Published May 2020
Humans and computers can both get viruses. In the future we might have electric doctors. The barrier between man and machine is becoming thinner and one day soon we might accidentally give our laptop the flu. Digital Health takes on a new meaning when you consider this possible scenario. Fortunately we are a few years away from this happening, but have you considered what is involved with E-health?
Did you know South Africa had an e-Health strategy for the years 2010 - 2014? How about our Digital Health Strategy for the years 2019 - 2024? Many people are unaware of our country’s electronic status. Everyone should know a little bit about what is happening with our electronic health strategy which is part of our National Development Plan to be achieved by 2030.
This article is important because never before has the general health of our population been such a huge consideration to individuals, corporates, organizations and government. The pandemic we are suffering from and all the social and economic ripple effects have filtered into every part of our lives. Will we have learnt any lessons? A question I answer in an article I will post within the next few months called: ‘Lessons for the Future Thinker from the Coronavirus.’
As a Tech Trend writer it was natural for me to ponder how our health status is supported by gadgets, it is the reason I took time to read our Digital Health Strategy. I would very much like to be one of the Change Agents referred to in the document. The definition of E-Health or Digital Health varies a lot. Some believe AI is part of a good E-Strategy. Others believe humans are still the core to any successful plan, even an electronic one. To simplify, let’s use my definition:
“A Digital Health or E-Health strategy is an all-encompassing plan, plotting out the use of electronic tools (software & devices) to enhance our ability to live a longer and healthier life.”
All around the world we are using technology against Covid-19. Not every tech solution works in Africa, for example we struggle to triangulate (track) infected citizens in rural areas because our cell phone towers are too far apart. Regardless, South Africa displays a genuine commitment to the use of technology. Not many can fathom the complexity of this task.
Our solution has to make provision for every person (including those from other nations) living within our borders. This point is not made in our plan, so let me make it now: disease does not discriminate by citizenship, race, age, language… or any other way we like to define people. (A practice that must stop in South Africa.)
The rest of my comments are made in no particular order and not to be seen as praise or criticism. My objective is to get my Followers quickly up to speed and share my professional opinion.
Within the document, digital technologies is cited to be a solution to reduce the burden on the health system. A complete health electronic record of every citizen is meant to be established by the year 2024. I would have set the timeline of around 7 years at least.
Major mechanisms needing elaboration are: leadership, engagement and investment. The ‘how’ is absent. Three other subjects missing substantial attention are: education, privacy and access. Entire sections of opportunity are missing, an example: medical waste, and how technology can play a positive part in the process of managing this.
There are 5 sections of legislation listed that impact digital health, but none referenced are specific to actual health legislation or even basic human rights. I was thrilled to read there is intent to create a national legislative with regulatory framework.
Free data during a natural disaster needs to be part of our plan. Access to electronic communication and information must be a basic human right, and that is not just my opinion, the Human Rights Council of the United Nations General Assembly declared access to internet a basic human right. If this was in place today we could have done so much more during this time of crisis, such as: online learning, sharing work & job information, engaging with government, sharing pertinent real time information. It would have helped us stay in contact with loved ones.
There are some extremely important objectives mentioned, for example: the intent to transition to WebDHIS. WebDHIS is the South African deployment of the web-based District Health Information System 2 (DHIS2). Most people will have no idea what this all means, to be honest myself included, and that is perfectly fine, but what I want you to take from this is comfort that actual technical decisions are being made to move us forward.
Unfortunately, the document is at best a draft. I felt I experienced an explanation of a dream rather than a real life moment. Cyril Ramaphosa’s dream of a Smart City made me consider him a Future Thinker. Another one of Cyril’s dreams has a real heartbeat, it is the Presidential Commission for the Fourth Industrial Revolution with a panel of 30 strong. I have attempted to engage with most of them and already received one positive reply.
One of the stepping stones is to develop a Human Resource Information System. I struggled to find information offering an update on progress. I have written to the Department of Health and perhaps I will get a reply so I can ask the questions I have ready for them.
Government communication is inadequate. In my experience it is hard to get a response from someone in the know. Both good and bad news is a necessity for me to believe a report. Let me share an example of something positive from the strategy document: South Africa has a Stock Visibility System for clinics and hospitals. This might not be something of general public interest, but why not communicate positive news vigorously? Good news hardly enjoys the same momentum as bad and the first sources of information on this subject don’t appear to come from Government. Here are the two examples I found first:
https://www.hst.org.za/hstconference/hstconference2016/Presentations/svs_hst_conference_20160503.pdf & https://www.vodacombusiness.co.za/business/solutions/internet-of-things/stock-visibility
An example of current innovation: the Faculty of Engineering at the University of Johannesburg are championing an open-source ventilator design for mass production. This is E-Health innovation.
