critical enhancements in educa- of the Guaranteed Income Supplement was only fea- tion and training, seamlessly integrated into existing sible due to the involvement of multidisciplinary teams curricula, are crucial. These educational upgrades will comprising data scientists and business experts. These ensure that healthcare professionals are well-prepared teams ensured that appropriate tools were selected to navigate and thrive in an increasingly digital-oriented and used effectively.105 Effective training and guidance health landscape. for frontline officials can directly facilitate the successful implementation of digitalization initiatives. In England, The Health ICT workforce also requires targeted train- local authorities have recognized the urgent need for ing for tasks specific to designing, building, operating, an independent national advisory service to provide and supporting digital health services. Strengthening expertise and guidance on the effectiveness of care local capacity in both health and ICT sectors is a top technologies.106 priority for governments working to digitalize health- care delivery systems. This strategic focus ensures Digitalization also enhances capacity building and that healthcare systems are well-prepared to handle empowerment in social protection service delivery. It the challenges and opportunities presented by digital enables service providers and clients to gain the nec- transformation. essary knowledge and confidence to use technology effectively for their personal and community advantage. Social Protection and Labor Tools like mobile phones, internet connectivity, and social media platforms not only facilitate access to infor- Many public employment services are now enhanc- mation, opportunities, and networks but also improve ing their traditional job seeker training programs with social and economic well-being through real-time inter- digital courses, some of which are specifically aimed actions, information exchange, feedback mechanisms, at developing participants’ digital skills. For instance, and coordination efforts. Importantly, they allow service Georgia’s Innovation and Technology Agency (GITA) providers to reach out to isolated or marginalized com- offers training and funding for startups and educational munities, such as indigenous peoples, refugees, and programs to enhance the skills of potential IT profes- women, offering customized services that cater to their sionals. These initiatives aim to build a local ecosystem specific needs and preferences. that retains talent by fostering a culture of innovation and entrepreneurship.103 In Armenia, the integration of digital courses into public employment services has 2.3 Services at scale been part of broader efforts to modernize and enhance vocational education and training (VET). Some key ini- Many countries are facing the dual challenge of tiatives include (i) the Dual VET System in the Preci- increasing citizen expectations for better public ser- sion Engineering and IT Sectors, which involves pilot- vices and the necessity for fiscal consolidation which ing software for computing equipment and automated drive a shift towards the modernization of the public systems in regional state colleges to align the training sector, leveraging digital technologies to enhance ser- with labor market demands; (ii) training for VET teach- vice design, delivery, and engagement with citizens. ers and managers to build capacity among VET man- The transformation aims to optimize service quality and agers and teachers to implement and manage e-learn- responsiveness while reducing costs and improving ing systems effectively; and (iii) continuing professional trust and transparency in government. Digital transfor- development in digital skills, to create a continuing mation plays a pivotal role in increasing service produc- professional development system for VET teachers in tivity, reducing labor intensity, and fostering greater cit- Armenia, enhancing their ability to teach digital skills. izen engagement. This progression encompasses the These programs are part of Armenia’s larger strategy shift from mere digitalization of back-office functions to integrate digital technologies into education and to full digital government initiatives, focusing on user- training systems, addressing the digital skills gap and driven services and policy outcomes. As such, govern- enhancing the employability of job seekers in the digital ments are encouraged to integrate digital technologies economy.104 and user preferences into public services and policy making to meet complex challenges, achieve efficiency, and maintain public trust.107 103 Nanitashvili and Vandenberg, 2023. 26 104 ETF, 2020. 105 ISSA, 2020. 106 Wright, 2021. 107 OECD, 2016. ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Figure 13: Online Service Index score compared to overall UN-E Government Development Index and rank E-Government Index Score Online Service Index Score E-Government Rank (Right Axis) 1 180 0,9 160 0,8 140 0,7 120 0,6 100 0,5 80 0,4 60 0,3 40 0,2 20 0 0 us va ne H sn ia go d Ko a o ia ia n ey ia n a an ic an an an n gi tio ja ov ze an bl Bo an on rb en r do rk vi st ist ist ist ai ai or la pu s Se ra lb kr rm ed Tu er ia kh rb Be jik en ek ol Ge de A Re U za M ac ze A Ta zb m Fe Ka A M rk yz U Tu rg n th ia Ky or ss N Ru Source: UN E-Government Development Index (EGDI) 2020. The integration of technologies like cloud computing, ECA countries are intensively adopting e-government social media, and mobile technology into daily life is services. ECA is above the world average but slightly transforming how citizens, businesses, and govern- below the Continental Europe average in the UN E-Gov- ments interact, leading to more open and participa- ernment Development Index (EGDI).110 This index pre- tory public governance. This digital environment facili- sents the state of e-government development in UN tates collaborative relationships, allowing stakeholders member states through the measurement of three indi- to actively participate in shaping political priorities and cators: quality of online service, inherent human capital, co-designing public services. Such participation is alter- and development status of telecommunication infra- ing expectations of government, necessitating a shift structure. from government-centric to citizen-driven approaches in service delivery. Moldova’s E-Government Agency established in 2010 has used several digital platforms to ensure con- This transformation extends beyond just adopting sistency and simplify further digitalization efforts. new technologies in public administration (digitaliza- As presented in Figure 14, this includes a government tion) to fundamentally integrating these technologies hybrid cloud platform (MCloud), authentication and sin- into public sector modernization (digital government). gle-sign-on service (MPass), e-signature service (MSign), The challenge lies in enhancing government services in e-payment gateway (MPay), and a data exchange and line with efficiency, economic growth, societal equality, interoperability platform (MConnect). The public ser- and governance goals such as transparency and citi- vices portal that averages half a million unique visitors zen engagement. Achieving that transformation will, in per year, functions as an electronic catalogue of about some areas, require a more progressive path through 700 public services for citizens and businesses offer- greater use of digital technologies to achieve better ing access to more than 230 e-services. The citizens government (e-government), providing a stronger plat- portal (MCabinet) is a secure, customized area of the form for later transformation. Governments must adapt portal, offering access to personal data and services their capacities and operations to these digital dynam- from authoritative government data sources. With the ics, fostering open policymaking and service delivery appointment, for the first time, of a Deputy Prime Min- centered around user needs. To effectively implement ister for Digitalization in 2021, and the development of digital strategies, a framework involving project man- a new Digital Transformation Strategy 2023-2030, Mol- agement, stakeholder involvement, continuous commu- dova is expected to accelerate the pace of digitalization nication, and evaluation is critical. of government services and public administration in the next period.111 Digitalized public services are more citizen-centric, universally accessible, and help build efficient, and Education transparent government systems. In fact, open data has improved governments, empowered citizens, con- Education service delivery lies at the core of the edu- tributed solutions to complex public problems, and cational process, representing the gateway to unlock- created new economic opportunities for companies, ing the benefits of digitalization. A high level of digi- individuals, and nations108 as case studies show. Data- tal integration in service delivery enables personalized driven innovations can yield enhancements in produc- learning experiences, responsive teaching approaches tivity, growth, and social well-being.109 tailored to the needs of students and educators, and 108 See: Open Data’s Impact - Global Impact (odimpact.org). Accessible at link: https://odimpact.org/key-findings.html 27 109 Data-driven innovation for growth and well-being - OECD. 110 UN E-Government Knowledge Base: the E-Government Development Index incorporates the access characteristics, such as the infrastructure and educational levels. The EGDI is a com- posite measure of three important dimensions of e-government, namely: provision of online services, telecommunication connectivity and human capacity. 111 World Bank, 2023. an ic an an an ia n ey ia n a s va e H sn ia go d Ko a vo ia u gi n n ti o ja ze an bl en Bo an on rb ar do rk st ist ist ist vi so ai ai or pu Se ra lb rm kr ed l Tu er ia kh rb Be jik en ek ol Ge de A Re U za ◄ Table of Contents M ze ac A Ta 2. Digitalization of Human Development Services zb m Fe Ka A M rk yz U Tu rg n th ia Ky or ss N Ru Figure 14: Moldova Digital Government Architecture. Source: E-Governance Agency of Moldova Public Service Portal Citizen Portal Source: World Bank, 2023d. improved management and analytics for informed nated with larger government initiatives and programs— decision-making. To effectively leverage digital tech- for example, Cloud infrastructure, AI laws, Privacy laws, nologies in education services, it’s crucial to prioritize and regulation of telecommunications. teacher-learner interactions, enhance instructional leadership among administrators and school managers, By establishing close coordination and linkages and strengthen curriculum, teaching materials, assess- between the education sector specific ICT systems ments, analytics, and institutional management at vari- and whole-of-government digital foundations, plat- ous levels—from individual schools to local and regional forms, and infrastructure, the entire system is more authorities. Equipping teachers with the necessary com- likely to make better data-informed decisions. The petencies, including skills, knowledge, and attitudes, to depth and scale of systemic public education transfor- effectively integrate technology into teaching methods mation would rise when coupled with whole-of-govern- and curricular content is essential for enhancing learn- ment digital infrastructure and platforms. Countries like ing outcomes. Estonia and India have further developed education system architecture to interoperate at the level of the Establishing a whole-of-government ecosystem with whole of government, and to integrate relevant informa- shared digital public infrastructure, foundations, and tion for even more targeted and holistic service delivery platforms is often at the level of national government using single window procurement systems and secure and must be closely in sync with sector-level efforts. vendor management systems, backed by data regula- When the education sector specific ICT systems are tions that serve public purposes.112 linked with whole-of-government digital foundations, platforms, and infrastructures such as a whole-of-gov- The digitalization of education transforms the learn- ernment single window procurement system and a ing landscape by broadening access to information data pipeline/service bus for education-related informa- and educational resources, while also introducing tion exchanges, the system may be better harmonized novel approaches to teaching. This shift allows for and able to take better informed data decisions. This remote education via online platforms, making learn- ensures that countrywide regulations are implemented ing opportunities more equitable and reachable for by default and education sectoral needs are coordi- people across different locations and economic back- World Bank, 2023d. 112 28 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia grounds. Interactive tools like simulations, virtual labs, political economy, and associated disparities. These and adaptive learning technologies tailor education to transformations are set to continue having a profound fit various learning preferences and requirements. Addi- impact on the development of