• Public Health
  • 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 careAdherence to clinical guidelines and best practicesEfficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources Health-financing models and processesRegulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errorsHealth 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?

  • African countries setup Country Health Situation Rooms for better health monitoring

    Two weeks ago, I was fortunate to participate in a workshop in Ethiopia hosted by the African Union, Africa CDC and UNAIDS.  The workshop aimed at strengthening the Country Health Situation Room initiative and roll-out across African countries.  Its goal is to support better use of health data and help countries keep populations healthier by improving their response to infectious diseases and epidemics.  

    Kenya was the first African country to adopt the Situation Room in 2015.  A further six countries – Cote d’Ivore, Lesotho, Namibia, Zambia, Uganda and Zimbabwe – have launched their Situation Rooms and are currently at different stages of scale-up and roll-out. 

    The Situation Room software integrates health data from multiple sources such as the DHIS2 and logistics management information systems (LMIS) at a country level.  Data are presented visually to help countries track progress and identify gaps in key health indicators.  The customisable interface allows countries to design their Situation Room around their health areas of interest and user types. 

    Matthew Greenall’s case study on the Country Health Situation Rooms describes the progress so far. Achievements include; 

    Enhanced collaboration between different health programmesImprovements in health decision makingImprovements in data qualityIncreased data use for decision makingImproved data sharing between stakeholders at national and regional levels

    Important challenges are also identified, such as;

    High turnover of staff and leadership compromised progressOperational and budgeting constraints interrupted roll-out in some countriesPoor quality of data at sub-national levelsOwnership – a strong desire for countries to host the software themselvesMaintenance of the Situation Room software requires strong technical support

    The Health Situation Room is a bold step for the participating African countries. We look forward to reporting the progress of this important eHealth contribution to health systems strengthening.  

  • eHealth start-up Redbird can expand access to rapid diagnoses across Ghana

    Africans suffer from diabetes at more than twice the global average. Resource constraints mean that millions lack proper access to healthcare to help them manage the disease. Launched this year, July has been a month of swift advances for Redbird Health Tech (Redbird HT) to try to bridge the gap.

    Chronic diseases, such as diabetes and hypertension, account for half of Ghana’s healthcare activity. Responses require treatment and long-term monitoring and management. Travelling to a hospital and waiting was the only the services for chronic disease patients. Risks of patients ignoring their conditions, either by necessity or willfulness, are very high. Consequences can be devastating.

    An interview  with Patrick Beattie, Redbird’s CEO, in Disrupt Africa, says his team could leverage existing, approved, under-utilised Rapid Diagnostic Test (RDT) technology to create convenient health monitoring points for routine health questions and, alleviating pressure on overburdened physician. Redbird secured funding from Gray Matters Capital an Atlanta-based impact investor. Redbird’s success with third place in the Ghanaian round of the DEMO Africa Innovation Tour seems to have helped its case.The solution develops a network of locations for primary care diagnoses and personal health monitoring to offer patients local access to healthcare at minimum disruption and cost. Existing national networks of pharmacies are part of the service. Redbird supplies them with verified RDTs, health monitoring software, and trained staff to interpret RDTs’ data.

    Having secured finance, Redbird’s plans to expand its pharmacy partnership from two to thirty in the next three months. The project’s scalable, and could become regional. Eventually, it could expand across all Africa’s health systems.

     CureAid pharmacy in Adenta advertising Redbird health monitoring services. Image from the Redbird website.

  • GIS software helps optimise health efforts

    Graphic information systems (GIS) software could change the way countries tackle public healthcare issues. GIS helps capture, store, combine, analyse and display aggregated data from censuses and national health information systems and then overlays this data onto regional maps.  This visual representation of data then allows departments of health and ministries to better manage resources and plan accordingly. 

    A great advantage of using GIS technology in healthcare application is the spatial dependency of health related factors.  Several countries and organisations have already started to invest in GIS programmes.  In the United States, the Centre for Disease Control (CDC) launched its 500 Cities Project, which aims to provide geographic data on the distribution of chronic disease risk factors.  In South Africa, the South African National Aids Council (SANAC) launched the Focus for Impact Project, which aims to identify populations most at risk in areas most severely affected by HIV and TB. 

    The hope is that by better visualising and understanding the geographic distribution of health variables, health departments and planners will be able to plan public health interventions more effectively.  GIS software helps with this by answering 2 key questions; 

    Where are the high burden areas? – by overlaying routine health data on geographical regionsWhy is it a high burden area? – by profiling epidemiology and associated risks using secondary data and community dialogue 

    This in turn allows health departments and health planners to identify; 

    Who is at risk in this high burden area?What interventions can help reduce this burden? 

    To improve the overall health of our communities, access to these kinds of services is vital.  Further investment into GIS programmes could reveal other beneficial use cases for the healthcare industry, improve overall efficiency and better manage the cost burden of the healthcare system.

