Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa

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dc.contributor.authorSwartz, Alison
dc.contributor.authorLeFevre, Amnesty E.
dc.contributor.authorPerera, Shehani
dc.contributor.authorKinney, Mary V.
dc.contributor.authorGeorge, Asha S.
dc.date.accessioned2021-10-08T07:50:38Z
dc.date.available2021-10-08T07:50:38Z
dc.date.issued2021-07-06
dc.date.updated2021-07-11T03:16:33Z
dc.description.abstractBackground With the aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme (PPIP) and Child Healthcare Problem Identification Programme (Child PIP) (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). Results A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case in four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise community health worker service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system. Inadequate and unsustained investment from donors and government, particularly in human resource capacity and robust monitioring and evaluation, continue to threaten the sustainability of digital health solutions. Conclusions There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems.en_US
dc.identifier.apacitationSwartz, A., LeFevre, Amnesty E., Perera, S., Kinney, Mary V., & George, Asha S. (2021). Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa. <i>Globalization and Health</i>, 17(Article number: 77), http://hdl.handle.net/11427/35037en_ZA
dc.identifier.chicagocitationSwartz, Alison, Amnesty E. LeFevre, Shehani Perera, Mary V. Kinney, and Asha S. George "Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa." <i>Globalization and Health</i> 17, Article number: 77. (2021) http://hdl.handle.net/11427/35037en_ZA
dc.identifier.citationSwartz, A., LeFevre, Amnesty E., Perera, S., Kinney, Mary V. & George, Asha S. 2021. Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa. <i>Globalization and Health.</i> 17(Article number: 77) http://hdl.handle.net/11427/35037en_ZA
dc.identifier.ris TY - Journal Article AU - Swartz, Alison AU - LeFevre, Amnesty E. AU - Perera, Shehani AU - Kinney, Mary V. AU - George, Asha S. AB - Background With the aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme (PPIP) and Child Healthcare Problem Identification Programme (Child PIP) (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). Results A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case in four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise community health worker service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system. Inadequate and unsustained investment from donors and government, particularly in human resource capacity and robust monitioring and evaluation, continue to threaten the sustainability of digital health solutions. Conclusions There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems. DA - 2021-07-06 DB - OpenUCT DP - University of Cape Town IS - Article number: 77 J1 - Globalization and Health KW - Digital health solutions KW - Scale up KW - Sustainability KW - South Africa KW - Health systems LK - https://open.uct.ac.za PY - 2021 T1 - Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa TI - Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa UR - http://hdl.handle.net/11427/35037 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12992-021-00716-1
dc.identifier.urihttp://hdl.handle.net/11427/35037
dc.identifier.vancouvercitationSwartz A, LeFevre Amnesty E, Perera S, Kinney Mary V, George Asha S. Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa. Globalization and Health. 2021;17(Article number: 77) http://hdl.handle.net/11427/35037.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Public Health and Family Medicineen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceGlobalization and Healthen_US
dc.source.journalissueArticle number: 77en_US
dc.source.journalvolume17en_US
dc.source.urihttps://globalizationandhealth.biomedcentral.com/
dc.subjectDigital health solutionsen_US
dc.subjectScale upen_US
dc.subjectSustainabilityen_US
dc.subjectSouth Africaen_US
dc.subjectHealth systemsen_US
dc.titleMultiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africaen_US
dc.typeJournal Articleen_US
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