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Table 1 Summary description of four case studies of digital solutions in South Africa

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

Case study Why?
Value proposition
Components/ Functions
Timeline of key milestones
Geography and Coverage
Perinatal Problem Identification Programme (PPIP) PPIP was developed to address the data needs of clinicians to understand the reasons for perinatal deaths to inform further action An electronic perinatal mortality auditing tool: Captures and allows for analysis of perinatal (22 weeks’ gestation- 7 days after birth) and maternal deaths, as well as other related morbidity information.
PPIP focuses on: 1) Numbers of deliveries, stillbirths and early and late neonatal and maternal deaths (“Identification”)
2) Causes of death
3) Avoidable factors (carer, health care personnel or health system). The data is used during audit meetings to identify solutions.
Adopters: facility health providers who are often nurses supported by doctors.
Tech: Clarion and later Windows.
Implementation: National Department of Health (NDOH), Provincial Department of Health (DOH)
External Funders: Limited overall funding, some South Africa Medical Research Council (SAMRC) and Centre for Disease Control (CDC) funding.
Pre-1994- paper-based recording of ‘avoidable’ factors
1994- first digital version of PPIP developed [20]
1995–2000- scale-up driven by champions; scale increases with time
2003- Saving Babies Task Team established
2008- National Perinatal and Neonatal Morbidity and Mortality Committee (NaPeMMCo) established
2012- PPIP mandatory for all public health facilities where deliveries and care for new-borns occurs [31]
Nationally endorsed but unevenly used across the country. In 2015, it included 588 participating sites, covering 75.6% of government facility births as per District Health Information System (DHIS) [31].
Most complete PPIP data: Western Cape, Mpumalanga, North West and Free State provinces.
Least complete PPIP data: Eastern Cape, Gauteng and KwaZulu Natal provinces.
Child Healthcare Problem Identification Programme (Child PIP) Child PIP was implemented to improve the quality of care that children were receiving in public hospitals, based on lessons learned from a review of deaths in these institutions An electronic child mortality auditing tool designed to assist health providers better understand and improve care for infants and children from birth to 18 years
Child PIP focuses on:
1) Numbers of child deaths
2) Causes of death
3) Modifiable factors (carer, health care personnel or health system).
Adopters: more clinician driven than PPIP
Tech: Jembi
Implementation: DOH
Funders: limited CDC, GlaxoSmithKline (GSK) funding
1994- first digital version of PPIP developed [20]
Early 2000s- Dr. Angelica Krug piloted in North West province [32]
2004- Child PIP field testing led to first Saving Babies Report
Nationally endorsed but unevenly used across the country.
Approximately 80% coverage of hospitals across the country. Rapid scale-up from 4 pilot sites in 2002 to over 50 in 2008.
MomConnect MomConnect was primarily developed to address the failure to meet the Millennium Development Goal targets related to maternal and child survival by 2012, as part of a suite of interventions [5] A pregnancy registration and mobile messaging service for pregnant and postpartum women in the public sector. Messages to women (a) provide stage-based health information messages bi-weekly and (b) a helpdesk to enable users to ask questions, and provide compliments or complaints about services received Adopters: Health workers who register women; pregnant women who receive messages and send feedback
Tech: Jembi, Praekelt
Implementation: NDOH, DOH, Praekelt
Funders: USAID/ PEPFAR; Johnson&Johnson; Elma Philanthropies; UNICEF; NDOH
Other: Mobile Network Operators
2013- MomConnect Taskteam established
2014- MomConnect officially launched in August
Nationwide, includes over 2 million pregnant women attending first antenatal appointment (but only 60% of all pregnant women), provided by 30,000 nurses, over 4000 public health facilities across 52 districts [5].
CommCare CommCare was originally developed to assist frontline health workers deliver services to populations in low-resource settings A digital application for CHWs that includes primarily features for data capture and secondarily for decision support, in this case for HIV and TB Adopters: CHWs
Tech: Dimagi, Jembi
Implementation: Aurum Institute supported by NDOH
2007- CommCare tool launched by Dimagi. Inc. [33]
2008- CommCare tested in two AIDS treatment sites in SA [34]
2018- Digital Square Report describing significant digital solutions in SA [19]
At the time of interviews, implementation was not initiated. It was slated for late 2019 and projected to scale-up to 10,000 users over a nine-month period, starting in 12 out of 27 health districts in Gauteng and KwaZulu Natal provinces (SA_301_CommCare, tech partner).