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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.
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