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The impact of e-referrals on South Africa's healthcare ecosystem

Researchers Tasneem Motala and Natasha Blanckenberg, of Stellenbosch Business School, analyse the effect of Vula – the smartphone medical app – upon a developing country’s healthcare system.

The big dispute: Healthcare in developed vs developing countries

South Africa as a country has come a long way since its post-independence days and has managed to rebuild its healthcare system where necessary. However, as an emerging nation, providing public healthcare to a large population doesn’t come easy while specialist expertise and care are evidently scarce. With the Western Cape Government Health Department declaring Vula – an electronic referral application – as the main communication tool for medical experts, can this technology be considered a breakthrough in South African public healthcare?

Many countries have experienced progressive growth in the healthcare system with the use of referrals, but e-referrals are still a novel invention for developing regions. With the advancement of technology, healthcare has observed a revolutionised shift. However, globally, there are many countries still wading through obstacles to fix their healthcare system.

While healthcare is expensive as it is, when spiced up with high-tech appliances and innovations, the bills aren’t cheap. Unfortunately, it’s just the countries with already developed healthcare arrangements that afford the advancement faster than most, and the middle-to-lower income countries keep mending their medical services in their own budgeted way.

Zeroing in on the diverse country of South Africa, which carries with it a hefty concern of social, wealth, and health inequality since and before its independence, it has been tirelessly working to improve its healthcare ecosystem. With a population of almost 60 million people, South Africa’s public health services are based on a primary health care (PHC) model which serves approximately 85% of the population. Expert and professional care for severe conditions aren’t easily found and the rising population of the country is taking a toll on healthcare workers.

However, according to past studies, the concept of a referral system, which is when medical professionals can refer the patient to another specialist doctor and help them find the right kind of treatment quickly, has been very impactful. Studies narrow down on topics such as maintaining demand for referrals or improving the quality of referrals provided. Currently, with the increasing usage of e-referrals systems, studies have wandered towards the efficiency of the new web service.

As most of this research has been conducted in well-resourced countries like the UK, the USA, Canada, and other parts of continental Europe, there is a large chasm regarding the widespread and effective online communication practice for medical referrals in developing countries.

About Vula: The e-referral app

In 2018, Western Cape Government Health (WCGH), the primary healthcare provider in South Africa, announced the mobile e-referral application – Vula – as the principal media to issue referrals for medical experts. Officially launched in 2014 to amend the scarcity of medical specialists, this referral app was created to benefit the public health service in South Africa. Vula was a starting point for tech being actively used alongside healthcare and as a modern innovation in the market, but its prospective impact was still unknown.

As this application had the scope to make a large difference in the South African health sector, researchers Natasha Blanckenberg and Tasneem Motala believed understanding the functionality and usage of Vula is key to further discussing its impact and thus conducted a descriptive study of the application.

When technology meets healthcare

Using Vula’s Mobile database, the researchers carefully categorised the data received and dug deeper into understanding how doctors have been using the e-referral application.

First and foremost, versatility shines out to be Vula’s key strength as it is favourably used for both acute and non-urgent cases. This is rare, as most electronic case reporting technologies in the past solely served the purpose of non-urgent cases. What’s more, Vula is a one-of-a-kind smartphone application that victoriously progressed past the pilot phase, while being an application exclusively created to ease out the referral process on a large scale in a middle-income country. The dyad benefit that Vula further brings along is its expedited response time experienced by receiving doctors, and secondly, with the rise of emergency medicine, Vula is as apt as it could get in terms of sending and receiving e-referrals for specialty doctors.

It bridges the gap between doctors and creates an effortless direct connection between the referring doctor and the relevant specialists, which even allows them to share pictures securely and progressively leading to reduced time, as compared to the previous non-electronic ways. Vula also personalised the whole experience for doctors to follow up on patients, while providing the correct guidance concerning their cases. Furthermore, Vula makes itself even more desirable and grabs the title of a demand management tool by reducing the burden of work on healthcare workers and screening the referrals sent and received by doctors to check for their intactness, suitability, and level of urgency.

Moreover, Vula was more than just a shift in using smartphone applications for medical purposes in South Africa. It brought along with it a cultural and mindset drift that increased trust, not only in referring and specialist doctors but also in patients. Specialist knowledge has also been a severe need, and as Vula partially solves this big issue, doctors haven’t held back in using the application as it serves the purpose of getting their patients the right care.

Knight in shining armour: Changing the medical sphere through e-referrals

Vula won the hearts of South African healthcare workers as it showcased how well it serves its vital purpose of being an inter-communicative and co-dependant medical advisory platform. In today’s day and age, even Primary Care Physicians (PCP) can manage patients at the centres where they seek help, while walking hand-in-hand with the exceptional knowledge of specialists through Vula. This eased the whole in-person consultation process with specialists, especially for cases that aren’t highly pressing. Throughout the pandemic too, the need for the application only increased as it assisted in safely conducting social distancing measures with the reduced mobility at the time.

Apart from being a critical player in clinical care and assisting patient-oriented supply networks, Vula plays a major role as a large-scale single database that helps track referrals, their patterns, and types. Moreover, it examines the level of the caseload that the virtual consultation provides throughout this service. This previously-unknown data wasn’t prominently present in healthcare organisations, especially when the internet was absent.

Digital innovation driving growth in healthcare

The referral process in specialist departments in the country took a large leap from previously being conducted through telephone calls and other applications like WhatsApp to now being securely and swiftly sent through Vula. Vula’s usage in South Africa exhibits that even across a large number of people, in a country with fewer resources, if technology is used in the right areas, it doesn’t necessarily have to be an expensive technological advancement to make a large difference.

For the blossoming nation of South Africa, Vula came in the pinch of time and moderated the communication process between referring and receiving doctors, without the need for any other technological intervention. The application proved its necessity and eminence in the healthcare sector and claimed its rightful place in three spots – as a demand management tool, a consulting platform, and an e-referral service.

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