Digital Health Ecosystem Framework to Address Fragmentation of the Health System in South Africa

Authors

DOI:

https://doi.org/10.25159/2520-5293/11547

Keywords:

fragmentation, Health system, Health Information Systems, Digital Health Ecosystem, South Africa

Abstract

Globally, the healthcare industry is plagued by fragmentation, and this fragmentation of the health system has become one of the major problems facing especially low- and middle-income countries. Likewise, the current health system in South Africa is highly fragmented and segmented, with two-tiered systems characterised by a multiplicity of health information systems. This fragmentation has inhibited the efficient delivery of healthcare services and resulted in limited access to integrated health data across healthcare providers. This paper proposes a Digital Health Ecosystem framework to address fragmentation of the health system in South Africa. A qualitative approach was employed, using desktop-based research. A literature review was conducted to elucidate the need for a framework to address fragmentation of the health system in South Africa. It emerged from the literature that the coexistence of subsystems operating independently contributes to health system fragmentation in South Africa. The proposed framework aims to address the ubiquitous problem of health system fragmentation and to enhance data-sharing capabilities across healthcare facilities. A Digital Health Ecosystem offers capabilities to create a digital environment for cooperation, data sharing and information exchange between a network of healthcare organisations. The technology offers South African healthcare facilities a new way to work seamlessly together to provide multidisciplinary and collaborative healthcare services to patients. Healthcare facilities in South Africa are urged to embrace a Digital Health Ecosystem to improve the safety and quality of healthcare and increase access to and availability of clinical, patient and administrative data.

Metrics

Metrics Loading ...

References

Afribary. 2021. “What is the Difference between the Theoretical and the Conceptual Framework?” Accessed May 21, 2022. https://afribary.com/blog/5/what-is-the-difference-between-the-theoretical-and-the-conceptual-framework/.

Agha, L., B. Frandsen, and J. B. Rebitzer. 2017. Causes and Consequences of Fragmented Care Delivery: Theory, Evidence, and Public Policy. Cambridge, MA: National Bureau of Economic Research.

Al-Sakran, H. O. 2015. “Framework Architecture for Improving Healthcare Information Systems Using Agent Technology.” International Journal of Managing Information Technology 7 (1): 17. https://doi.org/10.5121/ijmit.2015.7102.

Amado, L., N. Christofides, R. Pieters, and J. Rusch. 2012. “National Health Insurance: A lofty Ideal in Need of Cautious Planned Implementation: Forum.” South African Journal of Bioethics and Law 5 (1): 4–10.

American Educational Research Association (AERA). 2006. “Standards for Reporting on Empirical Social Science Research in AERA Publications.” Educational Researcher 35: 33–40. https://doi.org/10.3102/0013189X035006033.

Bhasin, H. 2020. Desk Research: Definition, Importance and Advantages. Accessed May 12, 2022. https://www.marketing91.com/desk-research/.

Borycki, E. M., and A. W. Kushniruk. 2022. “Reinventing Virtual Care: Bridging the Healthcare System and Citizen Silos to Create an Integrated Future.” Health Care Management Forum 35 (3): 135–139. Sage CA: Los Angeles, CA: Sage Publications. https://doi.org/10.1177/08404704211062575.

Bossert, T., N. Blanchet, S. Sheetz, D. Pinto, J. Cali, and R. P. Cuevas. 2014. “Comparative Review of Health System Integration in Selected Countries in Latin America.” Technical Note no. 585. Washington, DC: Inter-American Development Bank.

Botha, C., and M. Hendricks. 2008. “Financing South Africa’s National Health System through National Health Insurance: Possibilities and Challenges.” In Colloquium Proceedings. HSRC Policy Analysis.

Bourgeois, F. C., K. L. Olson and K. D. Mandl. 2010. “Patients Treated at Multiple Acute Healthcare Facilities: Quantifying Information Fragmentation.” Archives of Internal Medicine170 (22): 1989–1995. https://doi.org/10.1001/archinternmed.2010.439.

Briscoe, G. 2009. Digital Ecosystems, Dissertation. Cornell University. https://doi.org/10.1145/1643823.1643832.

