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Health Care: Delivery, Education, Communication

A Review of ICT Systems for HIV/AIDS and Anti-Retroviral Treatment Management in South Africa

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Discussion

To obtain an overview of the field was challenging for a number of reasons: some studies were not reported in indexed journals and were therefore not found when searching scientific databases. Several studies were only published by research institutions as reports, books, conference presentations, abstracts or papers. These in particular are difficult to identify in a literature review, since searches must be conducted on specific websites and within universities' report summaries. Therefore, to find these reports, one must first be aware that they exist. The search strategy reviewing scientific papers was expanded to a networking approach: for every positive finding, the author or person in charge of the project (or person referring to a project) was asked whether or not they knew of any telemedicine or e-health projects or services in the area of interest. This strategy is not foolproof.

In South Africa as in many other countries, implementation and support of health systems is managed at provincial level. This has resulted in different provinces implementing different systems depending on their specific requirements. In addition, a number of systems are based on the requirements of international funding agencies (e.g. PEPFAR) or NGOs. Some of the systems are pilot implementations as part of research studies, e.g. OpenMRS, with the support of the Medical Research Council, or based on private health-care systems such as Medicom. The NEPAD report highlighted the issue of 'turf protection' in their report, and it concludes that this is especially prominent in the public sector, impeding future collaboration and integration of services.[3]

As in other countries, the most common type of ICT system is for health information. Otherwise, various designs of electronic health records are in place. All clinics have some form of patient data-capturing system, be it paper-based or digital. Since clinics and health-care workers find different means of managing the data acquisition, paper-based and electronic systems can, in this environment, exist side by side. Most electronic health records are designed to suit the requirements of the local context. Due to the varying needs throughout South Africa's health services each province has a dominant EHR. However, none of these systems are implemented throughout any of the provinces. A number of the existing EHR systems have been developed and supported by NGOs as pilot projects which is an unsustainable situation. At the time of our study, a national initiative had been developed, calling for a tender to establish a national EHR system.

With the exception of the major HIS and EHR, none of the ICT systems found in the review were ready to be deployed in the country as a whole. The main reason for this was that the telemedicine and e-health activities identified were pilot projects and therefore not evaluated as a service in use. This means that there is consequently no telemedicine and e-health application which addresses various disciplines in health care. The study showed that there is no systematic review- or evidence-based telemedicine and e-health repository in South Africa. Such a system, for South Africa or for other developing countries, would assist stakeholders in their decision-making with regards to sustainable telemedicine and e-health solutions.

The study started out focusing on telemedicine and e-health for ART-management and HIV/AIDS. In the process of discussing the investigation with people working in the field, it became clear that the focus needed to be reviewed. Since nearly all primary health-care issues are related to HIV/AIDS issues, it is hard to draw a clear line between the telemedicine and e-health systems that should be included in the study, and the others. One example is teledermatology, which is a specific area within telemedicine and e-health. Patients are selected because they have a skin problem which may be linked to HIV, but they are not necessarily diagnosed with HIV/AIDS. The distinction between telemedicine and e-health for ART, and in general, was not very fruitful when it came to reviewing the status of telemedicine and e-health in South Africa. However, when discussing the target area and users' needs for telemedicine and e-health applications and systems, it was useful to narrow the scope.

Limitations of the Study

In view of the above complication, it is possible that some papers were omitted from the study due to their general approach to primary health care. If these had been reported and indexed as research reports, they would have appeared in the searches. Some studies could also have been missed because 'smart-card' was not included as a search term. Nevertheless, these studies should have been identified with the telemedicine and e-health and HIV-related search terms.

Health-care authorities at provincial and national level were only contacted via email and information sought from their websites.With follow-up telephone calls, the outcome could be expected to improve somewhat.

Conclusions

There is no all-inclusive ICT-based system in place for AIDS treatment in South Africa, but a range of pilot systems and projects are in use. Paper-based and ICT systems will clearly co-exist for some time to come. There is a need for sharing information on lessons learnt, in order to improve the development and research.With the exception of the major HIS and EHR, none of the ICT systems found in the review were ready to be deployed in the country as a whole.

Acknowledgements

We thank Lyn Hanmer, Rosemary Foster, Chris Seebregt, Moretlo Molefi, Kit Vaughn, Inger Torhild Gram, Eli Arild, Niklas Andersson, Sarah Brown and the Cell-Life team for discussions, and the Norwegian Network for ICT for financial support.

Contact

Tove Sørensen
Norwegian Centre for Telemedicine
PO Box 35
TromsoNO-9038, Norway
Fax: +47 77 75 40 98
Email: tove.sorensen@telemed.no


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