Inclusive digital health policy starts on the frontline: A South African case for cross-sectoral collaboration

GHFutures2030 Blog Series, Health futures: Youth voices at the forefront of digital health governance
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The culmination of the fourth industrial revolution and Covid-19 pandemic has fast-tracked the use of digital technology in healthcare. Mobile Health (mHealth), a wireless medical service accessible by mobile phone, is a rapidly expanding market that is expected to exceed 300 billion U.S dollars by 2025. For instance, the Google Play Store launched over 6,000 new medical applications in 2020 alone.

Remote healthcare increases the reach of health services, especially in rural areas where geography is a significant barrier. In Sub-Saharan Africa, some communities live up to 3 hours away from the nearest health facility. Digital health can also improve the health systems’ capacity. South Africa only has 7 medical doctors per 10,000 people, compared to the United Kingdom or the United States with 58 and 26 doctors per 10,000 people, respectively. Artificial intelligence and machine learning can facilitate task-shifting to maximise healthcare resources.

Although digital health is beneficial, it is often misrepresented as an all-encompassing solution. There is no silver bullet to addressing the healthcare crisis in South Africa, not even digital health. Should we fail to implement the appropriate use of digital health within the African context, due to the lack of digital health governance, we may inadvertently worsen the health inequity.

The healthcare crisis

More than 20 years post-democracy, only 53% of South Africans have full access to healthcare. Irrespective of the government expanding the facility network and subsidising healthcare, research reveals that ‘rural households, less educated, unemployed and black South Africans, are less likely to have adequate access to healthcare’. Digital health can only address health inequity if it empowers the most vulnerable. Paradoxically, the poorest and most marginalised groups in low to middle-income countries face structural barriers to technology such as low smartphone adoption, poor network coverage, and digital illiteracy. The digital transformation of healthcare services can inadvertently alienate vulnerable groups by creating additional barriers to accessing healthcare, which further exacerbates health inequity.

"Should we fail to implement the appropriate use of digital health within the African context, due to the lack of digital health governance, we may inadvertently worsen the health inequity."

The solution

I believe South Africa and other low-to-middle income countries need to prioritise the development of policies that protect and promote ‘a smooth digital transition to mitigate the risk of social discord (that is) perpetuated by digital divides.’ To successfully achieve this, skilful leadership, public-private partnerships, and narrowing of the participation gap in policymaking are required. Groote Schuur Hospital, an academic hospital in South Africa that prides itself in healthcare innovation and is well known for the world’s first successful heart transplant, hosts the Groote Schuur Hospital (GSH) Healthcare Innovation Hub which has dedicated efforts to solve this very conundrum.

The GSH Healthcare Innovation Hub is an independent and impartial space for young frontline healthcare workers to think, design, create, measure, and critically evaluate South Africa’s digital health ecosystem. It is a partnership between the Bertha Centre for Social Innovation and Entrepreneurship based at the University of Cape Town's (UCT) Graduate School of Business, UCT’s Faculty of Health Sciences, Groote Schuur Hospital (GSH), and the local government.

As a final year medical student, a tech-savvy millennial, and a rural health enthusiast, the GSH Innovation Hub provided me with the opportunity to step into a novel environment (separate from the hospital wards) to meet with policymakers and colleagues across various medical disciplines. Moreover, my experiences have allowed me to accomplish three things: 1. to share my stories, 2. to problem solve, and 3. to provide care beyond the bedside. The GSH Innovation Hub facilitates the creation of digital health solutions (e.g. electronic patient care management tools), enables open participation in health policy, and challenges healthcare norms that health policy needs to be limited to the healthcare setting. As a healthcare provider, I carry the stories of my patients who are often the most vulnerable in my community, I silently witness health inequity, and I constantly bargain with a resource-constrained healthcare system. As a young person, I am agile and open to innovation, which makes me uniquely positioned to provide an inclusive perspective into healthcare governance.

"It is time for key stakeholders in the private sector, healthcare workers, and community members to develop a formal long-term partnership with government and global organisations."

Frontline healthcare workers and marginalised groups are essential to the contextualisation and dissemination of appropriate digital health policy. While the healthcare sector does not struggle with the scarcity of innovation, it fails to successfully engage all stakeholders including vulnerable groups and frontline workers. For this reason, a neutral space for cross-sectoral collaboration is vital. Successful tech-enabled healthcare relies on the diverse know-how of information technology experts, network providers, education institutions, technical manufacturers, and ordinary members of society; this is the leverage point of the digital health ecosystem.

Health innovation labs, however, should not exist in silos. Within pharmaceutical companies, hospitals, or non-profit organisations (NPOs) such as the Berth Centre (South Africa). It is time for key stakeholders in the private sector, healthcare workers, and community members to develop a formal long-term partnership with government and global organisations. I hope that the Governing Health Futures 2030 Commission Report provides a pragmatic solution, like the GSH innovation lab has done for me, to the collaboration of business, government, society, and frontline workers for successful digital health innovation and governance. Collaboration enables stakeholders to share equal responsibility for the contextualisation of health innovation, particularly in low-to-middle income countries. This will reduce the risk of social discord and prioritise vulnerable groups.

"Cross-sectoral collaboration is the real solution to South Africa’s healthcare crisis."

Conclusion

Cross-sectoral collaboration is the real solution to South Africa’s healthcare crisis. The crisis is rooted in severe health inequity. Although digital health promises to solve these challenges through remote care and task-shifting, it may further alienate the poor. If tech-enabled healthcare negates the social determinants of health it can deepen the digital divide. For this reason, the GSH Healthcare Innovation Lab plays an important role in facilitating the participation of various stakeholders, including young frontline workers. However, it is time for a sustainable and scalable solution that narrows the participation gap. Young people, vulnerable groups and frontline healthcare workers must all be given opportunities to participate in the creation of digital health policies which ensure digital healthcare solutions are fit for purpose and that digital health progress does not leave anyone behind.

Dr Noxolo Gqada

Dr Noxolo Gqada

Dr Noxolo Gqada holds a Bachelor of Medicine and Surgery, a Post Graduate Diploma in Primary Emergency Care and is currently completing an MBA at the UCT Graduate School of Business as a Bertha Centre Scholar. Her insights as a clinician and co-founder of a health-tech start-up drive her commitment to finding innovative solutions that enhance healthcare systems. She works as a project manager for Praekelt.org, a digital health NPO based in Cape Town, South Africa.
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Reference notes:

  • The effect of Covid-19 on the use of digital technology in healthcare (Percept Actuaries and Consultants, 2020)
  • Definition of mobile health (mHealth) (Singh and Landman, 2017)
  • Justifying the rapidly expanding global market for mHealth (“Digital Health Market Size & Growth Report”, 2021) and market growth (Mikulic, 2020)
  • Number of mHealth applications in Google Play store (Statista, 2021)
  • The role of healthcare in society (Raworth, 2018)
  • Reporting the access to healthcare in South Africa (Burger and Christian, 2020)
  • Distribution of medical facilities in Sub-Saharan Africa; the nearest health facility is 3 hours away from communities (World Economic Forum, 2021)
  • Distribution of medical doctors: 7 medical doctors per 10 000 people (World Health Organization, n.d.)
  • Structural barriers to technology amongst vulnerable groups (Mechael et al., 2010)

Direct quotes:

  • ‘rural households, less educated, unemployed and black South Africans, are less likely to have adequate access to healthcare’(Burger and Christian, 2020, p. 9)
  • ‘a smooth digital transition to mitigate the risk of (the) social discord (that is) perpetuated from digital divides.’ (Akenroye, 2012)
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