Multiple pathways to scaling up and sustainability: An exploration of digital health solutions in South Africa
Loading...
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
Abstract
With the aim to support further understanding of scaling up and sustaining digital health, we explore
digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem
Identification Programme (PPIP) and Child Healthcare Problem Identification Programme (Child PIP) (mortality audit
reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service)
and CommCare (a community health worker data capture and decision-support application).A framework integrating complexity and scaling up processes was used to conceptually orient the study.
Findings are presented by case in four domains: value proposition, actors, technology and organisational context.
The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple
tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect,
supported by ongoing financial and technical support from donors and technical partners. Donor preferences
played a significant role in the selection of CommCare as the platform to digitise community health worker service
information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and
advocates for the value of the digital health solution. The technology need not be complex but must navigate the
complexity of operating within an overburdened and fragmented South African health system. Inadequate and
unsustained investment from donors and government, particularly in human resource capacity and robust
monitioring and evaluation, continue to threaten the sustainability of digital health solutions.
Description
Keywords
Digital health solutions, Scale up, Sustainability, South Africa, Health systems
Citation
Swartz, A. et al. (2021). Multiple pathways to scaling up and sustainability: An exploration of digital health solutions in South Africa. Globalization and Health, 17(1), 1–13. https://doi.org/10.1186/s12992-021-00716-1