Healthcare in South Africa – Two Systems, Common Challenges

When it comes to mHealth, most industrialised nations such as the U.S. and Europe have a head start. Money for healthcare technology investments is available, the infrastructure is in place, and most of the population is already engaged in the healthcare system.

As a country of about 52 million people, South Africa shares many characteristics with its larger brethren. There is a mix of public and private healthcare providers and health insurance plans, physician shortages in key areas, and South Africa is beset by many of the same chronic diseases that industrialised countries face (cardiovascular and obesity-related diseases, diabetes, etc.).

But, the country also faces unique challenges.  HIV/AIDS and tuberculosis rates are high. Maternity and infant health issues affect large segments of the population.  The system is highly fragmented. These and other factors contribute to a life expectancy of only 58.5 years, twenty years shorter than in the US.

The South African healthcare system is really a tale of two systems. Basic primary care is provided free by the state, and the public health system serves about 80% of the population. The public sector is woefully underfunded, and care is less accessible and/or inadequate for that 80% of the population.

The South African government has embarked on major reforms to the system, including a universal National Health Insurance (NHI) programme. From its implementation beginning in 2012, however, the system will take 14 years to roll out.

For the remaining 20% of the South African population, healthcare is more accessible, better-funded and more effective. Middle- and upper-class citizens purchase supplemental care through various medical schemes (insurance plans), giving them access to better clinicians and advanced medical practices.

Public or private, there are a number of challenges the two systems share:

  • An over-reliance on paper records – When patients present at a medical facility, runners are dispatched to gather up paper records and bring them to the clinicians. Even when records have been digitized, there are few online systems for viewing and reviewing them.
  • Silos and lack of interoperability – Primary care are the gateways to the system, both public and private. Even more so than in the US, there are few common systems across primary care practices, so even where automation has taken place, these silos of information do not interoperate.
  • Lack of detailed clinical information – Although South Africa implemented ICD-10 beginning in 2005 (yes, 2005), the fragmentation of the systems has led to only simple, lowest-common-denominator information being available; sometimes only patient ID and diagnosis code are available to other clinicians. This blunts efforts at any sort of analytics that could improve quality or core measures. Real-time analytics, dashboards accessible through mobile devices, or remote notifications are all impossible without tools to cut across disparate systems.
  • Healthcare for mothers and babies – Maternal, infant and childhood mortality present a major health crisis throughout Africa. Prenatal care and monitoring in particular are inadequate, resulting in combinations of high maternal mortality, infant mortality, and post-natal complications. With many expectant mothers in far-flung areas of the country, this is a health crisis begging for innovative remote technology.
  • The need for secure health records and communication – Although not as stringent at HIPAA regulations in the US, and driven more by the medical schemes, security and privacy are essential to overcoming patients’ inherent distrust of technology, especially if data are to be shared through a variety of systems.

The South African healthcare system needs to undergo major change. “Business as usual” is unlikely to yield progress quickly enough. Innovative healthcare technology can provide an accelerator to improving conditions more quickly, with interoperable mHealth and telehealth playing a major role in that transformation.

Christopher Whitfield, CEO, founded Batswadi Pharmaceuticals in October 2005 as a specialist healthcare company focusing on four core business areas: pharmaceuticals, diagnostics, research and development, and consumer health. After jump-starting the company by leading a management buy-out of Eli Lilly’s insulin portfolio in South Africa, Christopher has quickly built Batswadi into a diversified company with significant potential. As the only black-empowered (majority-owned by historically disadvantaged South Africans) pharmaceutical company in South Africa, Batswadi is a rising star.