A stakeholder-centred mobile health implementation inquiry within the digital health innovation ecosystem in South Africa: a practitioner-researcher’s perspective

Abstract

Background: The Internet is a useful interactive and multimedia platform for disseminating and accessing information unconstrained by time, distance and place. To the health care sector’s benefit, the advent and proliferation of mobile devices has provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalised people and their communities, particularly in developing societies. In many developing countries in particular, initiatives aimed at enhancing the delivery of health services and disease management are stifled in ‘pilotitis’ mode. In addition, many technological innovations and initiatives, including mHealth, have not progressed to their intended full capacity of addressing Goal 3 (good health and well-being) of the global Sustainable Development Goals, which succeeded the Millennium Development Goals. The term ‘pilotitis’ was aptly coined by Digital Health stakeholders to reflect on the multiplication or preponderance of several health-related pilot projects on the African continent, most of which have not been scaled up for community-wide use, resulting in major health concerns and challenges. Purpose: The purpose/ aim of the study was to review an existing government mHealth programme and design a re-engineered strategy based on best demonstrated practices (considerations and methods) and learnt experiences from the perspectives of the Digital Health Innovation Ecosystem stakeholders in South Africa. Methods: The study employed an ethnographic approach involving document review, stakeholder mapping, semi-structured individual interviews, focus group discussions and participant observations to explore, describe and analyse the perspectives of its heterogenous participant categories representing purposively sampled, but different constituencies. Non-probability judgement sampling was utilised for participant selection, while convenience sampling was used for selecting the study’s two geographically disparate sites during five phases of data collection. A total of 80 participants were sampled in the study, in addition to the 6 (six) meetings the researcher attended with senior government officials and members of a government appointed task team and advisory council. Additionally, 46 archived records and reports were consulted and reviewed as part of gathering data relating to government’s MomConnect project. Findings: Among the consulted stakeholders, there was general consensus that MomConnect should be implemented beyond mere piloting, to ‘as best as possible’ capacity within the available resources and time. Experience has shown that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem could be hamstrung by factors such as stakeholder mismanagement; lack of political support, appropriate choice of technology, funding, and integration of mHealth to existing health programmes in tandem with the Sustainable Development Goals. The findings also revealed that critical considerations for a re-engineered mHealth strategy included funding for eHealth and mHealth; impact assessment; data management of data; effective leadership and governance from the National Department of Health; integrating lessons learnt from other mHealth initiatives to avoid resource wastage and duplication of efforts; proactive evaluation of both mHealth and eHealth strategies; change management and developing human resources for eHealth. Moreover, contemporary issues of mHealth services could be addressed by applying digital development principles to strengthen best practices and address existing implementation gaps. The centralisation of mHealth at the National Department of Health was regarded as one of the critical steps to ensure coordinated governance. Conclusions: Based on its findings, the study has only laid a foundation for the implementation of mHealth services within the Digital Health Innovation Ecosystem. The study articulated the need for stakeholder collaboration, such as continuous engagement between academics, technologists and mHealth fieldwork professional. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer reviewed or systematic research documents from which South African professionals, research experts and practitioners could learn. Further research is needed for retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa. On the basis of the reviewed literature (for theoretical and secondary data) and the indispensable ethnographically oriented empirical (primary) data, a 10 (ten) point mobile health implementation framework was produced by this study as an attempt to utilise the findings as an enhancement of practice. The produced strategy implementation areas are: (1) Implementation of stakeholder management on eHealth from the national department of health, (2) Description and compliance process of user-centred design process within the digital health innovation ecosystem, (3)The development of eHealth governance and leadership from the national and provincial department of Health, (4) Guiding Infrastructure Developments and Monitoring compliance with SA Normative Standards, (5)The provision of proactive and maximum privacy and security measures for mHealth, (6) Development of eHealth policy that includes mHealth at national Level, (7) Implementation of Research and development processes that foster collaboration and evidence based implementation of mHealth initiatives, (8) The development of mHealth indicators as parts of the NIDS, (9) Endorsement of eHealth as an independent health program lead by health professionals and (10) Development and implementation of standard operating process for evaluating mHealth total cost of ownership.