Mobile Technology To Improve Health Service Delivery Within Government
Location
Improving the delivery of health services to the majority of South Africans is a key challenge faced by the SA government in the 2nd decade of democracy.Information& communication technologies(ICT)are an enabler that can enhance the ability of the public service to adequately address service delivery backlogs, while providing citizens with a range of more creative options for accessing services.Amongst the many ICT options available to govt to improve the efficiency& effectiveness of its delivery process,mobile & wireless technologies offer some exciting opportunities for a low cost,high reach service.There is strong evidence that mobile technologies could be instrumental in addressing slow response rates,of govt to citizen requests,poor access to services,particularly for low-income and marginalised populations in under-serviced rural areas.In addition,mobile technologies offer significant opportunities for improving the back-office operations of govt.In the SA context,medical institutions-hospitals & clinics-all operate on different systems for gathering & maintaining patient information.In addition,many primary healthcare clinics located in the rural areas do not have any electronic systems at all & continue to operate paper- based systems,resulting in patient records being kept by patients themselves. The impact of the use of multiple systems is that it is difficult& costly to develop a national overview of patient statistics.On a more basic level,it is extremely difficult for idividual institutions within the healthcare sector to share information between each other.One of the clearest examples of this is to be found in the sharing of patient laboratory results.Currently in most instances,this only takes place through manual exchange.Govt identified the Dokoza pilot as one that could enable electronic data-sharing in a manner that enhances the ability of the health worker.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Service/process
Year the initiative began (yyyy)
2004
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Patients not empowered
Which of the principles is the primary focus of your work?
Simplify through technology
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
This field has not been completed
Name Your Project
Mobile Technology To Improve Health Service Delivery Within Government
Describe Your Idea
Improving the delivery of health services to the majority of South Africans is a key challenge faced by the SA government in the 2nd decade of democracy.Information& communication technologies(ICT)are an enabler that can enhance the ability of the public service to adequately address service delivery backlogs, while providing citizens with a range of more creative options for accessing services.Amongst the many ICT options available to govt to improve the efficiency& effectiveness of its delivery process,mobile & wireless technologies offer some exciting opportunities for a low cost,high reach service.There is strong evidence that mobile technologies could be instrumental in addressing slow response rates,of govt to citizen requests,poor access to services,particularly for low-income and marginalised populations in under-serviced rural areas.In addition,mobile technologies offer significant opportunities for improving the back-office operations of govt.In the SA context,medical institutions-hospitals & clinics-all operate on different systems for gathering & maintaining patient information.In addition,many primary healthcare clinics located in the rural areas do not have any electronic systems at all & continue to operate paper- based systems,resulting in patient records being kept by patients themselves. The impact of the use of multiple systems is that it is difficult& costly to develop a national overview of patient statistics.On a more basic level,it is extremely difficult for idividual institutions within the healthcare sector to share information between each other.One of the clearest examples of this is to be found in the sharing of patient laboratory results.Currently in most instances,this only takes place through manual exchange.Govt identified the Dokoza pilot as one that could enable electronic data-sharing in a manner that enhances the ability of the health worker.
Innovation
Define the innovation
Improving the delivery of health services to the majority of South Africans is a key challenge faced by the SA government in the 2nd decade of democracy.Information& communication technologies(ICT)are an enabler that can enhance the ability of the public service to adequately address service delivery backlogs, while providing citizens with a range of more creative options for accessing services.Amongst the many ICT options available to govt to improve the efficiency& effectiveness of its delivery process,mobile & wireless technologies offer some exciting opportunities for a low cost,high reach service.There is strong evidence that mobile technologies could be instrumental in addressing slow response rates,of govt to citizen requests,poor access to services,particularly for low-income and marginalised populations in under-serviced rural areas.In addition,mobile technologies offer significant opportunities for improving the back-office operations of govt.In the SA context,medical institutions-hospitals & clinics-all operate on different systems for gathering & maintaining patient information.In addition,many primary healthcare clinics located in the rural areas do not have any electronic systems at all & continue to operate paper- based systems,resulting in patient records being kept by patients themselves. The impact of the use of multiple systems is that it is difficult& costly to develop a national overview of patient statistics.On a more basic level,it is extremely difficult for idividual institutions within the healthcare sector to share information between each other.One of the clearest examples of this is to be found in the sharing of patient laboratory results.Currently in most instances,this only takes place through manual exchange.Govt identified the Dokoza pilot as one that could enable electronic data-sharing in a manner that enhances the ability of the health worker.