human capital and the tionally, digitalization supports continuous learning and growth path of a country. skills development, preparing individuals for the evolv- ing workforce demands.113 The 2020 Digital Education Health Action Plan from the European Commission highlights the role of digital technology in creating more accessi- The digitalization of healthcare involves leveraging ble and customized educational experiences, catering technology to meet the diverse needs of healthcare to a range of learning needs and styles. systems. A Digital Health Platform (DHP) provides the critical infrastructure necessary to integrate a compre- The application of digitalization in education can also hensive suite of services and applications, essential for significantly improve service provision at multiple enhancing health outcomes and expanding care acces- levels, from individual learners to broader educational sibility on a large scale. structures. Digital solutions provide varied learning and skill enhancement opportunities through different chan- Establishing a DHP is a fundamental prerequisite for nels and approaches. These tools are crucial for man- the effective digitalization of health systems. A DHP aging the teaching and learning processes, covering serves as the critical infrastructure that supports and both traditional education and adult learning, and they integrates various digital health applications and sys- enhance the administrative aspects of education. tems that are essential for enhancing health and care services. By ensuring that these systems operate cohe- However, the COVID-19 pandemic brought to light sively and interoperate seamlessly, a DHP eliminates and amplified concerns over the uneven expansion of the challenges posed by isolated applications. At its digital education, unveiling a significant digital divide core, a DHP utilizes a standards-based “infostructure” in both access to and usage of digital technologies. that consists of common and reusable components This situation significantly widened the gap in learning such as registries, identity verification, and data reposi- opportunities, favoring individuals with access and the tories. These components are crucial for the platform’s capability to utilize these technologies over those dis- operation, enabling multiple applications within the advantaged by poverty or residing in remote locations digital health ecosystem to efficiently leverage shared without stable electricity and internet access.114 It has technology services (Figure 15). This integration not heightened the concerns about the “datafication” of only enhances interoperability but also reduces redun- personal student data, algorithmic reinforcement of dis- dancies and costs associated with developing and crimination against structurally disadvantaged groups, maintaining isolated systems. The standardized “info- and the role of algorithmic processes in the dissem- structure” provided by the DHP allows for consistent ination of misinformation and disinformation. Digital and reliable functionality across diverse digital health transformations are closely linked with wider systemic services, ultimately improving healthcare delivery and changes, including geopolitical rivalry, the dynamics of outcomes. Figure 15: A sample how a DHP interacts with external applications and users Terminology Services Other Data Digital Health Components Repositories Digital Health Applications for Applications for Desktop Mobile Devices Computers Analytics Registries Information Workflow Security and Algorithm Digital Health Services Services Digital Health Applications for Applications for Medical Devices Integration Interactive Wearables Services Communication DIGITAL HEALTH PLATFORM Source: WHO and ITU, 2020, Digital health platform handbook: building a digital information infrastructure for health. OECD, 2019b. 113 29 UNESCO, 2020. 114 ◄ Table of Contents 2. Digitalization of Human Development Services To effectively leverage digital technologies, it is cru- • Healthcare Management and Administration: Ser- cial to integrate a comprehensive suite of services vices that enable healthcare managers and admin- and applications tailored to meet the diverse needs of istrators to effectively manage the delivery of care healthcare systems. Below is a description of essential to individuals and monitor the health of the broader components (not exhaustive) of a digital health system, population. These services include adverse event outlining their roles and providing examples of applica- monitoring, risk analysis, compliance monitoring, tions that support these functionalities: surveillance and at-risk identification, healthcare operations management, clinical practice improve- • Individual Electronic Health Information: Services ment, health program design and optimization, that support the collection and storage of health health policy development, and health care and clin- information for an individual, including electronic ical research. The DHP provides the necessary infra- health records (EHR), electronic medical records structure for data collection, analysis, and reporting, (EMR), and personal health records (PHR). These supporting informed decision-making and efficient applications rely on the DHP for secure data storage, management. identity verification, and seamless access across healthcare providers. The integration of these components ensures that healthcare providers and patients can access and uti- • Healthcare Communications and Collaboration: lize health information effectively, which is paramount Services that enable healthcare providers to elec- for enhancing healthcare outcomes. By adopting such tronically communicate and share information with digital solutions, healthcare systems can not only meet other providers as part of providing care to an indi- current needs but also adapt to future challenges and vidual. This includes electronic referrals and spe- innovations. cialist letters, electronic health event summaries, prescribing and test ordering, access to an individ- Enhancing equity and inclusion through the digitali- ual’s EHR and test results, healthcare provider and zation of healthcare services also involves addressing service directories, care plan management, and several key challenges to ensure that all segments appointment booking and management. The DHP of a country’s population can benefit from digital facilitates these interactions by providing a unified health advancements. One major challenge is ensuring platform for communication and data exchange. access to healthcare through digital means, which can help narrow the equity gap by streamlining medical pro- • Healthcare Service Delivery Tools: Services that cesses and eliminating geographical and transportation support healthcare providers in making diagnosis barriers. However, access remains limited by affordabil- and treatment decisions, and in managing the deliv- ity and availability, with high treatment costs and limited ery of care to an individual, whether electronically insurance coverage being significant barriers.115 or in person. Examples are medications manage- ment, prescription and test ordering decision sup- Social Protection and Labor port, clinical decision support, alerts monitoring and management, chronic disease management, real- Moving into digital government typically results in the time clinical data access and analysis, telemedicine gradual development of shared digital architecture (telehealth) and mobile health (mHealth). These tools for SPL services. For example, an interoperable infor- use the DHP’s data repositories and real-time data mation system may develop in which databases of dif- access capabilities to provide accurate and timely ferent SPL programs are either centralized or able to information. seamlessly communicate for unique intake and enroll- ment, integrated provision of benefits and services, • Health Information and Knowledge: Services consolidated participant operations management, and that enable individuals and healthcare providers monitoring purposes. Shared architecture may also be to access trusted and verified health information developed for more efficient payment service provision and knowledge. This includes consumer health across different programs which, in some cases, may knowledge sources, healthcare provider knowl- even result in coordinated payment of multiple bene- edge sources, and distance learning and electronic fits.116 resources. The DHP supports these services by ensuring that the information is accurate, up-to-date, In broad terms, service provision is undergoing digi- and easily accessible. talization through three primary approaches, encom- passing both social protection and employment services. First, technology is increasingly enhancing McKinsey & Company, 2023. 115 30 Lowe et al., 2023. 116 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia traditional, face-to-face services. For instance, in Swe- ationalize the model by integrating information from dif- den’s IT support for the Advanced Care in the Home ferent administrative data sources to register applicants scheme, nurses and care staff are encouraged to utilize and determine eligibility of different social programs in digital guidance during client visits and to communicate the country. Ukraine has also gained significant advan- electronically with other providers using touchpads tages from digitalizing its human development service and digital learning platforms.117 Second, technology is delivery. Box 6 outlines Ukraine’s implementation of the replacing certain face-to-face services with virtual alter- electronic social protection system. natives, thereby reducing time and travel costs for ser- vice providers and users. Prior to the pandemic, some Digitalizing social protection and employment ser- countries, like Norway, already offered virtual meetings vices introduces significant risks of exclusion, as well, for jobseekers to consult with advisors via phone or especially for marginalized groups lacking necessary Skype. Similarly, Sweden had a significant portion of digital assets. One billion people worldwide are with- its employment service provision conducted digitally out official identity, disproportionately affecting those even before the pandemic, and it now offers a digital disadvantaged by gender, ethnicity, income, and geo- interview platform linking jobseekers and employers graphic inequalities.121 Mobile phone ownership and directly through video calls within the public employ- financial account access remain low in those communi- ment service system.118 Third, governments are increas- ties, with significant digital and financial literacy gaps.122 ingly exploring the use of new technologies to replace Technological failures, such as biometric authentication human activities in service provision where human dis- issues, further hinder access, particularly among older cretion is deemed nonessential. For example, Denmark individuals and those with disabilities.123 has introduced assistive care technology to aid clients with daily activities such as toileting, eating, and mobil- ity.119 Social services represent another domain where gov- ernments and their partners are leveraging digital technology. A UNICEF survey highlighted progress in Azerbaijan, Croatia, Kyrgyzstan, Romania, and Uzbeki- stan in transitioning from paper-based to online social work case management systems. These countries ini- tiated the shift well before the COVID-19 pandemic, which underscored the importance of remote work capabilities and the use of online tools for case man- agement. Numerous instances from the ECA region also present enhanced efforts to support the most vulnera- ble children through digital tools and solutions. Exam- ples include equipping community centers for children and families in Albania to facilitate access to services via digital methods, standardizing parenting services in Croatia, and deploying digital solutions to assist chil- dren and families with disabilities, particularly in com- munities in North Macedonia that previously lacked such services.120 Many ECA countries have revamped their social pro- tection services through digitalization. The Republic of Moldova’s approach, detailed above, exemplifies the digitalization and centralization of social assistance payments and serves as a model for other nations con- sidering similar digital transformations. In Armenia, the ongoing reform to offer integrated provision of benefits and services to vulnerable groups is based on two main principles of colocation and coordination. At the core of these two principles is the development of the Unified Information System, an information tool that would oper- 117 OECD, 2016. 31 118 ETF, 2021. 119 OECD, 2016. 120 UNICEF, 2022. 121 Desai et al., 2018. 122 World Bank, 2022d; Klapper, 2019. 