The National Department of Health (NDoH) has identified IT and health information systems (HIS) as a critical requirement for successful implementation of National Health Insurance (NHI). This is according Chief Director: Human Resources for Health at the NDoH, Gavin Steel, who was speaking at the launch of the new SAMRC-Jembi Collaborating Centre for Digital Health Innovation.

During his presentation, Steel talked about the successful eHealth programmes that the NDoH has developed and implemented in collaboration with its partners, including the Council for Scientific and Industrial Research (CSIR), the South African Medical Research Council (SAMRC) and Jembi, to improve health outcomes across South Africa.

Before outlining the eHealth initiatives the NDoH has spearheaded in South Africa, Steel explained how the World Health Organisation (WHO) has defined HIS as one of the six building blocks of a health system. In 2005 the WHO adopted a resolution on eHealth and in 2013 a resolution on eHealth standardisation in interoperability. At the World Health Assembly in May 2018, the WHO also adopted two resolutions supporting member states in digital health.

“The first resolution on digital health recognised the potential of digital technologies to advance the Sustainable Development Goals (SDGs); support health systems in all countries in eHealth promotion and disease prevention; improve accessibility; quality and affordability of health services; and improve population health and health equity, including gender equality,” said Steel.

The second resolution adopted by member states of the World Health Assembly, including South Africa, was a resolution on mHealth. “This recognises the specific role of mHealth technologies in revolutionising how populations interact with national health services and how mHealth has been shown to improve the quality and coverage of care, increase access to health information, services and skills as well promote positive changes in health behaviours to prevent the onset of acute and chronic diseases,” said Steel.

Local eHealth policy

As a WHO member state, South Africa has made significant progress in establishing and implementing its eHealth policy. In 2012 the NDoH partnered with the SAMRC to develop an eHealth Strategy for South Africa, which has since guided national eHealth initiatives. Two years later, in 2014, the NDoH collaborated with the SAMRC and the CSIR on the development of the National Health Normative Standards Framework for Interoperability in eHealth in South Africa (HNSF).

“This landmark policy was adopted as an extension to the National Health Act and has heralded in a new era of HIS development, including the implementations of standards, interoperability and health information exchange,” said Steel.

Although being a long way from perfect in its current version, the HNSF has formed the basis of new digital health systems being implemented by the NDoH. The most successful example being MomConnect, the SMS-based messaging platform that was launched in 2014 to support mothers from pregnancy to their baby’s first few years of life with information and advice.

Digital patient management

Although the official South African eHealth policy was only published in 2012, in reality the NDoH has been using eHealth systems to manage HIV and TB patients since the early 2000s. In 2002 the NDoH collaborated with the SAMRC’s biomedical information’s research division to develop and implement the Electronic TB Register (ETR). The ETR platform enables an efficient method for the collection and analysis of TB data, including patient information such as case findings and treatment outcomes.

“The system has been implemented nationally in South Africa and has been supporting the national TB control programme for two decades,” said Steel.

According to Steel, the system is now being incorporated into TIER.Net, the electronic patient management system that was developed and introduced by the University of Cape Town (UCT) in 2011 to capture and manage HIV patient data. The system provides a trusted source of information to monitor patients on Antiretroviral Therapy (ART) as well as HIV counselling and testing, thereby enabling an effective method for HIV surveillance and programme analysis over time.

“This new integrated system will provide routine health, HIV and TB treatment implementation nationally in South Africa,” said Steel.

Stock management

Another successful programme being led the NDoH, in partnership with Vodacom, is the Stock Visibility System (SVS). The mHealth programme enables pharmaceutical stock levels in public healthcare facilities to be captured daily on a smartphone and synchronised to a central cloud where automatic alerts are then sent out where needed. The system also generates reports for the different levels of the supply chain.

The NDoH first partnered with Vodacom in 2013 to develop and deploy SVS to improve the drug supply chain network in South Africa. Prior to the development of the app, the NDoH relied on manual processes to manage drug stock levels in South Africa’s primary healthcare system as not all clinics were equipped with ICT systems.

“This system enables the NDoH to have heat maps of medicine availability at 3,400 clinics across the country. The SVS is one of the reasons why you don’t hear so much about stock-outs anymore; the drug manufactures have not changed, it’s our access to information that has changed and how we use that information to improve health systems,” said Steel.

Steel went on to talk about the success of the centralised chronic medicine dispensing and distribution system, in which the government uses a courier pharmacy that enables patients to collect their medication at a convenient location outside of a healthcare setting. “This was based on the paper-based system but at the moment we are busy migrating to an automated electronic platform,” said Steel.

It’s worth nothing that while SVS covers primary healthcare clinics, RxSolution is the electronic stock management system that is being used in the hospital setting. RxSolution is used to manage inventory, purchase orders, report any stock issues and medication dispensing.

Gearing up for NHI

According to Steel, to facilitate patient identification and continuity of care under NHI, the NDoH is currently working on implementing a unique patient identifier system – the Health Patient Registry Number (HPRN), nationally at public health facilities. This will be an important component of the national HIS.

“The system uniquely identifies patients across the health services and facilities and provides the opportunity to link information systems and strengthen data-based systems,” said Steel.

Steel added that contributing to the national HIS is the African Health Information Exchange programme. The programme was kicked off by UCT in early 2017, with funding from the Bill & Melinda Gates Foundation, with the goal of maturing openly available technologies to develop an integrated HIS to improve health system performance and clinical care for patients in the public sector.

According to Jembi, who is a programme partner, the project aims to “harmonise person-level health data to function as a standards-based health information exchange and disease cascade reporting system. The project will deliver a replicable and context-appropriate implementation of a health information exchange for clinical data working across national and provincial health departments in South Africa, as well as successful interoperability implementations for key contributing and subscribing systems critical to the HIV and TB response.”

Digital health collaboration

The latest national eHealth project in South Africa is the SAMRC-Jembi Collaborating Centre for Digital Health Innovation, which will be responsible for initiating, driving and facilitating digital health initiatives in the country, particularly those initiated by NDoH, with a focus on digital health implementation and operations research.

“The NDoH has requested the SAMRC to assist in the strengthening of mHealth in the public sector in South Africa. In response to this request, the Collaborating Centre has adopted mHealth as its first priority area,” said Steel.

“The Unit will also work closely with the CSIR, which is the main partner of the NDoH in the development of the national public HIS, to develop the mobile normative standards to cater for mobile apps,” said Steel.

Steel also said that the NDoH recently convened the Ministerial Advisory Council for eHealth, which is chaired by the Chief Operating Officer of the NDoH, Dr Gail Andrews. “The Ministerial Advisory Committee is providing guidance and oversight of key NDoH activities in the areas of digital health, including coordinating efforts of funders and partners,” said Steel.

“As we move into the era of NHI we will need greater and stronger HIS to support equitable distribution of health services and systems that are integrated with routine systems required by the NDoH,” concluded Steel.

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