As a first year student, I had the opportunity to complete a Global Academic Travel Experience (GATE) course on South Africa that culminated in a two-week trip to South Africa over spring break. Over the course of two weeks, we spent time in Cape Town, Durban, the Entabeni game reserve, and Johannesburg. The trip was a once in a lifetime opportunity to venture to the other side of the world and experience an emerging, but strong economy with an incredibly rich, but complicated, social and political history. I was also interested in learning more about South Africa’s healthcare system, given widespread HIV and tuberculosis (TB) prevalence that further complicates care delivery. The trip definitely did not disappoint!
Our main class assignment required us to develop a business plan for a particular industry prior to our trip, and then write a follow-up assessment to evaluate its actual potential based on our company visits, cultural tours, and the trip overall. Given my impending summer internship at athenahealth, I chose to focus my paper on electronic medical record adoption and implementation in South Africa. Several factors complicate the South African healthcare landscape:
- The system varies in both its breadth and depth across the private and public sectors. While the state provides primary care and accounts for 40% of all healthcare expenditures, the private sector currently provides care for 80% of the total population[i]. This divide between the private and public sectors has led to widespread disparities in access to healthcare services–an underfunded, understaffed public health sector provides care to lower income individuals, and a private health sector employs 80% of all providers and targets middle to higher income individuals[ii].
- Secondly, the burden of infectious disease, particularly HIV and tuberculosis, adds additional complications to this dichotomous system. Currently, the South African life expectancy hovers around 53 years of age as a result of these two infections and their complications; 60% of South African TB patients are also HIV+[iii]. This translates to approximately 1,000 deaths per day due to AIDS.[iv] Mother-to-child transmission is also a significant area of concern, as 30% of pregnant women were found to be HIV+ as of 2011[v]. By comparison, tuberculosis affects approximately 1% or 500,000 South Africans,[vi] translating to the second highest rate of new tuberculosis cases in the World and the highest rate of drug-resistant tuberculosis in Africa.[vii] The drug resistance adds another complicating factor that also significantly increases medical costs; further, it is almost certainly driven by varying levels of adherence to medication regimens due to sporadic and inadequate access to care.
Post-Trip Assessment: While on the trip, I had the opportunity to see a few medical facilities, and visit the traditional Zulu Muthi market in Durban. However, the most interesting “reality check” for my business plan was a front page, Johannesburg newspaper article titled “Is there a doctor in the house?” , centered entirely on the shortage of doctors and nurses in South Africa. By the numbers, South Africa only graduates half of the physicians it needs on an annual basis: 1,200. This, for a country of approximately 52 million individuals. Additionally, the average age of a specialist is 55 years [2].
Numerous factors were discussed as part of the rationale, including a lack of interest in the medical profession, mass exodus of South African physicians to other countries, and insufficient capacity at medical schools that prevents taking on larger class sizes.[viii] Additionally, private hospitals are not allowed to train medical students, so training is restricted to public hospitals, further decreasing the national recruitment pipeline. There has been movement to lobby for government approval of training in private hospitals, but thus far has not been successful despite significant support from the private hospitals.
Given this dramatic shortage of physicians, my final assessment was that it may be early for South Africa to consider full-scale EMR adoption. EMR adoption would require governmental support, via potential subsidization and regulation, and it seems that their efforts would be better focused on insuring sufficient clinicians to care for South Africa’s citizens. However, I do think adoption of a point-of-care app could be a great resource for training medical students in general. Access to the latest technology could change the perception of the profession and also incentivize the younger generation to consider treatment options and resources that may be “outside the box”.
Overall, the opportunity to vet my business plan was an important lesson in applying the business skills I learned throughout my first year at Fuqua. But most importantly, the trip was an amazing experience!
[i]http://www.southafrica.info/about/health/health.htm#.Uw0Y2_ldWSp
[ii] Ataguba, John Ele-Ojo. “Health Care Financing in South Africa: moving toward universal coverage.” Continuing Medical Education. February 2010 Vol. 28, Number 2
[iii] Ibid
[iv]http://www.avert.org/south-africa-hiv-aids-statistics.htm
[v]http://www.avert.org/south-africa-hiv-aids-statistics.htm
[vi]http://www.nicd.ac.za/?page=c_tb&id=17
[vii]http://www.cdc.gov/tb/topic/globaltb/Southafrica.htm
[viii] Ibid.