123 Gelb et al., 2017; Allu et al., 2019. ◄ Table of Contents 2. Digitalization of Human Development Services Box 6: Ukraine’s Electronic Social Protection System124 Ukraine inherited its social protection system from the former USSR, similar to other post-Soviet countries. Ini- tially, this large and diverse system relied solely on paper, requiring individuals to submit physical applications with numerous supporting documents, often necessitating multiple in-person visits to compile. The provider side also faced challenges due to paper archives that made the system cumbersome, costly, and susceptible to corruption. Over the years, the Ukrainian government has made strides in digitalizing this system. It began by transitioning from an analog setup to an e-government system, digitizing databases and archives. Since 2014, there has been a push towards a whole-of-government transformation, spearheaded by the newly established State Agency for Science, Innovation, and Information, later renamed the Ministry of Digital Trans- formation. A 2014 law enabled centralized access to data across various institutional registers via an infor- mation system named “Vulyk,” in compliance with data protection regulations. In 2016, the Trembita software platform was launched, facilitating rapid and secure data exchange across different registries, modeled on Estonia’s X-ROAD platform. By 2017, the national network of “single window” administrative service centers was integrated with the Vulyk system, allowing quick processing of citizens’ requests for documentation and registration in public and social services. More than 150 state and local government bodies, and over 50 electronic resources, are now interconnected through the Trembita platform. From 2019, the focus of digitali- zation shifted towards enabling remote access to public services via the “state in a smartphone” concept. This marked a significant advancement in crafting a digital social protection system centered around user needs. In early 2020, the Ministry of Digital Transformation launched the DIIA digital identification platform, accessi- ble through a mobile app and web portal. The app saw over two million downloads within the first two months, though growth slowed due to concerns over personal information security and state surveillance, as well as digital infrastructure, literacy, and access challenges. However, by late 2020, as part of the social protection response to COVID-19, the user base tripled when the government initiated a registration and payment pro- cess via DIIA for the first time. Citizens seeking assistance could apply through DIIA and receive digital pay- ments on their bank cards after verification using an electronic digital signature or BankID. Citizens can access a wide array of services for individuals and businesses through DIIA, including numerous social protection schemes such as child and family benefits, pensions, social insurance, subsidies, unemployment benefits, and preferential state mortgages. Document submission is quick, results are typically available within one to five days, and the services are free of charge. As of the end of 2021, the DIIA portal offered 72 services, and the mobile app provided access to 15 digital documents and nine e-services. DIIA also includes a Government Services Guide to help citizens learn about all state services, even those not yet available digitally. For those without personal digital access, DIIA centers established within the network of administrative service centers provide support through social workers, continuing to offer traditional in-person application processes. Following the invasion in February 2022, the Government of Ukraine has further expanded the functionalities and services available through DIIA, supporting those affected by the conflict through various social protec- tion programs. DIIA also serves as an information and consultation hub for Ukrainian refugees abroad. As of August 2022, DIIA digital documents carry the same legal weight as their paper counterparts, with the mobile app’s user base reaching 18 million people globally. World Bank, 2024e. 124 32 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia 3. Key Takeaways and Ways Forward Strategic Investments in Digital Infrastructure To harness the transformative power of digital technol- individuals and families, ensuring social workers have ogies for human development, significant investments a comprehensive view of the challenges and resources in digital infrastructure are crucial. This infrastructure available to their clients. For instance, Moldova’s use of serves as the foundational layer in the digital develop- digital platforms like MCloud and MPass, which stream- ment process, encompassing access to reliable, high- line government services, exemplifies effective digital speed, and universally available internet, as well as governance that boosts service efficiency and acces- modern data hosting capacities. As discussed in previ- sibility. The establishment of common data standards ous sections, countries in the ECA region generally have and protocols enhances interoperability. Digital case good mobile broadband (MBB) coverage and internet management tools can improve social workers’ work- access. However, the cost of mobile phones and mobile flows by providing mobile access to case files and data broadband subscriptions can be prohibitive in some in the field, resulting in better-informed decisions and areas. Developing fixed broadband penetration to the quicker response times. These tools also support the last mile—homes, hospitals, medical facilities, schools— integration of healthcare, nutrition, and early learning is equally vital, as it provides access to high-speed (over interventions through unified platforms. For example, 100 Mbps), reliable internet that complements MBB. To digitized health and immunization records linked with reduce costs associated with MBB and mobile phones, early childhood education enrollment systems enable fostering competition in the telecommunications market timely interventions and comprehensive care. Türkiye’s is essential. Revising regulatory frameworks can facil- method of automatically registering newborns exempli- itate the entry of new players in the mobile communi- fies effective integration between social protection and cations market and enhance competition at retail and education sectors, facilitating seamless data sharing wholesale levels in the fixed-broadband market. Robust that not only increases efficiency but also ensures more digital foundations, such as high-speed internet access targeted and effective delivery of benefits. and modern data hosting, are universally necessary for the digital transformation of health, education, and social Enhancing Security and Building Trust protection services. This common need can encourage collaboration in building and investing in these critical As digital technologies become increasingly integrated digital infrastructures. into human development services, enhancing security and building