Context for Disruption:
The Dokoza system is a new innovative cost-effective interactive real-time mobile system for fast-tracking & improving critical services to the broader majority.Components of the system have been patented(SA Patent#2002/1242),the system has been developed in SA for use initially in HIV/AIDS(specifically in respect of the roll-out of anti-retroviral therapy)and TB treatment,with the view to including other diseases.The system involves the use of SMS& cell phone technology for information management, transactional exchange & personal communication.The cell phone makes use of a regular issue SIM card across any existing cell phone network.The system standard is normal SMS text messaging and therefore does not require special additional SIM software or downloading of templates for interacting.Dokoza back-end system is extensively rules based for intelligent interaction to build capacity for health workers with little knowledge.For e.g.,the system is able to process an ARV/TB programme in the context of particular disease management protocols managed by a chosen group of Patient Management Clinicians(PMC).The PMC is not the treating health worker,but rather the person responsible for the design and monitoring of treatment protocols.Furthermore,Dokoza back-end system is easily integrated with all existing hospital systems(such as the National Lab)and Dokoza can also be accessed in real-time via PC web,laptop,PDA,Smartphone,Palmtop and is able to interact with fax and email.Overall there are various levels of security measures,firewalls and encryption.Dokoza does not display HIV sensitive information on the web and further security is required to view these in a back-office environment.Dokoza offers the Dept of Health a cost- effective accessible national platform,with the capacity to collect& disseminate real-time data& transaction exchange,without further systems development on the part of the Dept apart from establishing connectivity with Dokoza.
Delivery Model
The idea is that the system is concieved from the outset as a system that is fundamentally common to all participating facilities across the country, by using the Web and GSM platforms,and that is an integral part of the broader public health system of South Africa, or any other country. The system is designed to support key health requirements and functions, such as offering capacity for resource poor settings( resource poor in terms of no computer hardware and /or little knowledge), national patient tracking and surveillance, or easy access to patient history in order to make accurate clinical decisions and so on. The system caters for: 1)Single Patient View 2)Mobility 3)Open Source Solution. We believe that our model is designed to reach and improve health service delivery to low-income or marginalised populations, cost-effectively and easily achievable in the short term.
Key Operational Partnerships
During 2004/2005 the pilot project was implemented at 2- government sites (Helen Joseph Hospital HIV/AIDS Adult Clinic and Johannesburg General Hospital HIV/AIDS Childrens Clinic) with the cooperation of the Gauteng Provincial Health and the National Department of Health. Other participants were members from the 2- hospitals' Health Information Systems:Medicom & PAAB, and The National Health Laboratory Service.The Dokoza pilot project was commissioned and fully funded by the following government departments: State Information Technology Agency (SITA), Centre for Public Service Innovation(CPSI), Centre for Scientific and Industrial Research(CSIR), Meraka Institute with the cooperation of the National Department of Health. Also, the pilot was simultaneously implemented at a private site: Tugela STD (Sexually Transmitted Disease) Clinic in KwaZulu Natal South Africa. This STD clinic is run by the National Road Freight Industry and is supported by the Department of Health in terms of staffing and providing medicine supplies. The STD Clinic services national long distance drivers and sex workers from within the area. This private pilot was fully funded by Dokoza and its partners. Regarding our business, Dokoza's strategic partners are Neil Harvey & Associates (NHA)who is Dokoza IT partner and Deloitte is Dokoza partner for Data Analysis & Reporting, Risk Management and Strategic Advice.
