Nationalised health care has been implemented by numerous developed countries worldwide, each structuring their organisation around electronic health (eHealth) systems to efficiently improve patient care. South Africa is in the development phase of such a process. A 14 year plan has been developed by the South African government to implement a National Health Insurance (NHI) system to combat the ever increasing health crisis (HIV & AIDS, TB, maternal, infant and child mortality, non-communicable disease, injury and violence) and lack of access to healthcare facilities.
The NHI aims to grant all South African citizens (and legal long-term residents) access to essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI fund. To do so requires the strengthening of the healthcare public sector so as to improve the health systems performance. However, there are numerous issues, such as the implementation of a national strategy, better and cheaper broadband connectivity to establish a nationwide medical network, improved cooperation between sectors, improved planning and the creation of a national master patient index (MPI), that first have to be resolved before such a system can be properly implemented.
Two years ago the South African Department of Health released the National Health Insurance in South Africa policy paper outlining what has to be done to establish an effective eHealth strategy; the need for better regulation of healthcare, improved quality of care and the strengthening of information management. According to the policy, this year and next has and will continue to witness the further establishment of the NHI fund by the appointment of CEO and staff, the establishment of governance structures and the establishment of administrative systems.
It has been governmentally acknowledged in eHealth Strategy South Africa 2012-2016 that many of the challenges facing the implementation of the South African NHI can be resolved through the implementation of an efficient eHealth system that is capable of producing real time information for decision making. Electronic healthcare includes health care informatics, mobile health (m-health), e-prescriptions, electronic medical records (EMRs) and telemedicine, all of which can be harnessed to benefit the South African healthcare industry.
The South African government created a 10-point strategy for implementing eHealthcare for 2012-2016 that includes strategy and leadership, stakeholder engagement, standards and interoperability, governance and regulation, investment, affordability and sustainability, benefits realisations, capacity and workforce, e-health foundations, applications and tools to support healthcare delivery and monitoring and evaluation of the health strategy. At the end of the two year mark there is still a lot that needs to be established before the strategy can be marked as complete.
Internationally there have been a lot of eHealth standards developed by organisations, such as ISO and CEN, but only a few have been localised and formally adopted in South Africa. Currently ISO 21549 is being localised, and SABS is coordinating a local standard that will be referred to as SANS 828-2 Health informatics – Heath Smart (HS) card. The Private Healthcare Information Standards Committee (PHISC) also aims to maximise cooperation in eHealth standards across South Africa.
The goal of implementing eHealth technology is to improve the healthcare service delivered to all South African citizens. However, the issues of network access and bandwidth, staff training, formulation and implementation of a new management, record and MPI system all have to be resolved. The South African government hopes to achieve this within the allocated 14 year period by building on what already exists in the private and public sector, and then filling in the gaps.