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Title: The Vutivi study : understanding the potential role for appropriate digital technological solutions in the innovation of health system design, implementation and normalisation in rural South Africa for both patients and health-workers : a critical exploratory analysis
Author: Anstey Watkins, Jocelyn Olivia Todd
ISNI:       0000 0004 5992 8794
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2016
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Background: In South Africa, 81 per cent of the population are dependent on the public health system. The country faces a complex burden of a combination of chronic infectious illness and non-communicable diseases and high maternal mortality, 310 deaths per 100,000 live births. These and many other systemic health challenges have meant the government is starting to invest in digital solutions to strengthen health services delivery and public health; due to their ease of use, broad reach and wide acceptance. Digital communication systems are an intriguing possibility for delivering healthcare in low-resource settings. This thesis considers how mobile (mHealth) and non-mobile communication technologies are currently and potentially being used by patients and health-workers within the rural South African health system. Health system dimensions are also analysed at the macrolevel to define the enablers and barriers to mHealth. Methods: This qualitative exploratory study was a case study design guided by theory-driven realist methodology. Mixed-methods research triangulated in-depth individual interviews, focus group discussions, prolonged engagement in nonparticipant observations and documentary analysis from a diverse range of participants (community members, patients, health-workers, policy-makers and experts) operating at different tiers within the country (community, facility, district, provincial and national). A realist review of patient mobile monitoring of chronic disease was conducted to determine hypotheses to inform the interpretation of empirical data and refine theory from the Context-Mechanism-Outcome configurations. These were supported by high-level theories of access, normalisation and the capability approach. Results: Supportive government policy combined with patient and health-workers’ informal mHealth use can act as enablers to the uptake of digital communication systems, particularly with improved maintenance and management strategies. Access to health information is a barrier to care, which may be overcome with an evidence-based health website though inequities may still remain. Likewise, digital reminders may support chronic disease management particularly for patients with hypertension. Poor patient referrals and remote diagnosis can be overcome by digital communication as smartphone ownership increases and mobile data prices reduce. Local digital innovation relies on government backing for greater scale. Conclusion: Informal digital communication solutions for health used by patients and health-workers are evident as mobile phone use becomes normalised within society. This is occurring in parallel with the government’s interest in digital health technologies to strengthen the delivery of care. A novel healthcare delivery framework proposes that a foundational electronic health and mHealth ecosystem (Context) can support a health system with multiple challenges. The four health system dimensions of government stewardship, organisational, technological and financial systems are necessary to support mobile health solutions. These dimensions give reinforcement (Mechanisms) to improve communication between patients and health-workers which may increase access to healthcare and continuity of care. Work practices are made more efficient, health service delivery is enhanced and patient outcomes can improve to maximise health gain (Outcomes).
Supervisor: Not available Sponsor: Economic and Social Research Council ; GE Healthcare Limited
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA Public aspects of medicine