Impact
Financial Model
1)Dokoza will charge no upfront development fees 2)On successful implementation of the system, the Department of Health will be charged a small capitation fee on a per registered patient per month basis 3)The Department of Health will also pay for Dokoza ingoing and outgoing SMS costs, via a toll-free/reverse charge SMS line, for all health worker interactions 4) Patients receiving SMSs for health alerts, medicine compliance reminders, appointment reminders, notification for receipt of blood test results and so on, will receive this as a 'free service' i.e., this will be treated as a Dokoza outgoing SMS as per point no. 3 above and invoiced to the Department of Health.
What is your annual operating budget?
0%
What are your current sources of revenue? (please list any sources that are foundation grants)
The project currently generates no income.
Effectiveness
1. User Acceptance. During the pilot, some health workers who were not computer literate and in some cases had never used a computer, were easily willing to learn and successfully used the cell phone for data & transaction exchange. 2) Increased Treatment Compliance. Feedback, from patients who participated in receiving SMS health alerts, was very encouraging and positive. Patients indicated that, by receiving an SMS reminder to take their meds twice a day at the appointed times, this made treatment compliance easier.
Which element of the program proved itself most effective?
Accessibility to clinical data easily and timeously. There is a general lack of computers and lack of readily available clinical and other information.
Number of clients in the last year?
0 last year
What is the potential demand?
We believe that all 'resource-poor' countries('resource- poor' in terms of health workers with no computers and /or little knowledge) would benefit from Dokoza.
Scaling up Strategy
We are involved in various health tender submissions to the SA government.
Stage of the initiative:
1
Expansion plan:
The South African National Department of Health has issued out a tender for the SA National Electronic Record, where Dokoza has responded as part of a large consortium. Should we be successful, then the project for the next 3-years is to roll-out mobile technology to all 9-provinces in South Africa. Simultaneously we will sell mobility to other SA goverment departments and we will also actively look to other health markets in other countries who may be interested in our proven solution.
Origin of the Initiative
Dokoza is a registered trademark and brand name for a health mobile system created by Kubatana Close Corporation. Jessie Dias-Alf is the sole owner of Kubatana CC / Dokoza project and has been working on this project since 2004 to date. Jessie Dias-Alf has been active in the SA medical aid industry since 1992.A main motivation for the invention was real-time empowerment for rural doctors who do not have access to computers to switch or submit patient medical aid accounts to private sector Medical Aid Schemes, for example.We believe that Dokoza is an exciting opportunity that will enhance government service delivery and improve internal efficiencies.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
The greatest challenge with most pilot projects in the public sector is that they do not move beyond the piloting phase, with very little replication or mainstreaming taking place. The Dokoza project faces similar challenges. In order to ensure that the project becomes sustainable, a number of environmental challenges need to be overcome, both within the specific pilot sites,and within the public healthcare sector more broadly. Due to the fact that pilots such as Dokoza are selected through a public solicitation process, but one not fitting with requirements of formal public sector procurement, departments are reluctant to take over the outcomes of the project, particularly when they are linked to a specific service provider. A limited number of options are available to any Department, as they are to the Department of Health in this case.
How did you hear about this contest and what is your main incentive to participate?
Have heard about this contest through a colleague. Our main incentive for participation is around potential funding to assist with the scaling up of the project.
The Story
Do you have an annual financial statement?
The project currently generates no income.
Do you currently have an annual financial statement that tracks profit/loss?
The project currently generates no income.
