Towards Personal Connected Health in SA eHealth AFRO, Oct 2017 Dr Peter Benjamin

Vision of Personal Connected Health for NHI South Africans are empowered to take care of their own health and access appropriate health services through personal connected health. 1. Support individuals, families and communities improve their own health 2. Accessible health services (DOH in NHI) Use personal mobile tech (94%) – Next stage of mHealth Respect to all work on eHealth & telemedicine for diagnosis, treatment, informatics, health system efficiencies

WHO definition of health “State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity”

Health is more than healthcare

Service & linkage to care Outside health-service Buildng blocks to PCH Service & linkage to care Outside health-service Integration of services Policy & coordination  Coherent national PCH in foundation of NHI

Digital Health for Health system Telemedicine eHealth HIS Links to but separate from HIS Digital Health for Health system Telemedicine eHealth HIS Point-of-care

Vision of Personal Connected Health for NHI   Health Field Program area A1. MomConnect expansion Maternal health Service & linkage to care A2. Health information for all (Wikihealth 100 x 100) Health promotion Outside health-service A3. Personal diagnostics linking to healthcare A4. Service-access to support survivors of gender-based violence Female health & violence A5. Integrated health app All (initial focus on MCH) Integration of services A6. Assessment of all patient-facing digital health services All Policy & coordination A7. Last mile of PMTCT A8. Smoking cessation “StopSMS” Health promotion Respect to all work on eHealth & telemedicine for diagnosis, treatment, informatics, health system efficiencies

Testing: Usage of health information when accessible Health Information for all Testing: Usage of health information when accessible WikiHealth 100 x 100 100 most important health issues as approved Wikipedia-style articles 100 languages Mobile as way to link Develop in SA languages, available

Testing: Usage of personal diagnostic tools Personal diagnostics Testing: Usage of personal diagnostic tools Hypertension serious issue in pregnancy (pre-eclampsia etc) Blood pressure monitor: via App? In facilities, high-risk women with smartphones Daily SMS encouraging test; record data Respond as indicated Trial

Test: Use of mobile for individual and community response to crisis Gender-based violence Test: Use of mobile for individual and community response to crisis Link to care servics after attack Notifications to friends Mapping of services SMS messaging follow-ing

lth, South Africa

Test: New model for Health System interaction with population Next steps for MomConnect Test: New model for Health System interaction with population WhatsApp/text interaction Link to care, Integrated with Road To Health Booklet, continuum of care One integrated helpdesk for all SA DOH

Vision of Personal Connected Health for NHI B1. Pre-emptive health H promotion Outside health-service B2. Supporting community mobilization on social determinant B3. Health as a human right All Patient empowerment B4. Community ambulance Emergency Linkage to care B5. Adherence support: diabetes Non-Comm diseases Service & linkage to care B6. Medical callcentre   Emergency linkage to care B7. Innovation framework for new health content and services Policy & innovation B8. Policy for integrated personal connected health Policy & coordination B0. Pre-loaded on smart phones All (initial MCH) Integration and innovation Respect to all work on eHealth & telemedicine for diagnosis, treatment, informatics, health system efficiencies

Partnership towards PCH A partnership to plan, implement and evaluate projects; support policy developments and build a community of practice in South Africa to realise the vision of Personal Connected Health for all in SA by 2022. Led by DOH (Ministerial Advisory Committee eHealth) Collaboration of health implementers, NGOs, private sector, suppliers of digital health systems, researchers, donors and other related organisations. Respect to all work on eHealth & telemedicine for diagnosis, treatment, informatics, health system efficiencies

EFFECTIVE COVERAGE INTERVENTION OF KNOWN EFFICACY Thanks to: Alain Labrique, JHU Jo Y, Labrique AB et al. In Press 2013

EFFECTIVE COVERAGE INTERVENTION OF KNOWN EFFICACY mHEALTH: A Health Systems Catalyst EFFECTIVE COVERAGE POOR DEMAND FOR SERVICES DRUG OR SUPPLY STOCKOUT FAILURE TO FOLLOW GUIDELINES INTERVENTION OF KNOWN EFFICACY Thanks to: Alain Labrique, JHU Jo Y, Labrique AB et al. In Press 2013

DETERMINANT LAYERS OF UHC And begin to align mHealth strategies with the post-2015 agenda to achieve universal health access (Labrique & Mehl, 2015) DETERMINANT LAYERS OF UHC mHealth Strategies COST Financial Coverage H H Mobile financial transactions Decision support, POC diagnostics, Telemedicine, Reminders, Incentives Persistent electronic health records, Provider- to-provider communication, Work planning, Reminders Behaviour change communication (BCC), Incentives Hotlines, Client mobile apps, Client information content subscriptions Human resource management, Provider training, Telemedicine Supply management, Counterfeit prevention Client registration, Electronic medical records, Unique identifiers, Data collection and reporting, Screening tools, Civil registration and vital events QUALITY Effective Coverage G G DEMAND Continuous Coverage F F Contact Coverage E Accessibility of health facilities E SUPPLY TARGET: universal effective coverage of health interventions of known efficacy D Availability of human resources C D Availability of commodities and equipment B C B AVAILABLITY Accountability coverage A A Target population Total population Current gap in determinant performance Illustrative mHealth strategies to close performance gaps Minimum performance of supply determinant

technologically boring” “These tools don’t get socially interesting until they’re technologically boring” (Clay Shirky, 2010) © Cell-Life 2010 18