  • Predictive analytics needed for better infectious disease tracking

    When outbreaks of new diseases emerge, public health’s impact inevitably follows events. Eventually, it catches up. The US Government Accountability Office (GAO) report in May 2017, Emerging Infectious Diseases Actions Needed To Address the Challenges of Responding to Zika Virus Disease Outbreaks, found that the Zika virus case counts from the national disease surveillance system underestimate the total number infections because: 

    Infected people may not seek medical care because they have only mild or no symptoms, or other reasons,May not be diagnosed because of limitations in Zika virus diagnostic testingIncomplete surveillance reporting.                                                                                                                                   

    Better, prompt and accurate information’s still needed. Three Congress representatives have written to the GAO boss, the Comptroller General, suggesting a subsequent study into predictive models and systematically integrating modelling into outbreak responses. They think the US can respond more effectively bt learning if:

    Federal agencies use predictive modelling to inform planning for emerging infectious diseases?How federal agencies use models to inform regulatory decisions about infectious disease outbreaks?Do medical product sponsors use predictive modelling?What funding’s available for infectious disease predictive modelling?What challenges do predictive modellers face?If and how, federal agencies validate models’ predictions? 

    With predictive modelling and analytics expanding their potential, these seem like a good set of questions that all countries should ask. Answers can inform eHealth strategies and strengthen the role and impact of public health professionals.

  • Egyptians’ OHI profiles identified

    As African’s have increasing opportunities to use the Internet to find Online Health Information (OHI), it’s extremely valuable to know about how they use it so health systems can expand and improve the service. A study by a team from the UK’s Birmingham University and Egypt’s Suez Canal University, reported in the Journal of Medical Internet Research (JMIR) has identified the characteristics of adult Egyptian OHI users.

    Internet World Stats has estimated that about a third of Egyptians seek OHI. Most users looked for information about more than one health topic. The team’s sample of 490 of these had an OHI topics’ profile of:

    Most people, 83%, rated OHI quality as good or excellent. The other 17% thought it was fair, so no-one said it was poor.

    Over half, 53%, were searching for information about their own health. Under a third, 30% were seeking information for someone else.

    The main personal characteristics associated with frequent OHI searching by Egyptian adults were:

    Younger ageFemalesHigher educationGood general health.

    People with one or more chronic health problem was more likely to search for OHI more frequently than people without any chronic health conditions. This may indicate a vital role for OHI.

    The study’s results can only be generalised to Egyptian OHI seekers. It would be good to see equivalent studies from all African countries. Until then, Africa’s health systems can continue to rely on the Internet as an important tool for health information dissemination and to support healthcare delivery. It can build on the findings that OHI has made the Internet a major and growing source of health information for Egyptian Internet users.

  • Protecting our children from HPV

    One in every eight women in South Africa die from complications of  cervical cancer. Each year, 5,743 new cases of cervical cancer are reported. Almost half of these, 3,027 cases are fatal.

    About 80% of cervical cancers are caused by the Human Papilloma Virus (HPV). It infects the genital area and causes anything from a small genital wart to cervical and other cancers. Vaccination can prevent the virus infection developing on the cervix. 

    In 2014, the South African National Departments of Health (NdoH) and Basic Education launched a national vaccination campaign to prevent cervical cancer by vaccinating girls aged over nine against HPV. The vaccination was aimed at 500 000 girls from 17 000 public and special schools to provide them with protection before they can be exposed to HPV infection. 

    In co-ordination with the government’s Integrated School Health Programme (IHSP), school health nurses visit schools twice a year to vaccinate the girls. None of them are vaccinated without parental consent.

    As the vaccination campaign grew, collecting data became more complex and challenging. NDoH approached the Health Information Systems Program South Africa (HISP-SA) to lead implementation of a mobile data capturing application. It supports data capture during the campaigns. 

    The app’s part of the NDoH's routine health information system, DHIS2, sometimes referred to as webDHIS. It was customised for the campaign by HISP-SA’s Lusanda Ntoni and piloted in three provinces. Then, it was developed further using findings from field visits, and implemented during the 2016 campaign. 

    A Standard Operating Procedure (SOP) document helps vaccinators and data capturers to transfer HPV data from registers into the tracker capture app. There’s also a guideline for programme managers and information officers on accessing dashboards with information from the campaign on  webDHIS. These were updated as the app was implemented. 

    To date, the app’s been implemented in all nine provinces in South Africa, a task co-ordinated by HISP SA’s HPV project manager, Margaret Modise. It’s simplified HPV dashboards for monitoring and reporting and shows how a simple mHealth initiative can enhance the productivity of vaccination campaigns. Will this way of capturing data lead to more large-scale campaigns in South Africa?   

  • How can patients’ data follow them around health systems?