Bukowski, A. 2016. “How Fragmented Health Systems Hurt Patients. Global Cancer Institute. (2016).” Accessed April 22, 2019. https://globalcancerinstitute.org/healthtrends/fragmented-health-systems-hurt-patients/.

Cebul, R. D., J. B. Rebitzer, L. J. Taylor, and M. E. Votruba. 2008. “Organizational Fragmentation and Care Quality in the US Healthcare System.” Journal of Economic Perspectives 22 (4): 93–113. https://doi.org/10.1257/jep.22.4.93.

Cilliers, L. 2022. “A Digital Health Ecosystem for Africa during the Covid-19 Pandemic.” In Digital Innovation for Healthcare in Covid-19 Pandemic, 39–51. Academic Press. https://doi.org/10.1016/B978-0-12-821318-6.00013-X.

Cline, G. B., and J. M. Luiz. 2013. “Information Technology Systems in Public Sector Health Facilities in Developing Countries: The Case of South Africa.” BMC Medical Informatics and Decision Making 13 (1):13. https://doi.org/10.1186/1472-6947-13-13.

Darking, M., E. A. Whitley, and P. Dini. 2008. “Governing Diversity in the Digital Ecosystem.” Communications of the ACM 51 (10): 137–140. https://doi.org/10.1145/1400181.1400211.

Department of Health (South Africa). 2012. “National eHealth Strategy, South Africa 2012–2017.” Pretoria: Department of Health.

Diaz, S. 2018. “The Implications of Fragmentation in Care.” Accessed September 17, 2020. https://www.healthify.us/healthify-insights/the-implications-of-fragmentation-in-care.

Elhauge, E. (Ed.). 2010. The Fragmentation of US Healthcare: Causes and Solutions. Oxford University Press on Demand. https://doi.org/10.1093/acprof:oso/9780195390131.001.0001.

European Patients Forum. 2016. “EPF Position Paper on eHealth, 2016.” Accessed April 2019. http://www.eu-patient.eu/globalassets/policy/ehealth/epf-final-position-paper-onehealth_19december2016.pdf.

Federal Ministry for Economic Cooperation and Development. 2020. “Digital Health Ecosystem for African Countries: A Guide for Public and Private Actors for Establishing Holistic Digital Health Ecosystem in Africa.”

Fu, H. 2006. “Formal Concept Analysis for Digital Ecosystem.” Proceedings of the 5th International Conference on Machine Learning and Applications, 143–148. https://doi.org/10.1109/ICMLA.2006.24.

Gleiss, A., and S. Lewandowski. 2022. “Removing Barriers for Digital Health through Organizing Ambidexterity in Hospitals.” Journal of Public Health 30: 21–35. https://doi.org/10.1007/s10389-021-01532-y.

Gomez, S., H. Andersson, J. Park, S. Maw, A. Crook, and P. Orsmond. 2013. “A Digital Ecosystems Model of Assessment Feedback on Student Learning.” Higher Education Studies 3 (2): 41–51. https://doi.org/10.5539/hes.v3n2p41.

Gray, A., J. Riddin, and J. Jugathpal. 2016, “Healthcare and Pharmacy Practice in South Africa”. Canadian Journal of Hospital Pharmacy 69 (1): 36–41. https://doi.org/10.4212/cjhp.v69i1.1521.

Greer, S., M. Wismar, and J. Figueras. 2016. “Strengthening Health System Governance: Better Policies, Stronger Performance.” New York: European Observatory on Health Systems and Policies, World Health Organization. Accessed July 27, 2020. https://www.euro.who.int/__data/assets/pdf_file/0004/307939/Strengthening-health-system-governance-better-policies-stronger-performance.pdf?ua=1.

Health Systems Trust. 2014. “South African Health Review 2013/14.” http://www.health-e.org.za/wp-content/uploads/2014/10/South-African-Health-Review-2013-14.pdf.

Herselman, M., and A. Botha. 2016. “Strategies, Approaches and Experiences: Towards Building a South African Digital Health Innovation Ecosystem.” CSIR Meraka, Pretoria, South Africa. https://doi.org/10.1109/ISTAFRICA.2016.7530615.

Healthcare Information and Management Systems Society (HIMSS). 2021. “Building a Digital Health Ecosystem.” Accessed March 12, 2022. https://www.himss.org/resources/building-digital-health-ecosystem.

