While technological advances and mobile phone penetration offer the potential to reduce inequalities and improve health outcomes, South Africa’s approach offers useful lessons for policymakers elsewhere.

Despite great promise, telemedicine projects in the late 1990s failed to improve access to medical services for rural communities. One reason was the complexity of trying to merge 14 different manually operated administrations into a unified national health system.

Poor connectivity limited applications to uses, such as teleconferences, rather than functions, such as giving rural radiology services access to urban facilities for interpretation and clinical guidance. Informatics and technology skills were also scarce in the health sector.

From The Financial Times. Story by Malebona Matsoso.

The projects were costly but did not deliver an integrated and interoperable national medical information system as rapidly or effectively as intended.

South Africa took a first step in 1996 with the District Health Information System. It has since been embedded in facilities across all provinces for routine data collection, collation, integration, storage, analysis, and utilization for decision making. It is now web-based, which improves data quality and reduces input errors.

There have since been many significant innovations. For example, South Africa has become adept at utilizing the GeneXpert test to accelerate the diagnosis of tuberculosis, facilitating rapid collection, and collation of results using the cloud. The technology has since served as a platform for diagnosis of other diseases, including Covid-19.

Mobile technology has also helped improve antenatal care. Using text messages, MomConnect allows pregnant women to access maternal health and education services, providing advice, and avoiding long waits in clinics. But the journey has not always proved easy, as highlighted by the insufficient integration of different systems. A study in 2011-12 identified 42 disparate health information systems across South Africa. Individual patient data could not be produced nationally because the systems did not interconnect. Files were duplicated, queues were long, and administration poor.

Read more at The Financial Times.