    Most patients are mobile. Their healthcare’s provided by different types of health professionals and other workers and organisations. In Africa, many people change towns and migrate from remote communities, so they access their healthcare in different districts and regions. It’s hard for their information to keep up, even between local clinics and hospitals.

    A major eHealth goal is to provide access to patients’ information wherever they turn up for their healthcare. A report from Health IT Analytics sets out a way to achieve it. Best Practices for Building an IT Infrastructure to Support Digital Transformation. It sets out five main steps:

    Create an eHealth footprint focused on connectivityUnlock data to move information securely across different systemsEliminate data silos to enable secure data sharingEngage patients electronically in a way that’s convenient and meaningful for themUse analytics to optimise health data’s value. 

    It needs a significant parallel investment in the data itself. These eHealth programmes can be pursued in the context of the five goals. For Africa’s health systems, this may easier to construct than developed countries because of the current, limited legacy systems. It might be easier, but it’s not easy.

    The report sets out a hierarchy of eight steps moving from an integration foundation up toe ecosystem engagement:

    AnalyticsMobile app developmentIdentity federationApplication Programming Interface (API) managementExtensible Markup Language (XML) and Service-Oriented Architecture (SOA) servicesAPI integrationB2B Electronic Data Interchange (EDI) integrationManaged file transfer

    This perspective sets an eHealth horizon beyond information systems. It needs rigorous eHealth leadership. It needs considerable resources and eHealth capacity too. For Africa’s eHealth, the eight steps offer a long term direction. It’s still a direction that’s needed, and building blocks can be put in place in the short term.

  • Africa’s relative poverty is increasing

    Poverty and poor health worldwide are inextricably linked, and it’s both a cause and a consequence of poor health, which traps communities in poverty. The Health Poverty Action (HPA) initiative’s clear about it, and says links between poverty and poor health are:

    Economic and political structures that sustain poverty and discrimination need to be transformed for poverty and poor health to be tackledMarginalised groups and vulnerable individuals are often worst affected, and deprived of the information, money or access to health services that would help them prevent and treat diseaseVery poor and vulnerable people may have to make harsh choices, knowingly putting their health at risk because they can’t see their children go hungryCultural and social barriers faced by marginalised groups, including indigenous communities, can mean they use health services less, with serious consequences for their health, perpetuating their disproportionate levels of povertyCosts of doctors’ fees, courses of drugs and transport to reach health centres can be devastating for poor people and their relatives who care for them or help them reach and pay for treatmentIn the worst cases, the burden of illness may mean that families have to sell their properties, take their children out of school to earn money, sometimes  by beggingCaring burdens are often taken on by female relatives who may have to give up their education, or take on waged work to help meet households’ costsMissing education has long-term implications for women’s opportunities and their healthOvercrowded and poor living conditions can contribute to the spread of airborne diseases such as tuberculosis and respiratory infections such as pneumoniaReliance on open fires or traditional stoves can lead to deadly indoor air pollutionA lack of food, clean water and sanitation can be fatal.

    The Economist has reviewed data from the World Bank.  The good news is that the number of people living in absolute poverty, defined as having less, than US$,90 a day at 2011 purchasing parity, has dropped from over 1.8 billion in 1990 to under 0.8 billion in 2013, down by about 55%. Within this considerable achievement, Sub Saharan Africa’s (SSA) relatively worse off.

    In 1990, about 15% of its population were in absolute poverty. In 2013, it was approaching 50%. Two reasons are first, absolute poverty in South Asia and East Asia and the Pacific has dropped enormously. Second, Africa’s population has expanded by about 2.5% a year, more than twice Asia’s growth rate. SSA’s absolute poverty rate has dropped from 54% to 41%, but the relatively high population growth means that more people in SSA are now living in absolute poverty.

    For many years, SSA’s been attributed with a relatively high burden of disease. Now that other global regions are pulling away from absolute poverty, it has an increasing relative absolute poverty burden. The HPA commentary indicates a heightening challenge. It’s clear where Africa’s eHealth’s focus should be.

  • VFAN is expanding into more countries

    After its success in Rwanda, Vision for a Nation (VFAN) is planning to take its approach to other countries. It could be good news for some African countries.

    It’s already helped more than a million people in Rwanda to access eye care services. In four years, VFAN’s provided:

    Over 1.2 million eye screenings, more than 10% of the population560,000 prescriptions144,000 referrals for specialist treatment109,000 pairs of glasses.

    VFAN’s programme has supported Rwanda’s Ministry of Health to build an affordable, successful nationwide eye care service locally available to 10.5 million people. It’s fully integrated into the public health system.

    Tom Rosewall, VFAN’s CEO says “Rwanda is the first emerging country in the world to provide all of its people with local access to affordable eye care.” The service in Rwanda’s sustainable. eHNA reported earlier that Rwanda’s Ministry of Health will assume full responsibility for new eye care services from January 2018. VFAN now plans to take its initiative to other countries around the world. Other parts of Africa are good places to start.