Head of the Family Medicine Department at the University of Pretoria, Prof Jannie Hugo, talks about how eHealth can be leveraged to encourage healthier practices and lifestyles and how his mHealth system, AITA Health, is empowering community health workers (CHWs). 

 Prof Jannie Hugo will be a keynote speaker at eHealthALIVE2016 talking about how healthy families should be at the core of eHealth strategies. Get your ticket now and be part of this transformational event.

Tell us about your medical background and role as Head of the Family Medicine Department at the University of Pretoria.

From the mid to late 80s I worked in primary care in the Qwa-Qwa bantustan (homeland) where I gained experience as a young doctor driving to different community clinics with a medicine box in the bakkie to see patients and support staff. During that time I got to see and experience first-hand what happens in the rural areas. From there I went to work at the Medical University of South Africa (MEDUNSA), which is now known as Sefako Makgatho Health Sciences University (SMU), where I trained doctors in family medicine. Seven years ago I became the Head of the Family Medicine Department at the University of Pretoria, where I’m  now  involved in primary healthcare  in Tshwane and Mpumalanga, which is a huge area of responsibility over and above educating students.

With the re-engineering of primary healthcare in the run up to implementing NHI, we were given the opportunity to re-look at how we could envisage and develop primary healthcare. Community Orientated Primary Care (COPC) is especially important in addressing healthy homes and the space between the clinic and the home. And obviously the development of technology, especially mobile technology, has opened up a whole new space there.

Let’s talk about healthy families and how that perpetuates into communities. How would you define that, particularly when it comes to rural areas where there isn’t a lot of access to healthcare?

First of all, just to make it clear, our understanding of family is a group of people that live together. The concept of the nuclear family as the standard format is no longer valid. So the whole concept of health is what’s practiced at home and between home and work. If you want to understand a person’s health you have to understand that it’s connected with those that he or she lives with and together they make a lifestyle. Communities are made up of people who live in those families, so in terms of health and what we conceptualise in terms of delivery, and what we need to teach students and what we need to practice, you actually need to impact on what happens in the household to be able to impact on people’s health and wellness.

How can eHealth be leveraged to encourage healthier practices and lifestyles in households and communities?

The use of eHealth or mHealth in rural communities will most likely be a success story because of how the African continent has leaped frogged to implement mobile technology. Mobile technology makes things more possible than before, because even if connectivity is a problem it’s always improving and there is the possibility that mHealth can function even if connectivity is limited or periodic. Mobile technology makes it possible to take healthcare into people’s homes.

Let’s talk about AITA Health, the eHealth system that you and your team developed for CHWs. How did it start and was it developed in collaboration with CHWs? Talk us through the process. 

Around 2010 when we started working with community orientated primary CHWs to learn and understand what was needed for improved communication, data collection and guidance. At the time I was fortunate enough to see Jacques de Vos, who was at that time with GeoMed and now Mezzanineware, present a pilot project on the use of mHealth with CHWs and I immediately saw its potential for our project.We then partnered with Jacques and his team and told them what we needed to enhance the efficiencies of the CHWs to provide patient-centred care at the patient’s home. CHWs are important because even though they are not trained clinicians or professionals, they understand the people in their community and have an on-going long term relationship with them.

We developed the first version of AITA Health in 2011 when we had about 54 CHWs. The first version was based on individual assessments related to the most important burden of diseases, epidemics and maternal and child health. That specific project came to an end around 2013 when we were approached by the City of Tshwane to roll out a community orientated primary care project at scale. That gave us the opportunity to develop a second version of the software using what we learned from the first version. We developed version two in phases and modules; first we looked at the household assessment and triage and then we looked at the disease or illness modules.

During the development process we realised that there was quite a lot of data that needed to be analysed. We therefore partnered with a group of actuary scientists at Wellnicity who were able to analyse the data in a quicker and more sophisticated manner. This was important because during the development phase we needed to see which data and which reports made sense before building it as a standard report in AITA Health.

We also needed a clinic-based data system that all the data could feed into, and because we couldn’t develop that on top of AITA Health, we went into partnership with Synaxon, the developers of a practice-based data system. Following that partnership we decided to register the name AITA Health, this belongs to the University of Pretoria and is delivered in partnership with Mezzanineware.

The system is still up and running and there’s an on-going process of clinicians reviewing the data and developing modules. There are also CHWs and team leaders involved in constantly testing the system.

What do you hope the impact will be on the health of the people within those communities using the tool?

To answer your question let me give you example of what we’ve done with TB patients.  By using AITA Health we immediately found that about half of those who have TB related issues are not in contact with the health service. As a result of finding this out we were able to immediately respond and engage with those patients to resolve the issue.

AITA Health has given us the ability to detect such problems early on, especially for those people who do not have access to healthcare services. It’s become clear that those that really need healthcare are the least likely to have access to it or actually make it to the clinic, especially if they previously had negative experiences at the healthcare facility. Therefore having a CHW visit that person’s home is a massive step, which is made even more impressive by having an mHealth system that is able to identify the patients and then make that data available so that we can track their follow up and outcomes. Obviously the impact on mortality and morbidity statistics will take us longer to develop, but we already have an immediate impact report on a number of people.

Most recently we partnered with the City of Tshwane to help combat the addiction problem they are experiencing. We’ve started implementing the project where CHWs visit households to find out what the issues are around addiction so they can identify them before it becomes a disaster and implement early interventions.

We are also working with the Renal Unit to link people on peritoneal dialysis with a CHW at home. These are all examples of how we are working towards our goal of linking the entire health system to what happens inside people’s homes.

At eHealthALIVE2016 you’ll be giving a keynote address about keeping families central to eHealth strategies. Can you share with us an overriding message that you’ll share with the audience?

One of my messages will be about “High Touch, High Tech”, meaning that care is about the people and that technology is just there to enhance that. In the future I believe healthcare is going to be more in people’s homes due to the growing trend of wearables empowering people to take charge of their health and wellbeing. So in the context of the development of community orientated primary care, we envisage that in future people will manage their health issues at home and the CHW will be there to assist them. Such a scenario is not only an affordable solution to reaching and connecting more people to health services but it’s actually the future of healthcare for everybody.

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