Iyawa, G. E., M. Herselman, and A. Botha. 2016. “Digital Health Innovation Ecosystems: From Systematic Literature Review to Conceptual Framework.” Procedia Computer Science 100: 244–252. https://doi.org/10.1016/j.procs.2016.09.149.

Iyawa, G. E., M. Herselman, and A. Botha. 2019, September. “Building a Digital Health Innovation Ecosystem Framework through Design Science Research.” In 2019 Conference on Next Generation Computing Applications (NextComp), 1–6. IEEE. https://doi.org/10.1109/NEXTCOMP.2019.8883650.

Janes, C. R., O. Chuluundorj, C. E. Hilliard, K. Rak, and K. Janchiv. 2006. “Poor Medicine for Poor People? Assessing the Impact of Neoliberal Reform on Healthcare Equity in a Post-socialist Context.” Global Public Health 1: 5– 30. https://doi.org/10.1080/17441690500321418.

Janjua, N. K., M. Hussain, M. Afzal, and H. F. Ahmad. 2009. “Digital Healthcare Ecosystem: SOA compliant HL7 Based Healthcare Information Interchange.” In 2009 3rd IEEE International Conference on Digital Ecosystems and Technologies, 329–334. IEEE. https://doi.org/10.1109/DEST.2009.5276681.

Kapepo, M. I., and S. Yashik. 2018. “A Process Analysis of the Namibian Health System: An Exploratory Case Study.” Ethiopian Journal of Health Development 32 (4): 201–209.

Katuu, S. 2018. “Healthcare Systems: Typologies, Framework models, and South Africa’s Health Sector.” International Journal of Health Governance. https://doi.org/10.1108/IJHG-10-2017-0054.

Kautzky, K., and S. M. Tollman. 2008. “A Perspective on Primary Healthcare in South Africa: Primary Healthcare: In Context.” South African Health Review (1): 17–30.

Kelly, Y. P., D. Goodwin, L. Wichmann, and M. L. Mendu. 2019.” Breaking down Healthcare Silos.” Harvard Business Review, 1.

Kern, L. M., M. M. Safford, M. J. Slavin, E. Makovkina, A. Fudl, J. E. Carrillo, and E. L. Abramson. 2019. “Patients’ and Providers’ Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: A Qualitative Study.” Journal of General Internal Medicine 34 (6): 899–907. https://doi.org/10.1007/s11606-019-04859-1.

Kim, J., E. McCloskey, P. Hailey, and D. Maxwell. 2018. “Constraints and Complexities of Information and Analysis: Data Planning in Famine-risk Countries. Findings and Recommendations for Food Security Analysis: South Sudan, Somalia, Nigeria and Yemen.” Washington DC: MQSUN+/DFID.

Lau, F. 2019. “From Siloed Applications to National Digital Health Ecosystems: A Strategic Perspective for African Countries.” In Improving Usability, Safety and Patient Outcomes with Health Information Technology: From Research to Practice, 404.

León, M. C., J. I. Nieto-Hipólito, J. Garibaldi-Beltrán, G. Amaya-Parra, P. Luque-Morales, P. Magaña-Espinoza, and J. Aguilar-Velazco. 2016. “Designing a Model of a Digital Ecosystem for Healthcare and Wellness Using the Business Model Canvas.” Journal of Medical Systems 40 (6):144. https://doi.org/10.1007/s10916-016-0488-3.

Mahlathi, P., and J. Dlamini. 2015. “Minimum Data Sets for Human Resources for Health and the Surgical Workforce in South Africa’s Health System: A Rapid Analysis of Stock and Migration.” Pretoria, South Africa: African Institute of Health and Leadership Development and WHO.

Maphumulo, W. T., and B. R. Bhengu. 2019. “Challenges of Quality Improvement in the Healthcare of South Africa Post-apartheid: A Critical Review.” Curationis 42 (1): 1–9. https://doi.org/10.4102/curationis.v42i1.1901.

Masilela, T. C., R. Foster, and M. Chetty. 2013. “The eHealth Strategy for South Africa 2012–2016: How far Are we?” South African Health Review 2 (1): 15–24.

McGauley, J. 2019. “The Multibillion Dollar Consequences of Fragmented Healthcare Information Systems.” Accessed January 14, 2021. https://www.chiefhealthcareexecutive.com/view/consequences-of-fragmented-healthcare-information-systems.

