Technical Assistant to the National Department of Health (NDoH), Dr Peter Barron, talks about the development of mHealth and its impact on healthcare. Dr Barron also shares his insights on SA’s first large-scale mHealth initiative and one of the most successful of its kind in the world, MomConnect.

Dr Barron will be a keynote speaker at eHealthALIVE2016, talking about how mHealth is one of the tools for improving access to healthcare. Get your ticket now and be part of this transformational event.

Tell us about your background and your current role in the NDoH as a Technical Assistant.

I’m a public health specialist with over 30 years’ experience working in primary healthcare with a special interest in health information management. I trained as a medical doctor and practiced clinical medicine mainly in rural areas in the now Eastern Cape and Mpumalanga. I specialised in public health at Wits University and I then became a manager in what is now the Cape Town City Council where I was the manager responsible for health services in Khayelitsha. In 1994 I was seconded to the Northern Cape and I became the acting Head of the Strategic Management team. I also worked for Health Systems Trust (HST) for 14 years, initially as a research manager, and later I became the manager for strengthening district health systems.

Following HST I worked as a short term consultant working on projects in South Africa, as well as in a number of African countries, India and Nepal. At the end of 2009, I became a technical assistant in the NDoH and I have been there ever since. I have worked closely with the Deputy Director-General responsible for HIV, TB and Maternal, Woman’s and Child Health. The main role of the NDoH is to set policy and to monitor the implementation and I provide support in these areas.

What is your perspective of your 30 years in the public health sector? How do you think technology has and is impacting the health service and what would you like to see?

mHealth is a relatively recent development in SA and, while it hasn’t actively impacted much on our health systems or services yet,  it has enormous potential to do so in the future. mHealth has started to impact on both consumers and the users of the system and in the last year or two I’ve downloaded about five apps that were all initiated by the NDoH. In SA there is virtual  universal access to cell phones, people either own one or have access to one in their family and, with the  explosion of technology in the past 15-20 years, the sky is the limit in terms of making use of these cell phones. I believe the greatest impact is still to be seen in the future, and that we are only scratching the surface at the moment.

Are the opportunities driven by the volume of mobile phones that are out there and access that everyone has? What are the top opportunities that mHealth presents, both for the individual and the system as a whole?

There are opportunities within the health system itself – for example the NDoH recently implemented a mHealth project to digitise stock management. The system quickly alerts the relevant section of possible stock-outs. The NDoH has also harnessed mHealth to develop apps for HIV and TB guidelines, making it easier for clinicians to prescribe the correct treatment regimen in complex cases. Using the app, a clinician can put in a patient’s weight and other data that require different drug combinations. They can plug in the variables and the app automatically calculates what drug regime and the dosage of each drug that should be prescribed to a particular patient.

Let’s talk specifically about MomConnect; you were closely involved in that project. Can you give us your take about MomConnect, along with some examples of mHealth improving the quality of care at the primary care level?

About three years ago the NDoH realised that there were many small scale mHealth projects going on around maternal and child health, and we wanted to get all the different stakeholders in the same room to see what everyone was doing. The Minister of Health wanted to get maternal health information to pregnant women, therefore it made sense to use mHealth as it was probably the best way to go about getting this information out there. The Minister took ownership of this with great leadership and political will to implement it. He went as far as having a road-show in each of the nine provinces to get health workers in maternal and child health into one room to tell them what was going happen. That gave MomConnect its impetus to be a national programme. This support and the buy-in from critical leadership, was fundamental in bringing MomConnect to scale.

We have conducted some surveys of the women who are registered with MomConnect, where a lot of them said MomConnect made them more knowledgeable and indicated that they’d like to continue receiving the messages. Our surveys indicate that these women are quite happy with MomConnect.

In terms of impacting on the quality of care, we have built into the system, at the insistence of the Minister, a feedback mechanism from the users which enables them to ask questions and get answers to issues that they want to know more about. The users also give feedback about their experiences at a particular facility or clinic. In cases where we receive complaints, they are directed to the particular clinic or facility where the mother experienced poor service. That feedback has already resulted in some system changes.

Are there any other developments to come from MomConnect you can share with us?

There are lots of developments that are spinning off from MomConnect like NurseConnect that aims to involve healthcare workers much more than they have been previously. We’re registering nurses working in clinics and we are sending them information that is similar to the information that mothers get through MomConnect, but the difference is that the nurses get more technical information that is appropriate to improve their work practices, knowledge and skills.

NurseConnect was launched in May, and we’ve linked up about 6,000 nurses so far. The target is to get to 12,000 by the end of this year and 20,000 by the end of 2017. This has huge potential and it’s one of the most exciting things to come out of MomConnect – to get 100,000 or 200,000 nurses linked up and categorised in different ways so that you can segment them according to their specific work areas and needs. There are huge opportunities for in-service training, getting feedback on the system very quickly and so on.

Do you have an overall message for people attending the eHealthALIVE conference? What are you most excited about sharing and what do you hope people will get out of it?

The main message that I have for the eHealthALIVE attendees – specifically systems developers – is that when they design a new system, they need to take the users of the system into account. It’s difficult to change people’s behaviour, so all of these technologies need to take behaviour change into account. The technology is probably the easiest component of the programme.

The second message is to look at the entire system and assess what is required to make a particular system successful, and not to look only at the technical component. MomConnect, for example, has a host of partners involved. The successful ingredients include having sufficient resources;   technical expertise from mobile people needs to be available; ensuring that the interface between the mobile users and the technical people works; and then all the technical aspects and the system should interface with all the health services and the consumers. MomConnect is a very complex project with a number of components. It has worked up to now; it’s still in its infancy but initial indications show that it has been a resounding success.

Lastly, keep in mind that mHealth is not static; it’s constantly evolving at a very quick pace. As a systems developer you have to keep in mind developments and changes in handsets and changes in access to connectivity.

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