trust among users are paramount. This Policy Frameworks and Cross-sector Collaboration involves investing in advanced cybersecurity measures, developing comprehensive data protection laws, and A recurring theme across various sectors is the need creating transparent practices that safeguard user data for cohesive national digital strategies supported by against breaches and misuse. Countries should con- robust policy frameworks. These strategies should sider establishing dedicated cybersecurity agencies enable cross-sector collaboration to avoid duplicating and incident response teams to manage and mitigate efforts and to maximize collective strengths in adopt- potential cyber threats. Additionally, fostering public ing and adapting technology. Supportive policy frame- trust through clear communication about how user data works that promote innovation, ensure interoperabil- is collected, used, and protected is essential for increas- ity, and uphold stringent standards for data privacy, ing engagement with digital services. Countries in the security, and ethics are vital. These frameworks should ECA region can benefit from Estonia’s experiences to encourage collaboration across government agen- strengthen their cybersecurity posture. This includes cies, private sector entities, civil society, and interna- protecting citizens’ personal information and sensitive tional organizations to harness collective expertise and government data by creating cybersecurity centers, resources. Enhanced data sharing capabilities among implementing training programs for citizens, and enforc- agencies can improve the coordination of services for ing strict data protection regulations. Estonia’s model of 33 ◄ Table of Contents 3. Key Takeaways and Ways Forward integrated cybersecurity measures can serve as a com- and inclusivity. Addressing the digital divide also means prehensive framework for enhancing national security tackling access to technology and the skills needed in the digital age. for its effective use. This requires providing essential infrastructure and ensuring that vulnerable populations, Capacity Building and Digital Literacy including the elderly, people with disabilities, and those in remote areas, receive the necessary tools and train- The journey of digital transformation emphasizes the ing to leverage digital advancements. Additionally, dig- need for robust capacity building and the enhancement ital platforms focusing on women’s health and empow- of digital literacy across all societal levels. Developing erment can further enhance equality. Developing and and implementing comprehensive educational and disseminating digital health tools tailored for women, training programs is crucial to equip educators, health- along with providing ICT skills training to women and care providers, social service professionals, and the girls, empowers them to fully participate in the digital general public with the digital skills required. For exam- economy and society. ple, countries like Kazakhstan, North Macedonia, and Serbia have achieved high digital literacy rates through Leveraging Emerging Technologies focused educational policies and significant investments in technology integration, prioritizing the upskilling of Emerging technologies such as artificial intelligence, their citizens to actively engage in the digital economy. big data analytics, and blockchain offer significant Furthermore, innovative educational initiatives such opportunities to enhance service delivery in education, as Armenia’s TUMO Center for Creative Technologies, healthcare, and social protection. For instance, AI can which offers free digital skills training to youth, and personalize learning experiences in education, improve Azerbaijan’s strategic plan to embed ICT across all edu- diagnostic accuracy in healthcare, and enhance the effi- cation levels by 2025, are vital for promoting a culture ciency of social protection programs through better tar- of continuous learning and adaptation to technological geting and fraud reduction. Effectively leveraging these changes. The improvement of digital literacy extends to technologies requires investment in technical infra- the workforce in the education, health, and social pro- structure and workforce training, as well as implement- tection sectors, highlighting a common challenge that ing regulatory mechanisms to mitigate negative impacts transcends sectoral limits. This underscores the need such as increased monopolies, privacy risks, inequality, for unified strategies to enhance digital competencies and safety issues. Countries in the ECA region should that meet the digital transformation demands of all sec- closely follow the initiatives of OECD member countries tors. Digital platforms can further aid career transitions regarding the responsible development and adoption by offering skills assessments, training modules, and of AI technologies. For instance, the Global Partnership job matching services tailored to current market needs, on Artificial Intelligence (GPAI) advocates for principles which is especially useful in regions experiencing eco- of responsible stewardship and global coordination nomic changes or post-crisis recovery. of national policies and international cooperation for trustworthy AI. Additionally, to maximize the benefits of Addressing Societal Challenges and Ensuring Equity these technologies, countries need to ensure ongoing education and professional development to keep pace Digitalization must be inclusive, ensuring that all individ- with technological advancements. uals have equitable access to technology and services to avoid widening existing disparities. Tailored digital Sustainability and Environmental Considerations platforms can grant disadvantaged individuals easier access to social services, healthcare, and community The digital transformation of human development ser- engagement activities, which helps reduce isolation vices must carefully consider sustainability and envi- and fosters a more inclusive society. For instance, digital ronmental impacts. Digital infrastructure, including tools can gather and analyze data on urban accessibility data centers and network systems, consumes substan- for people with disabilities, guiding the development of tial energy. As the demand for digital services grows, more inclusive public spaces and services. Establish- it becomes crucial to enhance the energy efficiency ing mechanisms for grievance redressal through tech- of these infrastructures and shift towards renewable nology provides a platform for beneficiaries and the energy sources when feasible. Utilizing digital plat- general