McIntyre, D., and J. Ataguba, J. 2017. “Access to Quality Healthcare in South Africa: Is the Health Sector Contributing to Addressing the Inequality Challenge.” Parliament of South Africa 2017.

Meyer, J. C., N. Schellack, J. Stokes, R. Lancaster, H. Zeeman, D. Defty, B. Godman, and G. Steel. 2017. “Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa: A Preliminary Study.” Frontiers in Pharmacology 8: 751. https://doi.org/10.3389/fphar.2017.00751.

Mladovsky, P. 2020. “Fragmentation by Design: Universal Health Coverage Policies as Governmentality in Senegal.” Social Science and Medicine 260: 113–153. https://doi.org/10.1016/j.socscimed.2020.113153.

Modisakeng, C., M. Matlala, B. Godman, and J. C. Meyer. 2020. “Medicine Shortages and Challenges with the Procurement Process among Public Sector Hospitals in South Africa; Findings and Implications.” BMC Health Services Research 20 (1): 1–10. https://doi.org/10.1186/s12913-020-05080-1.

Montenegro, H., R. Holder, C. Ramagem, S. Urrutia, R. Fabrega, R. Tasca, G. Alfaro, O. Salgado, and M. A. Gomes. 2011. “Combating Healthcare Fragmentation through Integrated Health Service Delivery Networks in the Americas: Lessons Learned.” Journal of Integrated Care 19 (5): 134–150. https://doi.org/10.1108/14769011111176707.

Mosadeghrad, A. M. 2013. “Healthcare Service Quality: Towards a Broad Definition.” International Journal of Healthcare Quality Assurance 26 (3): 203–219. https://doi.org/10.1108/09526861311311409.

Mutasa, L. S., and T. Iyamu. 2022. “Application of Activity Theory to Examine the Implementation of E-health in Namibia.” International Journal of Healthcare Management: 1–10. https://doi.org/10.1080/20479700.2022.2083046.

Naidoo, S. 2012. “The South African National Health Insurance: A Revolution in Health Care Delivery!” Journal of Public Health 34 (1): 149–150.

Najem, F. M. 2016. “The Impact of Hospital Information System Quality on the Healthcare Quality: A Case Study on European Gaza Hospital.” Department of Business Administration, the Islamic University Gaza, 190.

Nengomasha, C. T., R. Abankwah., W. Uutoni, and L. Pazvakawambwa. 2018. “Health Information Systems in Namibia.” Information and Learning Science 119 (8): 358–376. https://doi.org/10.1108/ILS-03-2018-0015.

Ngoepe, M., and N. Marutha. 2021. “A Framework to Integrate Healthcare Records in the South African Public Hospitals Using Blockchain Technology.” African Journal of Library Archives and Information Science 31 (1): 29–38.

Ngulube, P. 2018. “Overcoming the Difficulties Associated with Using Conceptual and Theoretical Frameworks in Heritage Studies.” In Handbook of Research on Heritage Management and Preservation, 1–23). IGI Global.

Nolte, E., C. Knai., M. Hofmarcher., A. Conklin., A. Erler., A. Elissen., M. Flamm., B. Fullerton., A. Sönnichsen., and H. J. Vrijhoef. 2012. “Overcoming Fragmentation in Healthcare: Chronic Care in Austria, Germany and the Netherlands.” Health Economics, Policy and Law 7 (1): 125–146. https://doi.org/10.1017/S1744133111000338.

Oshni Alvandi, A., F. Burstein., and C. Bain. 2022. “A Digital Health Ecosystem Ontology from the Perspective of Australian Consumers: A Mixed-method Literature Analysis.” Informatics for Health and Social Care, 1–17. https://doi.org/10.1080/17538157.2022.2049273.

Pranata, I., and G. Skinner. 2009. “Digital Ecosystem Access Control Management.” WSEAS Transactions on Information Science and Applications 6 (6): 926–935.

Qureshi, B. 2014. “Towards a Digital Ecosystem for Predictive Healthcare Analytics.” In Proceedings of the 6th International Conference on Management of Emergent Digital Ecosystems, 34–41. https://doi.org/10.1145/2668260.2668286.

