South Africa stands at a critical point in its healthcare evolution. While the vision of a comprehensive digital health record for every citizen is appealing, the reality is more complex and far more achievable if we approach it with honesty and pragmatism.
Over the past decade, attempts to build home-grown systems, such as HPRS and the COVID-19 vaccination platforms, have shown the country’s willingness to digitise. Yet they have also highlighted the pitfalls of trying to stitch together disparate, locally developed applications into a national solution.
Instead of unifying care, these efforts have often resulted in fragmented islands of data, outdated records and systems that fail to serve clinicians and patients effectively.
Proven systems over patchwork experiments
In complex environments like healthcare, there is no substitute for rock-solid, proven digital platforms. Just as leading private sector businesses choose global enterprise software for critical operations, healthcare should rely on established, comprehensive electronic medical records (EMR) packages designed to handle the complexity of clinical care at scale.
These systems are built, maintained and continually improved by experts. They offer guaranteed data integrity, regular updates and the depth of functionality needed to support everything from outpatient visits to academic research.
Choosing these robust, off-the-shelf systems does not mean sacrificing local relevance. On the contrary, it allows provinces and districts to focus on configuring systems to fit their needs rather than spending years and millions of rands trying to build basic functionality from scratch.
From national dreams to district realities
The popular idea of a single national health record stored in one central system is more a dream than a deliverable. Instead, South Africa should focus on building complete, comprehensive electronic medical records at district or provincial level. This aligns with how healthcare is actually delivered, which is primarily within a person’s local area, district or province.
These local systems can and should be designed to share key data across regions when needed, ensuring that patients who move can have their information transferred safely and efficiently. But expecting a single record to follow a citizen seamlessly across every clinic and hospital nationwide is neither realistic nor necessary.
Interoperability with purpose
Interoperability remains essential. However, it should not become an excuse for creating endless connections between underdeveloped systems. Instead, integration should be strategic – connecting strong, comprehensive district or provincial EMRs to higher-level reporting tools, rather than attempting to patch together a fragile national database from weak foundations.
At a national level, what is needed is visibility into trends, outcomes and programme performance, not direct transactional access to each patient's full clinical record. That is both wasteful and unnecessary. National dashboards should provide insights into priority programmes such as HIV, TB and maternal health without compromising local system integrity.
Moving away from open source illusions
South African government departments have had a long-standing love affair with open source software, which is often presented as a flexible, low-cost alternative, but global experience shows this promise rarely matches reality. These systems rely heavily on small, highly specialised teams to maintain, patch and update them. Over time, as original developers move on and external funding disappears, health departments are left managing complex software with limited expertise and resources.
This creates hidden costs, operational risks and serious vulnerabilities, particularly dangerous in healthcare, where system failures or outdated clinical information can directly impact patient safety.
For South Africa, with limited budgets and an urgent need to improve health outcomes at scale, this model is neither practical nor sustainable. Proven, commercially supported systems offer stability, guaranteed updates and dedicated support teams who ensure clinical safety and compliance. While they may appear more expensive upfront, they provide long-term value and reliability, exactly what South Africa needs to build a strong, resilient digital health foundation.
A call for clarity and courage
South Africa does not need more partial systems, empty promises or vanity projects. It needs comprehensive, robust EMRs that can truly support clinicians and improve outcomes. It needs district and provincial leaders empowered to choose the best solutions for their populations, supported by national policy that understands and respects local realities.
A single, reliable medical record per citizen, securely held where care is delivered, and shared appropriately when needed – that is the future of healthcare and patient record systems South Africa can and should build. Not a fragile web of half-finished experiments, but a strong digital backbone worthy of the country’s healthcare ambitions.
In the end, success will not be measured by the number of pilot projects launched or systems announced. It will be measured by whether clinicians have the information they need to save lives, and whether every South African receives the care they deserve.
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