maurice mars

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eHealth in South Africa

Maurice Mars

Department of TeleHealthNelson R Mandela School of Medicine

University of KwaZulu-Natal

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South Africa

Area 1,221,037 km2

Population 52 million

Provinces 9

Rural 38%

< $1 /day ppp 13.8%

Languages 11

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Govt health spend US$228 / capita

Public health system 82% population

Private health spend 60% total spend

Doctors 78 per 100,000

Public service doctors 27 per 100,000

Devolved to 9 Provincial DOHs

Health

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eHealth - NHISSA

Information systems in

Hospitals Private > State

Insurance companies

Pvt sector radiology

Pathology both Pvt and NHLS

District health information systems

HIV and TB databases

Bio-informatics for HIV resistance

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1989 - CT scanners linked

1995 - National Health Information

Systems Committee

1998 - National Telemedicine Task Team

1999 - National Telemedicine System

28 Public Hospitals – 6

Provinces

Telemedicine – The Start

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National Telemedicine System Phase 1

28 Hospitals and National DOH

Teleradiology

Tele-ultrasonography

Telepathology

Tele-ophthalmology

Failed

Telemedicine in South Africa

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2006 – Attempt to form SATMA

2008 – Draft regulations for telemedicine

2008 – Draft ethics for telemedicine

2010 – Draft eHealth Strategy

2010 – Draft Telemedicine Strategy

2011 - Ministerial Advisory Committee

2011 – SATMA formed

Telemedicine – The Doldrums

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mHealth Strategy South Africa

eHealth : enabling a long and healthy life for all South Africans

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Shall vs Should

Mandatory?

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86 sites – 32 Active (Sites not services)

55 ISDN based videoconference

18 teleradiology

4 teleconsultation

9 telespirometry /ECG

No data on use, other store & forward

services or tele-education

2008 Audit

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2013 Audit

• Questionnaire – Provincial co-ordinators

• Only 4 of 9 Provinces responded

• Annual reports and plans reviewed

• Literature review of TM in South Africa

• Triangulation of data

• Very limited data on number of cases

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Telemedicine sites

State Hospitals 131 / 433

State Clinics 79 / 3075

State Clinics installing 69

No data on informal referrals

2013 Audit

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radiology pathology

dermatology psychiatry

ophthalmology orthopaedic surgery

audiology paediatrics

trauma tele-ecg

telespirometry occupational therapy

teleconsultation tele-education

2013 Audit – Services Reported

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mHealth Activity

http://www.mobileworldlive.com/mhealth-tracker

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mHealth Activity

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Plateau of Productivity

Slope of Enlightenment

Trough of Disillusionment

Technology trigger Time

Visibility

Peak of Inflated Expectations

Gartner Hype CurvemHealth

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Education

Long History – 1970s

Use of satellite and phones

Use of Web CT and Moodle

Medical Schools videoconferencing

eHealth research at several Universities

Coursework masters at one University

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Publication / Research Output- Methods – Scopus Search

Health Informatics e-Health

Medical Informatics eHealth

Clinical Informatics Telemedicine

Medical Information System(s) Telehealth

Electronic Health Record(s) mHealth

Electronic Medical Record(s) m-Health

Hospital Information System(s)

Biomedical Informatics

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TeleHealth 20,903 papers

Sub-Saharan Africa 256 1.2%

South Africa 112 43.8%

Health informatics 54,683 papers

Sub-Saharan Africa 613 0.9%

South Africa 202 32.9%

Publication / Research Output

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Where Are We?

Governance issues are being addressed

Need buy-in at Provincial DOH level

Need to: evaluate and monitor

report and publish

understand the private sector

Spontaneous telemed services starting

Develop an enabling environment

Raise Awareness

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No prior scans available for comparison. In my experience such an appearance warrants urgent surgical

intervention.