Ramdhani, A., M. A. Ramdhani, and A. S. Amin. 2014. “Writing a Literature Review Research Paper: A Step-by-step Approach.” International Journal of Basic and Applied Science 3 (1): 47–56.

Rapakwana, N. J. 2004. “Client Satisfaction with Regard to Accessibility of Primary Healthcare Services in Molemole Municipality of Limpopo Province.” Master’s dissertation. University of South Africa, Pretoria.

Ravitch, S. M., and M. Riggan. 2016. Reason and rigor: How Conceptual Frameworks Guide Research, 2nd edition. Thousand Oaks, CA: Sage.

Razavi, A., S. R. Moschoyiannis, and P. Krause. 2009. “An Open Digital Environment to Support Business Ecosystems.” Peer-to-Peer Networking and Applications 2 (4): 367–397. https://doi.org/10.1007/s12083-009-0039-5.

Rispel, L. 2016. “Analysing the Progress and Fault Lines of Health Sector Transformation in South Africa.” South African Health Review 1: 17–23.

Sahay, S., E. Monteiro., and M. Aanestad. 2009. “Towards a Political Perspective of Integration in Information Systems Research: The Case of Health Information Systems in India.” Information Technology for Development 15 (2): 83–94. https://doi.org/10.1002/itdj.20119.

Saltman, R., R. Busse, and J. Figueras. 2006. Decentralization in Healthcare: Strategies and Outcomes. McGraw-Hill Education (UK).

Seahloli, M. S. 2016. “Status of Medical Informatics and Implementing Electronic Healthcare Records, Challenges, and Future Direction in South Africa.” D.Phil. thesis. Texila American University.

Serbanati, L. D., F. L. Ricci, G. Mercurio, and A. Vasilateanu. 2011. “Steps towards a Digital Health Ecosystem.” Journal of Biomedical Informatics 44 (4): 621–636. https://doi.org/10.1016/j.jbi.2011.02.011.

Shih, A., K. Davis, S. Schoenbaum, and A. Gauthier. 2008. “Organizing the US Healthcare Delivery System for High Performance.” The Commission on a High-performance Health System. Commonwealth Fund.

Shisana, O. 2018. Strengthening the South African Health System towards an Integrated and Unified Health System. Johannesburg: Presidential Health Summit.

Sibuyi, I. N., R. de la Harpe, and P. Nyasulu. 2022. “A Stakeholder-Centered mHealth Implementation Inquiry within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case.” JMIR mHealth and uHealth 10 (6): e18188. https://doi.org/10.2196/18188.

Sinhasane, S. 2020. “Digital Healthcare Ecosystem: The New Era of Medical Care.” Accessed March 23, 2022. https://mobisoftinfotech.com/resources/blog/digital-healthcare-ecosystem-the-new-era-of-medical-care/.

Siqueira, M., M. Coube, C. Millett, R. Rocha, and T. Hone. 2021. “The Impacts of Health Systems Financing Fragmentation in Low- and Middle-income Countries: A Systematic Review Protocol.” Systematic Reviews 10 (1): 1–8. https://doi.org/10.1186/s13643-021-01714-5.

South African National Department of Health. 2014. “National eHealth Strategy, South Africa 2012–2017.” Accessed May 12, 2017. https://ndoh.dhmis.org/owncloud/index.php/s/ R5cmdp0gY4Fa43Z?path=/eHealth.

Spicer, N., I. Agyepong, T. Ottersen, A. Jahn, and G. Ooms. 2020. “It’s far too complicated: Why Fragmentation Persists in Global Health.” Globalization and Health 16 (1): 1–13. https://doi.org/10.1186/s12992-020-00592-1.

Stephanie, L., and R. S. Sharma. 2020. “Digital Health Eco-systems: An Epochal Review of Practice-oriented Research.” International Journal of Information Management 53: 102032. https://doi.org/10.1016/j.ijinfomgt.2019.10.017.

Svinicki, M. D. 2010. “A Guidebook on Conceptual Frameworks for Research in Engineering Education.” Rigorous Research in Engineering Education 7 (13): 1–53.

Tansley, A. G. 2007. The Use and Abuse of Vegetational Concepts and Terms. Sage Publications: Thousand Oaks, CA, USA, 517–522. https://doi.org/10.1177/0309133307083297.

