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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

What?

Components/ Functions

Who?

Actors

When?

Timeline of key milestones

Where?

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

Funders: PEPFAR, UNAIDS

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).