public to voice their concerns and strengthen forms to promote sustainable practices, such as waste accountability. For example, Ukraine’s DIIA platform, reduction and energy-saving techniques, and incorpo- which ensures accessible government services to all rating these into educational curricula and public health citizens, especially in times of crisis, demonstrates how campaigns are vital for maintaining sustainability. For digital tools can improve governmental responsiveness instance, cloud computing can lower the energy con- 34 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia sumption needed for data storage and processing, demanding focused efforts to close digital divides and and encouraging shared services can reduce the need ensure that all segments of the population can benefit for redundant infrastructure. Estonia’s national Digital from digital advancements. Agenda for 2030, which aims to establish the green- est digital government globally, serves as an excellent It is important to remember that digitalization best acts example. Estonia’s strategies in minimizing redun- as a facilitative tool for broader HD objectives. Digitali- dant infrastructure and energy use through optimized zation should therefore be seen as a means to enhance resource management and advanced cooling technol- the achievement of HD goals, rather than as a goal in ogies, which decrease the energy required for data itself. center operations, should be considered as a bench- mark for other ECA countries to emulate. …Final Remarks As ECA countries continue to advance their digital transformation agendas, it is crucial that these efforts are strategically guided, inclusively designed, and comprehensively implemented. The key to successful digitalization lies in the ability to integrate technology into the fabric of society, ensuring that it serves as a tool for enhancing human development, equity, and sustain- ability. By drawing on regional successes and learning from global best practices, countries can build resilient, inclusive, and sustainable digital ecosystems that not only support current generations but also lay a strong foundation for future advancements. Over-reliance on technology may obscure the impor- tance of human-centered approaches and risk neglecting underlying issues that require comprehen- sive social and political solutions.125 Refraining from digitalization is not inherently negative, as proceeding without proper evaluation can entrench ineffective prac- tices and systems, complicating future reforms. There- fore, before digitalizing, it is crucial to assess the value and implications of the process to be digitalized and to understand its impact on subsequent and depend- ent steps.126 This leads to two main prerequisites: con- ducting a functional review of the service in question before digitalization and understanding the interactions between various steps and systems. Without deliberate efforts to mitigate these risks, technology may perpetuate existing inequalities. A comprehensive risk management approach is essen- tial but often absent in digitalization initiatives, which require collaboration across all government levels to ensure a smooth and secure digital transformation of services. When adopting digital methods, it is vital to adequately supplement them with alternative, addi- tional, and backup manual options which ensure that a variety of approaches are available, enabling users with diverse needs to access social protection in a manner that is accessible, convenient, and effective. Achiev- ing equity and inclusion remains a critical challenge, Sætra and Selinger, 2023. 125 35 Lowe, 2022. 126 ◄ Table of Contents 4. References 4. 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By: Subhashini Rajasekaran, Taskeen Adam, and Klaus Tilmes. https://documents1.worldbank.org/curated/en/099102124103012716/pdf/P173530151854505218eb417834e0f9 54cd.pdf Case Studies and Technical Notes: • Armenia: Options for integration and digitalization of Case Management • Azerbaijan: Primary Health Care Digitalization • Georgia: Digital Readiness Assessment of the Education System • Moldova: Digital Education Readiness Assessment • Moldova: Lessons learned from the implementation of the MPay platform • Ukraine: The experience of implementation of the digital public service delivery platform DIIA • Transforming Healthcare in Eastern Partnership Countries through Digital Health 44 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Annex 2 Digital Education Readiness Assessments Readiness for digital learning refers to the measure of these pillars plays a crucial role in shaping the digital of the degree to which a nation, country, or economy pathways of a country, providing a comprehensive frame- is prepared to obtain benefits from digital educational work for informed decision-making. These contextual technologies.127 A digital readiness assessment evalu- conditions collectively serve as foundational elements ates whether this nation, country or economy is prepared to ensure a country’s preparedness for successful digital to enter the digital world or requires additional prepara- transitions in its education system.128 tions. This process helps determine if the organization needs a few change initiatives or a comprehensive dig- Moreover, it is critical to consider not only ‘what is ital transformation. A rigorous assessment of the digital assessed’ but also ‘who is assessed’ to inform policy readiness of education and skills development systems making. Assessing the contextual conditions requires should follow a solid conceptual framework and ground a top-down and a bottom-up approach. Top-down per- in robust and validated data evidence reflecting the con- spectives address national, regional, and local institu- textual conditions. tions, committees, and private CxOs, while bottom-up aspects focus on children, youth, parents, teachers, The contextual conditions for the readiness of educa- and school administrators. This can ensure a balance of tion systems for digital transitions revolve around five practice and policy, empower the learner and learning, essential pillars (Table A1). These encompass: (1) stra- and focus on equity in examining the system. Thus, sys- tegic leadership and governance for human-centered tematic stakeholder mapping and engagement of vari- service delivery, (2) a robust data and technology infra- ous system-level actors and elements at different levels structure, (3) digitally-enabled education service delivery (national, subnational, and school/community) is key to and analytics, (4) education workforce capacity and cul- enabling and