Tuzii, J. 2017. “Healthcare Information Technology in Italy, Critiques and Suggestions for European Digitalisation.” Pharmaceuticals Policy and Law 19 (3/4): 161–176. https://doi.org/10.3233/PPL-180460.

Ukwoma, S. C., and P. Ngulube. 2021. The Application of Theoretical and Conceptual Frameworks in Open and Distance Learning Research. UnisaRxiv. https://doi.org/10.25159/UnisaRxiv/000023.v1.

Värri, A. O., H. Nieminen., N. Helander, and M. V. Gils. 2022. “DiHECO: Digital Healthcare Ecosystem Research and Networking.” Finnish Journal of EHealth and EWelfare 14 (2): 256–260. https://doi.org/10.23996/fjhw.114944.

Vambe, A. K. 2014. “An Examination of Healthcare Financing Models: Lessons for South Africa.” Journal of Finance, Accounting and Management 5 (1): 161–217.

Van Winkle, B., Y. Solad, N. Vaswani, and B. I. Rosner. 2019. “Navigating the Digital Health Ecosystem to Bridge the Gap from Innovation to Transformation: A NODE. Health Perspective on Digital Evidence.” Digital Biomarkers 3 (2): 83–91. https://doi.org/10.1159/000500194.

Varpio, L., E. Paradis, S. Uijtdehaage, and M. Young. 2020. “The Distinctions between Theory, Theoretical Framework, and Conceptual Framework.” Academic Medicine 95 (7): 989–994. https://doi.org/10.1097/ACM.0000000000003075.

Walunas, T. L., K. L. Jackson, A. H. Chung, K. A. Mancera-Cuevas, D. L. Erickson, and R. Ramsey-Goldman. 2017. “Disease Outcomes and Care Fragmentation among Patients with Systemic Lupus Erythematosus.” Arthritis Care Res (Hoboken) 69 (9):1369–76. https://doi.org/10.1002/acr.23161.

Warren, L. J., J. Clarke, and A. Darzi. 2020. “Measuring the Scale of Hospital Health Record System Fragmentation in England.” Health Services Research 55: 43–44. https://doi.org/10.1111/1475-6773.13386.

Weeks, R. V. 2014. “The Implementation of an Electronic Patient Healthcare Record System: A South African Case Study.” Journal of Contemporary Management 11 (1): 101–119.

WHO. 2008a. “The World Health Report 2008: Primary Healthcare: Now More than Ever.” Geneva: WHO.

WHO. 2008b. “Integrated Health Services: What and Why?” Technical Brief No. 1. Geneva: WHO.

WHO. 2014. “Report on the Regional Consultation on Engaging the Private Health Sector for Accelerating Progress towards Universal Health Coverage.” Accessed May 19, 2021. https://applications.emro.who.int/docs/IC_meet_rep_ 2014_EN_15465.pdf.

WHO. 2021. “Global Strategy on Digital Health 2020–2025.” Geneva: World Health Organisation.

Winchester, M. S., and B. King. 2018. “Decentralization, Healthcare Access, and Inequality in Mpumalanga, South Africa.” Health and Place 51: 200–207. https://doi.org/10.1016/j.healthplace.2018.02.009.

Yamauchi, L. A, E. Ponte, K. T. Ratliffe, and K. Traynor. 2017. “Theoretical and Conceptual Frameworks Used in Research on Family-school Partnerships.” School Community Journal 27 (2): 9–34.

Yip, W. C. M., and W. C. Hsiao. 2020. “Harnessing the Privatization of China’s Fragmented Healthcare Delivery.” In Healthcare Policy in East Asia: A World Scientific Reference: Volume 1: Healthcare System Reform and Policy Research in China, 335–375. https://doi.org/10.1142/9789813236134_0014.

Published

2022-11-10

How to Cite

Chuma, Kabelo, and Philangani Sibiya. 2022. “Digital Health Ecosystem Framework to Address Fragmentation of the Health System in South Africa”. Africa Journal of Nursing and Midwifery 24 (2):28 pages. https://doi.org/10.25159/2520-5293/11547.

Issue

Section

Articles
Received 2022-06-20
Accepted 2022-08-28
Published 2022-11-10