Sean Broomhead

Chief Technology Officer

  • South Africa’s new Digital Health Strategy emphasises person-centred health services

    South Africa's National Digital Health Strategy 2019-2024 has been published online. It updates the previous National eHealth Strategy 2012-2017. It presents a vision of Better health for all South Africans enabled by person-centred digital health.

    People are at the centre of the strategy. They include health workers, helping them experience better working lives; patients and their families, helping them access better care, and citizens, supporting them to make sound health-seeking choices. This strategic focus is encapsulated in the first of five cross-cutting strategic principles, which emphasises person-centeredness. The other four principles are expanded access to services, innovation for sustainability, workforce for economic development and a whole-of-government approach.

    Nine strategic components are:

    • Leadership: develop leadership capacity for digital health innovation and adaptive management
    • Stakeholder engagement: undertake appropriate multi-stakeholder engagement for shared opportunities and successful digital health implementation
    • Strategy and investment: develop sustainable interventions and appropriate investment and funding mechanisms for digital health implementation
    • Governance: review and strengthen governance structures and oversight mechanisms for the implementation of the strategy
    • Architecture and standards: establish an integrated information architecture for interoperability and effective, safe sharing of health information across health systems and services
    • Applications and services: develop appropriate digital applications and services that improve health services for patients and health workers
    • Infrastructure: establish a robust physical and network infrastructure and broadband connectivity for priority digital health applications and services
    • Legislation, policy and compliance: formulate national legislative, policy and regulatory framework for digital health
    • Capacity and workforce: develop enhanced digital health technical capacity and skilled workforce for digital technology support and implementation.

    An important aspect is the National Digital health Platform, which builds on previous standards and interoperability work. It will provide online technical resources to support developers in the digital health space to achieve:

    • Overall quality and continuity of care
    • Adherence to clinical guidelines and best practices
    • Efficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources
    • Health-financing models and processes
    • Regulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errors
    • Health policy-making and resource allocation based on better quality data.

    The platform will “help to democratise the health information systems development space for more stakeholders to participate” by creating reusable tools and architecture. 

    Now that the strategy has been published, and we enter the phase of implementation, collaboration becomes critical. We need to get better at how we do this, as we explore how to cooperate to achieve the aspirations of the strategy. It’s an exciting time for those of us who believe in digital health and its role as an enabler of health systems transformation.

    There is lots to be done and how we work together will be an important success factor. What parts of the strategy will you be helping to implement?

  • WHO digital health guideline: 7. Decision support for health workers

    Decision support is the topic of the seventh part of the WHO Guideline on Digital Interventions for Health Systems Strengthening. Key points are summarised below.

    The main WHO recommendation: the use of health worker decision support via mobile devices in the context of tasks that are already defined as within the scope of practice for these health workers.

    Electronic decision support systems help health workers to make better decisions, using available patient data to generate patient-specific assessments or recommendations for the clinician to consider. In many countries, where quality of care is suboptimal, decision support tools can offer guidance to health workers and help to improve adherence to recommended clinical practices.

    Decision support tools can support numerous clinical interactions, including diagnosis, treatment and referrals, to minimize errors and improve care. They use various techniques, including algorithms and rules based on clinical protocols, to create case management checklists and to assist with activity planning and scheduling. Over the last decade, they have progressed to mobile devices, providing unique opportunities for point-of-care assessment, diagnosis and management.

    For community health workers, effectiveness evidence suggests that these tools may have positive effects on their support for patients taking prescribed medication, though may make little or no difference to the clients’ overall health status and their satisfaction with the information they receive.

    Qualitative evidence suggests that health workers find decision support tools useful and reassuring for guiding the delivery of care. However, some health workers perceive algorithms as too prescriptive, and are concerned that they may lose their clinical competencies by blindly following treatment algorithms.

    Health workers are advised to explain to patients that they will use a digital device and seek clients’ permission first, to help ensure that use of the device does not impact negatively on the relationship with the patient.

    While health workers based in peripheral facilities and rural communities may find these interventions particularly helpful, they are also exposed to obstacles such as less access to electricity and network coverage. Challenges related to network connectivity, access to electricity, usability of the device, and sustaining training and support are noted.

    There is extensive additional discussion in the Guideline. Pertinent comments include that the validity of underlying algorithms and decision-logics must be carefully considered and that decision support tools should not be used for tasks that are beyond the health workers’ current scope of practices.

    My next piece in this eHNA series deals with digital tracking of clients’ health status and services.


    The WHO Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    Topics are:

    Evidence is presented under headings of:

    • Effectiveness
    • Acceptability
    • Feasibility
    • Resource use
    • Gender, equity and human rights.

    Implementation considerations address key topics from the WHO/ITU National eHealth strategy toolkit, such as:

    • Legislation, policy and compliance
    • Interoperability and standards
    • Workforce.

    Explore more eHNA coverage of WHO initiatives here.

  • A treasure trove of global goods revealed at DHIS2 2019 conference in Oslo

    Midsummer in Oslo, Norway has become synonymous with the DHIS2 conference, an annual meeting of the global DHIS2 community. This week I have had the pleasure of being part of it, along with 267 other participants from 61 countries and 118 organisation, 17 to 20 June.

    I have seen big changes over the three years I’ve been attending this event. Technology, people and ideas are maturing and aligning to provide a formidable vehicle for positive change, all brought together around the DHIS2, a remarkable global good supporting health strengthening and Universal Health Coverage efforts around the world.

    Hot topics this year include the DHIS2 FHIR adaptor, usability enhancements for a new DHIS2 Android App, extended analytics and visualisation, promising UX/UI enhancements, and many success stories of country DHIS2 use cases.

    I led a team to present on the Human Resource Information System work we have been doing in South Africa. In particular, we showcased an open standards-based interoperability architecture we've developed. It integrates a wide range of primary systems using OpenHIM, HAPI-FHIR, custom NodeJS, IHE mediators and DHIS2 to create a highly responsive, integrated environment. Key products are a Human Resources for Health Registry and a Data Warehouse. They will put data in the hands of various users, including the public, and give decision makers what they need to plan and manage the health workforce.