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Healthcare system design and the integration of digital and networked technology for patients with chronic conditions and antenatal women in primary healthcare within rural South Africa: A critical analysis

The Vutivi Health Technology Project

Jocelyn Watkins is a second-year PhD student who holds a Collaborative Social Science Studentship funded by the UK Economic and Social Research Council and GE Healthcare Ltd. The team of academic supervisors for her doctorate includes Prof Frances Griffiths at Warwick Medical School, and Dr Jane Goudge, Centre for Health Policy, and Dr F Xavier Gómez-Olivé, School of Public Health, both at the University of the Witwatersrand, South Africa.

The doctorate is in collaboration with the School of Public Health at the University of the Witwatersrand. Jocelyn is currently undertaking her fieldwork at the MRC/Wits Rural Public Health and Heath Transitions Research Unit at the Agincourt Health and Demographic Surveillance Site in north-east South Africa, Mpumalanga province.

There is deficient understanding about the social, organisational and cultural elements of the successful implementation and adoption of information and communication technology within South African healthcare (Leon et al, 2012). The World Health Organisation promotes the use of digital and networked technology, also known as m-Health and e-Health, as a means to improve health outcomes in low- and middle-income countries. This research explores the present and future implementation of e-Health within public healthcare facilities in rural South Africa.






This project is a critical analysis of the potential for innovation in health system design, implementation and normalisation in rural South Africa, including appropriate use of ICT (digital and networked) technology for health. Situated within the field of health policy and systems research, the project draws on multiple theories and perspectives in relation to healthcare systems and a range of methodologies including interviews with healthcare professionals, community leaders and policy-makers. This will be accompanied by documentary analysis and secondary analysis of health-related data from the Agincourt annual census. Therefore the research is considering the Agincourt site as a case study with a synthesis of theory, policy and data analysis.

Qualitative fieldwork is underway in four primary healthcare clinics within a rural sub-district called Bushbuckridge. Interviews are being conducted with Nurses, antenatal women and patients with chronic conditions. A pilot study at a district hospital called Tintswalo in Acornhoek was completed in November 2013 in the antenatal ward. Jocelyn is learning xiTsonga, the local language of the Shangaan people.

In addition a realist synthesis is underway which questions ‘What is it about digital and networked technologies that works or does not work in primary healthcare settings in rural South Africa, for whom, in what circumstances, in what respect and why?’.

This research is likely to aid the development of the South African national e-Health policy, which should have a top-down effect on resources and decisions at the district level. By informing policy it should also aid health services planning at the local level. The overall aim of e-health initiatives is to improve patient health outcomes. It is with this is mind that the people of Mpumalanga, who use public health services at the primary health level, will benefit, because there is growing recognition of the immense value that new technologies can bring to health access, the training of health personnel and the strengthening of management information systems. With greater evidence-based interventions in place, the community should access/receive better and more efficient healthcare in their local municipality. We will also try to establish and determine what is best for that setting which could contribute to only evidence-based health interventions are implemented in the future.

Contact Jocelyn Watkins at










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