The last two years have genuinely ripped the Elastoplast off an inequitable healthcare system that is just not geared to serve all patients, regardless of where they are.
By Henry Adams, country manager of InterSystems South Africa
As everyone was locked down in their homes and life moved online, the great healthcare divide in South Africa became even more evident as telehealth and virtual medical visits that became part of the remote healthcare norm for many simply didn’t extend to the most vulnerable populations.
One positive arose, and that was the change in the healthcare market came at speed, as opposed to the glacial rate we are accustomed to in this industry. But again, the change only benefitted a few.
The digital reality
Figures can be deceptive, as it is reported that 22-million, or one-third of the South African population, have access to smartphones and research data from GSMA Intelligence highlights 108,6-million cellular mobile connections in the country at the start of 2022 as some people have multiple connections, but data without context is useless.
As of 2022, around 18,2-million South Africans are reportedly living in extreme poverty. This is based on the global poverty index, which cites a threshold of $1.90 a day.
This number increased by a whopping 123 000 people from 2021, coupled with the fact that 19,3-million South Africans still live in rural areas.
While as a country, we are seemingly connected, the vast majority of our population cannot afford food, let alone data to call a doctor for a consultation as data is considered a luxury.
No access to digital health
The digital divide in South Africa far exceeds just access to the internet, and the healthcare digital divide has been around long before Covid came on the scene. But what the pandemic did do was highlight and exacerbate the problem.
We define digital health as anything from telehealth to mobile applications, wearables, and patient portals. And it is used to supplement in-person care using digitally enabled tools, which depends on digital literacy and internet connectivity.
These are known as “super social determinants of health (SDOH)”, which are locally also seen as barriers to entry for much of our population as they are the reason much of our underserved population is unable to engage in digital health.
Locally, healthcare systems also fail the population because there are so few, beyond private healthcare, that can be switched over digitally. One can’t overlook socio-economic issues such as financial resources, lack of technology skills, low literacy, digital literacy, and even cultural norms resistant to modern medicine.
No patient left behind
To ensure no patient gets left behind there are a multitude of things that need to change. Firstly, digital health companies need to build tools with intention and be cognisant that not everyone has the financial means to access them or the education to use them.
The US National Library of Medicine has published a Digital Health Equity Framework that offers insights into achieving this. The World Health Organisation has drafted strategies for digital health.
Notably, it can’t just come from digital healthcare providers, it needs to start with the systems themselves, and that buck stops with public healthcare. The government needs to embrace digital healthcare resources, which they are slowly doing, and they need to use its extensive platform to educate the population on how to use them.
From the technology partner’s point of view, these companies need to build systems as all-inclusive with the population using them in mind. This can be achieved by involving people from marginalised and vulnerable groups in designing and deploying digital health programmes.
Then in the same way that mobile operators have “free to use WhatsApp data packages”, as an example, digital healthcare applications shouldn’t require mobile data to access – their use must be subsidised.
Care for all
The problem of extending basic healthcare is not one exclusive to South Africa. Every country in the world grapples with it. And the proposed solutions are only the tip of a very complex iceberg, but they are a start. And that start is with technology solutions that enable interoperability across systems to create a unified care record of each patient.
Once this is in place, healthcare providers can draw insights from a unified data fabric that should really be the premise of any digital healthcare solution.
Ultimately data gives healthcare providers the ability to deploy analytics, and analytics delivers insights, but these insights are only of value if they are derived from an environment that is supported by a centralised data fabric. Looking ahead, if digital health is the future of healthcare, we must ensure everyone is included and the right technologies are deployed if we are ever to close the digital health divide.