Introduction
In many African countries, the healthcare system, including the supply chain, is often fragmented, and data and other vital records are sometimes stored in parallel digital systems that are not interlinked. This makes it difficult for different health facilities and even units within the same facility to share data, even when it is related to patient care. In South Africa, one paper observed that is some cases, different versions of the software used in the health information system created integrity problems due to limited or lack of version control (English et al, 20111). Another paper in 2020 observed that more than half of the public health centres were still using a paper-based filing system and that the systems were fragmented with no integrated electronic health records (Thulare, Herselman, and Botha, 20202).
Blockchain technology offers secure and transparent ways to manage health and procurement data, ensuring data integrity, privacy, and interoperability –records are easily transferrable between various healthcare units and institutions to ensure proper patient management. The technology’s distributed ledger allows data to be organised in a sequence of blocks, each reliant on the one before, safeguarding sensitive patient information. When combined with AI, blockchain-based solutions facilitate secure data exchange among healthcare providers, improve the integrity of medical records, and enable seamless access to patient information. Any changes must be verified, and any hacking attempts are noticed and quickly remedied.
South Africa has taken leadership in applying blockchain technology in the management of medical supplies implementing solutions such as MediLedger, to improve healthcare service delivery.
Application
MediLedger is an innovative supply-chain management platform, which aligns data and transactions between pharmaceutical manufacturers, suppliers and health systems, to validate the authenticity of drugs and other products (Reuters, 2020; Sage, 20203). In South Africa, MediLedger is used to track medications from manufacturers to patients (Savannah Blogpost, 20244). By recording every transaction on a secure ledger, healthcare staff can verify product authenticity, thus reducing the risk of counterfeit drugs entering circulation. Drugs can be traced back to the manufacturers at any point in the supply chain, which is especially useful when a manufacturer needs to recall a product.
MediLedger was adopted as a response to supply chain challenges during the COVID-19 period and the desperate need to eliminate counterfeit products. It also helps to track commodities to avoid stockouts and to reduce revenue leakage.
Policy and Regulatory Framework
To benefit from application of blockchain innovations, African countries require laws and regulatory frameworks to ensure appropriate data governance and privacy, as well as investments in research and digital infrastructure. An earlier study in 2018 in South Africa had found that the key barriers to wide adoption of electronic medical records in the country included lack of supporting infrastructure; lack of user training and commitment; political will or strategy; absence of clear legislation and regulations; and the lack of a framework for implementation and management of the technology (Katurura and Ciliers, 20185).
South Africa has a legal and policy framework that support integration of blockchain in records management. Since 1996, the country has been implementing the District Health Information System (DHIS) as the routine system for tracking health service delivery in the public health sector. The National Digital Health Strategy for South Africa (2019 – 2024) highlights this and other electronic record systems used in clinics and hospitals for patient records and drug stock management. The strategy prioritises establishing data science capability to exploit technologies such as big data, artificial intelligence and predictive analytics, and the development of a Health Enterprise Architecture that ensures data security and interoperability. It also includes plans for capacity building of staff, to ensure that the health system has enough workers skilled in digital health technologies.
The National Health Information System South Africa (NHISSA) committee coordinates the establishment, implementation and maintenance of health information systems in the provinces, and reports to a national health council.
In further commitment to the adoption of advanced health technologies, the 2nd Presidential Health Compact 2024-2029 cites the adoption of cutting edge solutions, such as blockchain technologies, to enhance efficiencies of the National Health Insurance, while safeguarding data security and the integrity of the healthcare system and providing safeguards against corruption and maladministration.
The Protection of Personal Information Act (2013), sets out regulations on security of personal data, including patient information/medical records, which can also provide oversight in use of health technologies.
To support innovations, the South African Medical Research Council collaborates with the Department of Science and Technology to provide funding for innovations in health including digital technologies.
Impact
Adoption of blockchain technology in supply chain management has reduced or eliminate dfraud and errors, reducing delays associated with paperwork and improving inventory management (Clouson et al, 20186). Blockchain systems also help identify record system issues more rapidly. It was also found helpful in reducing the illegal trading of medical products and counterfeit drugs (Kimari, Niyitunga et al, 20247). In addition, using blockchain would eliminate intermediaries/middlemen within the South African healthcare supply system, thereby reducing corruption and lowering the overall financial costs of healthcare. Anecdotal evidence cited by studies indicate that blockchain can greatly help countries build trust and security in the healthcare systems (Dineo and Ndayizigamiye, 20228).
Lessons Learnt
South Africa appears to have in place all the building blocks needed to fully make use of blockchain technology in the management of health data. Other countries in Africa can learn from these as they plan to adopt blockchain and other emerging health technologies. These blocks include:
- A solid legal and policy framework that supports innovations and requires efficient and secure management of health data;
- National experience with management of national health/medical data, and a pressing need to have an efficient system to support the reformed National Health Insurance;
- Political commitment to support innovations and advance the use of technology, as shown in the 2nd Presidential Health Compact 2024-2029.
- Local funding for innovations in health, to provide domestic resources.
Conclusion
Blockchain technology has the potential to transform healthcare in Africa by improving data security, supply chain management, and fraud detection, among other issues. African countries need to strengthen innovation systems to guide the adoption of blockchain technology within the health sector. African governments should lead the way by adopting supporting policies, standards and regulations to support the development and adoption of blockchain, and build the local capacity to accelerate the use of blockchain in health service delivery.