/ 8 June 2024

Doctors launch digital solution to boost health literacy in South Africa

Premier Makhura Observes Vaccination Programme At Hospitals In South Africa
Safe Patient is the first of its kind in the world and is a result of more than two years of research

Three doctors have launched a digital solution to help bridge the gap between health literacy and better healthcare. 

Safe Patient, a WhatsApp bot platform, provides the patient with step-by-step information about pre-surgery medical processes. 

Pradeep Mistry, a consultant vascular surgeon, president of Vascular Society of Southern Africa (Vassa) and vice-president of the World Federation of Vascular Surgical Societies, has been working alongside two other doctors — Dirk le Roux and Jay Pillai — to develop the solution.

Le Roux is a vascular surgeon and immediate past president of Vassa. Pillai is the academic head at the Wits Vascular Unit and Wits Donald Gordon Medical Centre.

According to the three doctors, Safe Patient is the first of its kind and is a result of more than two years of research in peer-reviewed publications and the state of health literacy in South Africa. 

“We’re going to educate people that there is a problem first, and then it empowers people to do something about it. You have to identify the problem for people first before you even give them a solution. It’s promoting wellness and well-being in our society, our patients and doctors,” Mistry said. 

Safe Patient provides the patient with information on the advantages, indications, eligibility, care, success, complications, risks and recovery of the operation they will undergo. The patient must read each prompt, and confirm that they understand the information, which will lead them to a consent form. 

If the patient does not interact with the platform or does not agree and understand the medical prompts, their doctor is alerted and they can book a face-to-face consultation to get clarity. 

The information used on the bot is not generated by artificial intelligence, the doctors said, but is instead research that comes from several credible, peer-reviewed articles that they broke down and simplified for people without a medical background. This, they said, eliminates the chances of misinformation and disinformation. 

“So the first thing is your proof of clinical outcome. In other words, whichever way you look at it, we take masses of people and educate them properly. They don’t just get better from the operation, they get better from the education. And therefore that educational format has to be formalised, by peer-reviewed publication,” Pillai said. 

Safe Patient has audio prompts in English and isiZulu for now. 

“The concept in terms of educating patients in the peri procedural period will result in empowering them down the line to take better care of themselves, decrease hospitalisation, be compliant with medication and spread the message of wellness after to improve community health as opposed to just help to the individual,” Mistry said. 

The concept was also born out of the legal issues medical doctors have encountered with informed consent.

“It protects the doctor for practising good medicine, benefits the patient because of education transfer and decreases the legal costs downstream from litigation,” he added.

According to Statistics South Africa, non-communicable diseases such as cardiovascular diseases, cancer, diabetes and chronic lower respiratory diseases increased by 58.7% from 1997 to 2018 in South Africa. The median age at death in years was 65 for males and 69 for females.

Pillai said surgery is a big risk and health literacy is crucial not just for the patient but also for ethical, legal and medical considerations for doctors. He said the issue of informed consent is very rarely, unknowingly, practised by surgeons, and this can have major legal repercussions for them. 

“You must tell the patient about the disease process, you must tell them about the operation that you’re going to do, you must tell them about the other operations that may be similar that you’re not going to do, and then you need to tell them if [the surgery is not done] what’s going to happen to them, and they must understand all of that.

“Then you need to tell them about the cost of the procedure, who else is involved in the procedure. Then you are going to include diagrams, the family, the cultural issue and then make an assessment whether they understand,” he said.

The patient can then make an autonomous decision about whether they would like to go ahead with the surgery. 

“So the law indicates it must be autonomous, you must make decisions for yourself, you must discuss it with your family, and you must be educated about it. In other words, I must transfer the information to you, and that information needs to become knowledge, not just not just reading but to ensure that you have understood it, and then be able to apply it now, so it’s not easy.”

It’s an onerous process, he added, because it takes time to explain everything to patients in great detail and ensure that they understand what the doctor is saying before they can proceed.

But, Mistry said, Safe Patient does not replace the doctor, it empowers the patient and guides them in the right direction. 

