By Dr Shakira Choonara, Independent Public Health Practitioner, South Africa
I find having worked the past decade in the public health space that there are not nearly enough bursts of energy which really push business unusual. COVID-19 came, and will probably go, and we still won’t see different healthcare systems. Again, Africa is set to be the last to receive any vaccines or even manufacture any vaccines, and despite a hundred talk shops held this year, it is set to continue that way. Our health systems are set to be even further debilitated.
This past month, the theme of the Sixth Global Symposium on Health Systems Research (HSR2020) is “Re-imagining health systems for better health and social justice”. In parallel to this, I participated in the launch of the the Philips Future Health Index report, which highlights the plight of young health professionals in the healthcare system (this is rare) across 15 countries worldwide including South Africa (SA) and a term which has me doing cartwheels – “smart dividend”. As a young professional myself, these two events prompted thoughts around the healthcare system I envision in 10-20 years time.
Unscripted, unfiltered, as I sit back to re-imagine the healthcare system, it would be similar to the Marvel movie or series, where Tony Stark or Felicity Smoak work with the latest technology to figure out just about anything, including health-related issues. Where these characters pull up screens, have all of the data and technology at hand in a matter of seconds and are able to devise a plan, whether it’s to take on villains or to figure out how to save their colleagues, civilians, patients. I recall health-related scenes in Black Panther with the latest technology and speedy healing. If this could happen in Wakanda, why can’t it begin to be a reality?
We are making some progress. Artificial Intelligence is increasingly being used to improve accuracy of diagnostic tests. The last time I was at a private hospital in South Africa (2019), there was a pilot being run for digital patient records versus those massive hard-copy patient data files. Research shows that technology also brings to the fore patient involvement and understanding of data through wearables or applications, which is growing at a fast pace – this is the smart dividend. The most common apps used these days are for weight tracking and reminders for medications.
Okay, so we are not in Hollywood and this wave of technology is out of reach for the majority of patients in low-and middle-income countries (LMICs) who use public sector care, where even access to data or electricity are major barriers to participating in the digital economy. To realise the smart dividend, we first have a bitter pill to swallow, which is to admit that there are faster, more efficient and smarter ways of doing things, but this has not been at the top of the priority list for many Governments.
Secondly, we need to move beyond the current health system orientation and stop thinking of a physical space for healthcare services. We must look at Uber distributing flu vaccines to drones delivering blood or medications, telemedicine as the way of the future, the apps we already wear. The world is changing, the use of digital technology is on the increase. Although public healthcare systems across many LMICs are not maximising the use of digital technology, systems and the ways of doing things are outdated, creating a need for a complete overhaul.