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
Our financial model has been drawn up and this is available on request.
 | countioshi said: learned something new http://www.google.com Does this show about this Competition Entry. - 796 days ago read more > |
| bajacaribe said: Supposedly, there was an outbreak of TB in homeless shelters in San Francisco California during months before September 2007 that ... about this Competition Entry. - 1601 days ago read more > |
| LAWRENCE said: Dear Deb Levine: As one who has worked in business and development management for the past 20+ years, mobile phone devices have ... about this Competition Entry. - 1644 days ago read more > |
| Jessie Dias-Alf said: Thank you for your comments. To answer your questions: (A)What is it (the system) capable of doing right now? 1) Real time data & ... about this Competition Entry. - 1670 days ago read more > |
| Jessie Dias-Alf said: Our back-end system is extensively rules based and capable of initiating an intelligent chain of activities to deal with situations such ... about this Competition Entry. - 1670 days ago read more > |
| Jessie Dias-Alf said: Hi Deb, Thank you for your comments. It's interesting that you talk about providing a service with "less clicks away"....We do not ... about this Competition Entry. - 1670 days ago read more > |
| Deb said: I applaud Ms. Dias-Alf's work using cell phones for HIV prevention and TB management in South Africa. It is quite brilliant. As the use ... about this Competition Entry. - 1675 days ago read more > |
| skrelnick23 said: Dear Ms. Dias-Alf: Cell phones are becoming ubiquitous even in rural Africa. The health sector can learn from your example and use ... about this Competition Entry. - 1681 days ago read more > |
| skrelnick23 said: Dear Ms. Dias-Alf: Theuse of text messaging as a form of health notifications is indeed fascinating. Due to our lack of knowledge on ... about this Competition Entry. - 1687 days ago read more > |
| skrelnick23 said: Dear Ms. Dias-Alf: The use of text messaging as a form of health notifications is indeed fascinating. Due to our lack of knowledge ... about this Competition Entry. - 1687 days ago read more > |
Comments
Dear Ms. Dias-Alf:
The use of text messaging as a form of health notifications is indeed fascinating. Due to our lack of knowledge on the technology, we would love an example of how your network is used. I do like the example of reminders of medicine schedules but how does it apply to other health or medical issues? Let's say for instance that there was a TB outbreak, how does your network respond and what is the role it plays? What is an example of a text that a village health practitioner or village member may receive?
Also, can your subscribers also report such outbreaks to you? With the knowledge of symptoms, members of a community may want to notify the greater network, do they have that capability? Some societies where the internet use is wide spread, symptoms can be researched online to help guide individuals for treatment or to gain knowledge. Could the SMS texting system do something similar?
Thank you for your response!
Changemakers Team
Our back-end system is extensively rules based and capable of initiating an intelligent chain of activities to deal with situations such as those described in your comments. For example one would write a rule that says in the event of a particular input in the TB outbreak field, select this text message, to send to all registerd clinicians and patients with this identifier on their master file (the identifier could be for a particular area)....hope this makes sense!
Thanks Jessie.
Dear Ms. Dias-Alf:
Theuse of text messaging as a form of health notifications is indeed fascinating. Due to our lack of knowledge on the technology, we would love an example of how your network is used. I do like the example of reminders of medicine schedules but how does it apply to other health or medical issues? Let's say for instance that there was a TB outbreak, how does your network respond and what is the role it plays? What is an example of a text that a village health practitioner or village member may receive?
Also, can your subscribers also report such outbreaks to you? With the knowledge of symptoms, members of a community may want to notify the greater network, do they have that capability? Some societies where the internet use is wide spread, symptoms can be researched online to help guide individuals for treatment or to gain knowledge. Could the SMS texting system do something similar?
Thank you for your response!
Changemakers Team
Supposedly, there was an outbreak of TB in homeless shelters in San Francisco California during months before September 2007 that involved five city funded homeless shelters and about 50 shelter (or respite) residents may have had to have been located and notified for additional screening. Their locations are likely scattered over a large number of locations.
If it had been the XDR-TB: Outbreak of a Drug-Resistant Tuberculosis (from Digg.com) then time would be a critical factor and notification in a densely populated area with highly mobile residents time is of the essence for notification. It can save a life.