implementing digital transition initiatives ture, and (5) EdTech market and business models. Each (Figure A1). Table A1: Digital Readiness of Education Systems: Key Pillars and subpillars Vision and strategy Pillar 1 LEADERSHIP AND Institutional capacity GOVERNANCE Legislation, Policy and Compliance Funding and Procurement Education Enterprise Architecture and Data Governance Connectivity Pillar 2 ENABLING INFRASTRUCTURE Technology Infrastructure Standards and Interoperability across Applications, Devices, Equipment Content standards and instructional materials Pillar 3 DIGITALLY-ENABLED Digitally empowered learning environment EDUCATION DELIVERY AND Digital skills of students ANALYTICS Teacher’s digital skills and pedagogical practices School management and administration National and regional Policy level Pillar 4 EDUCATION WORKFORCE School ownership level CAPACITY AND CULTURE Wider Public WORKFORCE ICT professionalism Management of EdTech Products and Services Pillar 5 EDTECH MARKET and BUSINESS Quality assurance of EdTech MODELS Support for Innovative Business Models and Entrepreneurship Sopu et al., 2016. 127 45 Godaert, E., Aesaert, K., Voogt, J., and Van Braak, J., 2022. 128 ◄ Table of Contents Annexes Figure A1: Education ecosystem stakeholders illustrative map Source: World Bank. Note: This is an illustrative map that would need to be contextualized based on local and global trends, including emerging and new players. 46 ◄ Table of Contents Digitalization of Human Development Services in Europe and Central Asia Annex 3 Building Blocks of Digital Health Ecosystem The critical building blocks for a robust digital health 5. Infrastructure: The physical and IT infrastructure strategy put together form a cohesive and resilient dig- underpins the entire strategy. It ensures that the nec- ital health ecosystem, ensuring a strong foundation for essary hardware, software, and network capabilities future health innovations and improvements: are in place to support digital health services and applications. 1. Leadership and Governance: At the helm of the strategy, leadership and governance provide direc- 6. Legislation, Policy, and Compliance: This compo- tion and oversee the entire digital health initiative. nent is responsible for the legal framework that sup- This involves setting clear policies, defining roles, and ports digital health. It ensures that policies and reg- ensuring that there is accountability and transparency ulations are in place to protect patient information, throughout the implementation process. ensure privacy, and comply with international health standards. 2. Strategy and Investment: This component focuses on planning and securing the resources necessary for 7. Workforce: A skilled workforce is essential for the the strategy’s execution. It involves setting priorities, development, maintenance, and management of dig- allocating funds, and ensuring that the investment ital health systems. This involves training healthcare made aligns with the overarching goals of the digital providers and IT professionals to use and support dig- health vision. ital health technologies. 3. Services and Applications: Central to the strategy Each building block must be addressed within the con- are the services and applications – for example, elec- text of the country’s unique environment and needs. A tronic medical record (EMR), patient portals, telemed- successful strategy will align these components with the icine – that address specific healthcare needs. This broader health system objectives and the specific goals involves the development and deployment of digital outlined in the national digital health vision. The interplay tools such as electronic health records, telemedicine between these building blocks paves the way for a coor- platforms, and mobile health applications. dinated and sustainable digital health ecosystem that can adapt to changing healthcare demands and techno- 4. Standards and Interoperability: Essential for the logical advancements. seamless exchange of information across different systems and platforms, for example, Integrating the The development of national health priorities marks the Healthcare Enterprise (IHE); common terminologies initial step in healthcare’s digital transformation. These such as International Classification of Diseases (ICD), priorities, derived from an analysis of a country’s princi- International Classification of Primary Care (ICPC), and pal health challenges and needs, guide policy making, Systematized Nomenclature of Human Medicine Clin- strategic planning, and resource allocation, focusing on ical Terms (SNOMED CT); standards like the Health disease prevention, healthcare access, equity, and ser- Level Seven International (HL7) standards for digital vice quality. medical data exchange, the Digital Imaging and Com- munications in Medicine (DICOM) standards for image A digital health strategy is formulated based on the and medical graphs transfers (e.g., x-ray, ultrasound, country’s digital readiness, accompanied by an invest- magnetic resonance imaging, computed tomography, ment roadmap to support efficient resource allocation. electrocardiogram (ECG), eye fundus images, differ- An inventory of digital assets and an enterprise archi- ent endoscopy). These and interoperability ensure tecture are established to integrate IT systems and pro- that the various elements of the digital health infra- cesses in line with strategic goals. Digital tools are then structure can work together effectively. implemented to meet specific health needs, designed for scalability and integration into ongoing health pro- 47 ◄ Table of Contents Annexes Figure A2: Building Blocks of Digital Health Ecosystem Leadership and Governance Services and Applications Strategy and Standards and Interoperability Legislation, Workforce Investment Policy and Compliance Infrastructure Source: World Health Organization, National eHealth Strategy Toolkit 2012. grams to ensure sustainability. Governance mechanisms enforce compliance and data usage standards, crucial for maximizing the benefits of digital initiatives. Supporting these efforts are the foundational elements of a national health strategy—leadership, investment, legal frame- works, workforce development, infrastructure, standards, and service applications—which together facilitate the effective execution of the digital health strategy. Figure A3: Essential processes of national digital health implementations Source: WHO 2020, Digital implementation investment guide: integrating digital interventions into health programmes. 48 © 2024 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org