A Mobile Health Re-engineering Strategy within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case (Preprint)

BACKGROUND The Internet is a useful interactive and multimedia platform for disseminating and accessing information unconstrained by time, distance and place. To the health care sector’s benefit, the advent and proliferation of mobile devices has provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalised people and their communities, particularly in developing societies. OBJECTIVE The objective of this study was to review an existing government mHealth programme and design a re-engineered strategy based on best demonstrated practices (considerations and methods) and learnt experiences from the perspectives of multi-stakeholders within the Digital Health Innovation Ecosystem stakeholders in South Africa. METHODS The study employed an ethnographic approach involving document review, stakeholder mapping, semi-structured individual interviews, focus group discussions and participant observations to explore, describe and analyse the perspectives of its heterogenous participant categories representing a purposively sampled, but different constituencies. RESULTS A total of 80 participants were involved in the study, in addition to the 6 (six) meetings the researcher attended with members of a government appointed task team. Additionally, 46 archived records and reports were consulted and reviewed as part of gathering data relating to government’s MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect programme should be implemented beyond mere piloting, to ‘as best as possible’ capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by factors such as: stakeholder mismanagement; impact assessment; management of data; lack of effective leadership and political support; appropriate choice of technology; funding for eHealth and mHealth; integration of mHealth to existing health programmes in tandem with Goal 3 of the Millennium Development Goals; integrating lessons learnt from other mHealth initiatives to avoid resource wastage and duplication of efforts; proactive evaluation of both mHealth and eHealth strategies; change management and developing human resources for eHealth. CONCLUSIONS Based on its findings, the study has only laid a foundation for the re-engineering of mHealth services within the Digital Health Innovation Ecosystem. The study articulated the need for stakeholder collaboration, such as continuous engagement between academics, technologists and mHealth fieldwork professional. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer reviewed or systematic research documents from which South African professionals, research experts and practitioners could learn. Further research is needed for retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa.