SA’s NHI needs collective will, shared data

Johannesburg, 27 Jul 2022

South Africa’s planned National Health Insurance (NHI) for universal healthcare will depend on all stakeholders showing a collective will for it to succeed, and on data shared across the healthcare ecosystem. 

This is according to experts who were participating in an AWS Cloud Technology event on technology-enabled healthcare delivery this week.

Dr Rajeev Rao Eashwari, Director for eHealth, Hospital Services at the Gauteng Department of Health, said: “Health and patient data needs to be shared across the continuum of healthcare to improve service delivery and patient outcomes.”

He cited Rolan Christian, CEO of CareConnect, who said data needs to be democratised and made more accessible especially in the public health space.

Dr Eashwari said: “In both the private and public sector, a lot of data exists, but that data is siloed on local servers, MRIs and other equipment. What is required is a vendor-neutral cloud that can assist us in getting all the information together and providing access to end-users such as rural healthcare practitioners.”

He noted that nationally, digital initiatives exist such as MomConnect, a National Department of Health app in partnership with AWS customer,, on which over three million women are registered. MomConnect supports maternal health through the use of mobile phone technologies integrated into maternal and child health services.

At Albert Luthuli tertiary hospital in Durban, digitisation of patient records took place as a public private initiative. Dr Eashwari said: “The reason we couldn’t take it to the next level was because it was a costly exercise. Therefore the records that were digitised at the hospital remain in a silo.”

He said shared, centralised national patient records would enable faster diagnosis and treatment and support an effective NHI. “We need shared data and close collaboration between government, private sectors and funders,” he said.

“The Electronic Vaccination Data System (EVDS) that launched at the start of the pandemic took just two and a half months to build and now represents a single centralised database of all the citizens who have been vaccinated,” he noted.

“Unique primary identifiers such as Road to Health booklet identifiers are the starting point to the Health Patient Registration System (HPRS). The second step is to look at citizen information, where we can pick up early diabetes and hypertension so we can diagnose and treat patients earlier, before they become ill, and work on a preventative approach. Creating integrated digital platforms is key to keeping citizens healthy. The Health Department is looking to work closely with AWS on a platform that will be useful for the NHI going forward modelled on the UK NHS digital strategy.”

Event attendee GovChat founder and CEO Eldrid Jordaan said political will and departmental collaboration were needed to improve healthcare service delivery. He noted that census data is outdated, which could hamper health response and service delivery, while GovChat offered real-time, up-to-date data. “Sharing of data is crucial – we need to start talking with one another. COVID-19 was a blessing in that it showed that technology is an enabler, and things like GovChat and the EVDS wouldn’t have happened.”

Another attendee, Ockert Coetzee, Sales and Marketing Executive at MEDITECH SA, noted that MEDITECH had enabled all hospitals and clinics in Botswana to be integrated into a single system. “Achieving this is around political drive and protection of information. The model at Albert Luthuli could be replicated within days – if it’s happening across the border with Botswana, it could happen here,” he said.

Protecting shared data

Christelna Reynecke, COO at the South African Health Products Regulatory Authority (SAHPRA), said: “We do believe digital technologies will close the health inequality gap. But the WHO Global strategy on digital health 2020 – 2025 stresses that there has to be commitment to the process, there must be integration and that the equality gaps must be closed for these technologies to succeed. We also have to continually monitor and manage progress and successes.”

Jean Pierre Horne, Head of Healthcare at Amazon Web Services, said: “We all understand the importance of the protection of personal information, particularly healthcare information, and the POPIA is very clear on how records should be managed. Now, patients must give their consent to the storage of their data. It’s also the responsibility of healthcare organisations to put the necessary systems and processes in place to protect it.

“This is where the cloud is important – we have the most comprehensive security and compliance controls in the cloud – so we address the security structure. The healthcare industry is highly regulated; for example, HIPAA eligible services framework and the HITRUST accreditation process for the protection of health information. AWS has ensured that our protocols meet those international standards and regulations. However, it is important that organisations manage the security of their data once it’s in the cloud, for example, through who they allow to access the data. Therefore, an AWS shared responsibility model exists,” Horne said.

Said Dr Eashwari: “The NHI is not negotiable, it’s the only way to provide universal health access. Public private partnerships and shared data are crucial to enable this.”