The Economist published a report on health literacy around the world in 2021 and found that South Africa ranked poorly when it comes to creating policies that improve health literacy, and instead relies on health promotion programmes to educate the public. 

The report states that aside from the absence of a strategy or policy to improve health literacy levels, there is no evidence that suggests South Africa has a body that champions health literacy, nor a population-based survey available for health literacy. 

It also highlights that there’s no evidence of an engaging health system portal, training for health professionals and organisational health literacy initiatives. 

When health literacy levels are low, people are at higher risk of death, especially those who suffer from cardiovascular disease, diabetes and mental illness. But people with high literacy levels make better health decisions, the report states. 

Mathildah Mokgatle, the head of department of public health at Sefako Makgatho Health Sciences University, said when people are literate in health and medicine, they know when to seek help. 

“People will screen or monitor themselves, and they will report early when cases are still manageable for primary health care, but when communities are not informed, they stay till their [conditions] are advanced and they are complicated, then you find a higher proportion of people who need advanced interventions that are more costly.”

Speaking at the launch of Safe Patient at the Johannesburg Surgical Hospital on Saturday, former Johannesburg mayor Mpho Phalatse said the burdens on the healthcare sector are increasing as the population grows and ages.

“Without patient literacy, we see an increased burden or increased use of the healthcare service, which also drives up costs,” she said. 

High legal costs are also eating the government’s healthcare budget. 

In November 2023, the auditor-general found that medico-legal claims against the health department increased because of poor record management systems in hospitals. High volumes of lost records weakened the state’s case against any legal complaints. 

According to the report, the total claims against the sector amounted to R68 billion (excluding the Limpopo health department). The sector paid R1.42 billion in claims in 2022-2023.

Claims are paid from funds earmarked for service delivery, further eroding the department’s financial sustainability.

“We need a healthcare delivery model that drives patients away from the existing curative health system, thus reducing the cost of healthcare. We need to fast-track the implementation of patient literacy programmes in our nation,” Phalatse said.

Raising the HIV/Aids misinformation issue in the early 2000s, Mistry said, “If we had an educated population, then, there would be a bigger awareness on the importance of anti-retrovirals. Today, we still a country with the biggest burden of HIV positive people percentage wise in the world, you know, so it’s a legacy of bad decision making, poor information and misinformation”

Although The Economist determined that South Africa’s health literacy levels are relatively low, it noted that digital technologies in the area are emerging. 

For instance, South Africa also has MomConnect. A cell phone-based platform designed to facilitate pregnant women’s interaction with healthcare providers. It allows pregnant women to register themselves in the health system, it sends health promotion messages and allows women to feedback on the service received. 

Another example is Ros Dowse, an emeritus associate professor at Rhodes University, who used pictograms, simple two-dimensional visuals, to convey health information for HIV and tuberculosis patients on how to take their medication. 

Mokgatle said these interventions show there is progress in health education, and understanding the difference between literacy, education and health promotion.

“So health literacy is being underplayed by health education and health promotion is also an extensive exercise of empowering people by you know, giving them responsibility by you know, in showing them how to take care of their life for them to develop their patient and community centre project that protects their well-being but health literacy is a big chunk of this aspect.” 

With South Africa’s health landscape taking a turn towards the recently signed National Health Insurance Bill, the deputy minister in the presidency, Pinky Kekana, said public and private healthcare will join hands to promote health literacy. 

“This element of health education, and understanding the basics has to go on. And if the private sector and public sector come together to say, guys, can we all be patriotic South Africans and start to educate our people about what is in it for them on National Health Insurance, it’s a step in the right direction,” she said. 

It also raises the basic issues that doctors or nurses or professionals will require, so there’s “synergy in that kind of engagement”, she said.

“If we see some of these gaps, we have to come in and look at some of these gaps and start to say, how do we join hands, and start to help our people to understand their basic rights as patients and some of these things.” 

This article has been amended to add comment from Mpho Phalatse