I think SMS Messaging sent to every resource center, homeless shelters, medical centers, etc. and all homeless clients registered could have been alerted in hours or a day instead of who knows how long. I think SMS could also be back linked to email, pagers, faxes (digitally).
Good comments on these uses.
Dear Ms. Dias-Alf:
Cell phones are becoming ubiquitous even in rural Africa. The health sector can learn from your example and use their rapid spread into remote rural areas in order to promote health. What is it capable of doing right now? What are the plans for making it more functional and user-friendly to people who lack computer or phone literacy? What is the exact evidence that patients using these phones were able to adhere to their medications? We would love to see more evidence of efficacy and further details about functionality, this proposal could be disruptive in urban and rural settings.
Again, we thank you in advance for your response.
Changemakers Team
Thank you for your comments. To answer your questions: (A)What is it (the system) capable of doing right now? 1) Real time data & transaction exchange - the system allows for interactive online information management/ sharing and real-time processing for cost of services/medication to a particular cost centre for a specific patient. 2) Capacity building - for example, the clinician's question could be answered for a paticular patient taking into account his/her full medical history, as captured initially and updated in real time on the back-end system 3) Authorisation - requests for authorisation of particular treatment may be made, should there be a need for such an authorisation system. For instance, based on the latest pathology results of a patient, a new medication regimen may be authorised electronically. Authorisation may be linked to practical administration, in the form of stock control and or delivery of medication. 4) National Patient tracking & surveillance - Dokoza is able to update registered patients from interfacing with all existing hospital information systems. Patients who access care across facilities, may receive appropriate care as the clinicians in different facilities are aware of key treatment already provided to patients. Lack of information about treatment already provided may significantly hamper protocol compliance. 5) Common Platform - For example, Dokoza was able to interface with the local hospital information system and the laboratory system which would allow both parties to exchange information efficiently in order to perform key functions more effectively. 6) Confidential communication with patients - capacity for automatic patient reminders to take medication, or of appointments, or encourage generally with short education messages. (B)What are the plans for making it more functional and user friendly to people who lack computer or phone literacy? User feedback on our software version was extremely favourable and supports the case that entry level SMS is accessible and user-friendly. This is an unedited response from a user " The system is very helpful - easy to use because we are (more) used to cell phones than computers. Can be used at anytime - easily available, no waiting for someone to finish using the computers - only one computer in department. Less paperwork. Can get lab results immediately and can also get subsequent result. Not easy to make (a) mistake with result because (one) will be looking at the figures unlike taking (verbal) result on the phone". (C) What is the exact evidence that patients using these phones were able to adhere to their medication? There is no way to ensure compliance, one can only remind patients and the reminder itself assists patients to remember to take meds for example.
Thanks, Jessie.
I applaud Ms. Dias-Alf's work using cell phones for HIV prevention and TB management in South Africa. It is quite brilliant. As the use of cell phones for text messaging has only recently become ubiquitious, it is hard to find any statistics or numbers to compare usage stats, as well as technological capabilities. Each day, we are finding out more and more about what we can do in terms of programming for mobile phones. For instance, we have a reproductive health/HIV prevention SMS service in the States, text SEXINFO to 61827. You then get a menu of information from which to choose. We had great response in San Francisco (4500 inquiries in the first quarter of the program), but after extensive usability testing, we found that the youth were not getting past the menu to the vital information and referral resources. We are now exploring new ways to program the service so that the information is "less clicks away" (using the computer model).
Best of luck!
Deb
Deb Levine, Exec. Director
ISIS, Inc.
www.isis-inc.org
Hi Deb,
Thank you for your comments. It's interesting that you talk about providing a service with "less clicks away"....We do not use menus or templates for our intelligent SMS interactive service. The user inserts a very short command which could be a combination of alpha / numeric and our back-end system applies rules and does all the work! We found this method to be very successful especially around clinicians who had limited time and needed quick access to key patient data; our response time is sub 5-10 seconds.
Kind regards
Jessie.
Dear Deb Levine:
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learned something new
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