South Africa has a history of innovation in Tech. Have you heard of the Biomatrix System? Biomatrix systems theory was developed through an interdisciplinary PhD programme in Cape Town at UCT. Here is a link if you want to learn more: https://en.wikipedia.org/wiki/Biomatrix_systems_theory
A health play store is to be established, which is where I assume you will be able to download health related apps. I believe this platform will work well in South Africa. Government has initiatives already in place and doing very well, for example: Nurse Connect (https://nurseconnect.org/) and MomConnect (https://www.praekelt.org/momconnect ) which has over 2 million users.
The Digital Health Strategy mentions its hope for life expectancy in South Africa for men and woman to be 70 years of age. Currently it is around 62 years for men and 68 for woman. I was sad to learn one baby dies for every 1000 born. This is a much higher death rate than Covid-19.
I was pleased with the explicit objective to have a largely HIV free youth. An estimate of 5.7 million are living with HIV in South Africa.
The Strategy document mentions a paradigm shift of health information systems to include patient monitoring focus. I have a general objection to make at this point because technology can be used to focus on preventative solutions and not just reactive or treatment of those already ill. AI and big data with predictive algorithms can address problems before they even arise and these systems can improve our habits to support a better quality of life. This will go a far way in achieving a primary objective of reducing stress on our health systems.
Interoperability between existing platforms and the need for a cohesive strategy, breaking down silos are all good objectives. It is easier said than done because of many legacy systems in place. I would be interested to know who the suppliers are for the robust physical and network infrastructure broadband connectivity priority digital health application systems will be. (I almost ran out of breath reading that.)
I assume Telkom and Vodacom will be key players. When I last checked a certain South African cell phone provider had paid over 5 billion Rand in taxes… that is more than the entire SMME relief fund for Covid-19.
Any sort of monopoly or preference in service providers in delivering our digital health system must be eradicated. It must be an open source and equal opportunity environment. This is the only way to create space for innovation, speed up advancements and reduce price to consumers.
In the strategic principles table they repeated ‘stake holder engagement’, was this by error or a point that is doubly important? Perhaps it was just an error not picked up during the proof read.
The policy says it wants to be client centric with humans being the epicentre. If this is the case, where is the engagement and communication with South Africans? If you build something for someone, you ask how they would like it to work. Cyber security, resistance to change and funding shortages are highlighted as reasons implementation will be slow, but the lack of engagement and consultation might start our plans off on the wrong foot entirely.
Technology must address a need in order to be successful. Our main problems prohibiting progress for the E-Health sector are: access, affordability and education. Tuberculosis, HIV, Diabetes and Cerebrovascular diseases are the main reasons for a shorter life in South Africa. Our plan must consolidate all these factors and then we must attack with technology from three angles:
Nearing the end of the document is a section that mentions digital health needs new skills. It also mentions entrepreneurship will play a role and I agree. Unfortunately there is no point made about re-skilling the current work force and without this mass job losses will follow and a further skill migration. We import too many skills when we could be offering work to our own people, for example the team we flew in from Columbia to support our Covid-19 efforts at a cost of R400 million.
Many parts of the strategy document talk to the fact that National Treasury needs to be engaged with and creative ways of raising funds need to be investigated. Spending wiser is something the public needs to see. A re-allocation of available funds needs to be the first step.
The private sector is a source of income but proposed changes to legislation in the sector, specifically for national health insurance, must have many companies nervous as well as their clients.
Government must support an environment for corporates to do well and not appear to want to replace them, especially if you don’t have a track record of success in running businesses or offering a better product.
A continued study of countries with the best health care systems and the healthiest people is an imperative task to be maintained, we need to tweak our plan after review of this data because what works in Finland, might not work in South Africa. Open source technology, decentralized management, multilevel funding, are all common in successful strategies and a good place to start. Unfortunately, none of these points are titles in our plan.
I like the concept of the Digital Health User Journey. My broader understanding is all people will be assigned a Digital Personality and a Digital ID. The Digital Personality concept I won’t get into now and relates to our habits more than our physical status. Our Digital ID will have absolutely all records: identifying and personal details, transactional and experience information, and of course our health history. These records I envision living in part on a smart microchip implanted into our body, a concept I started to write about in July 2019, a futuristic narrative:
Soon, the decision to be part of the E-Health system or not will need to be made. Do parents make this decision for their child or do they get to decide when they are older? Human rights will evolve as we integrate more with the Internet of Things and Industry 4.0.
Ethical boundaries will need to be defined before we can ever realize E-Health.
Our plan is commendable but has gaps. The timeline is not achievable and must be reworked.
Ironically a health issue has set us back in rolling out our plans for a long and healthy life.
Stay Healthy Future Thinkers.
Future Thinker. Innovator. Change Expert. Industry 4.0 & IoT Specialist. Green & Sustainable Solutions. Digital Marketing, Security, Devices & Trends. Author, Consultant, Project Manager & Scenario Planner.
Published May 2020Read more articles