Exploring the barriers and facilitators to implementing electronic health records in a middle-income country : a qualitative study from South Africa

Introduction: As more countries are moving towards universal health care, middle-income countries in particular are trying to expand coverage, often using public funds. Electronic health records (EHR) are useful in monitoring patient outcomes, the performance of providers, and so the use of those public funds. With the multiple institutions or departments responsible for providing care to any individual, rather than a single record, an EHR is the interface through which to view data from a digital health information eco-system that draws on data from many different sources. South Africa plans to establish a National Health Insurance fund where EHRs will be essential for monitoring outcomes, and informing purchasing decisions. Despite various relevant policies and South Africa's relative wealth and digital capability, progress has been slow. In this paper, we explore the barriers and facilitators to implementing electronic health records in South Africa. Methods: In this qualitative study, we conducted in-depth interviews with participants including academics, staff at parastatals, managers in the private health sector, NGO managers and government staff at various levels. Results: The Western Cape provincial government over a 20-year period has managed to develop a digital health information ecosystem by drawing together existing data systems and building new systems. However, despite having the necessary policies in place and a number of stand-alone population level digital health information systems, several barriers still stand in the way of building national electronic health records and an efficient digital health ecosystem. These include a lack of national leadership and conflict, a failure to understand the scope of the task required to achieve scale up, insufficient numbers of technically skilled staff, failure to use the tender system to generate positive outcomes, and insufficient investment towards infrastructural needs such as hardware, software and connectivity. Conclusion: For South Africa to have an effective electronic health record, it is important to start by overcoming the barriers to interoperability, and to develop the necessary underlying digital health ecosystem. Like the Western Cape, provincial governments need to integrate and build on existing systems as their next steps forward

Impact in networks and ecosystems: building case studies that make a difference

open accessThis toolkit aims to support the building up of case studies that show the impact of project activities aiming to promote innovation and entrepreneurship. The case studies respond to the challenge of understanding what kinds of interventions work in the Southern African region, where, and why. The toolkit has a specific focus on entrepreneurial ecosystems and proposes a method of mapping out the actors and their relationships over time. The aim is to understand the changes that take place in the ecosystems. These changes are seen to be indicators of impact as increased connectivity and activity in ecosystems are key enablers of innovation. Innovations usually happen together with matching social and institutional adjustments, facilitating the translation of inventions into new or improved products and services. Similarly, the processes supporting entrepreneurship are guided by policies implemented in the common framework provided by innovation systems. Overall, policies related to systems of innovation are by nature networking policies applied throughout the socioeconomic framework of society to pool scarce resources and make various sectors work in coordination with each other. Most participating SAIS countries already have some kinds of identifiable systems of innovation in place both on national and regional levels, but the lack of appropriate institutions, policies, financial instruments, human resources, and support systems, together with underdeveloped markets, create inefficiencies and gaps in systemic cooperation and collaboration. In other words, we do not always know what works and what does not. On another level, engaging users and intermediaries at the local level and driving the development of local innovation ecosystems within which local culture, especially in urban settings, has evident impact on how collaboration and competition is both seen and done. In this complex environment, organisations supporting entrepreneurship and innovation often find it difficult to create or apply relevant knowledge and appropriate networking tools, approaches, and methods needed to put their processes to work for broader developmental goals. To further enable these organisations’ work, it is necessary to understand what works and why in a given environment. Enhanced local and regional cooperation promoted by SAIS Innovation Fund projects can generate new data on this little-explored area in Southern Africa. Data-driven knowledge on entrepreneurship and innovation support best practices as well as effective and efficient management of entrepreneurial ecosystems can support replication and inform policymaking, leading thus to a wider impact than just that of the immediate reported projects and initiatives

Towards understanding interactions between Sustainable Development Goals: the role of environment–human linkages

Only 10 years remain to achieve all Sustainable Development Goals (SDGs) globally, so there is a growing need to increase the effectiveness and efficiency of action by targeting multiple SDGs. The SDGs were conceived as an ‘indivisible whole’, but interactions between SDGs need to be better understood. Several previous assessments have begun to explore interactions including synergies and possible conflicts between the SDGs, and differ widely in their conclusions. Although some highlight the role of the more environmentally-focused SDGs in underpinning sustainable development, none specifically focuses on environment-human linkages. Assessing interactions between SDGs, and the influence of environment on them, can make an important contribution to informing decisions in 2020 and beyond. Here, we review previous assessments of interactions among SDGs, apply an influence matrix to assess pairwise interactions between all SDGs, and show how viewing these from the perspective of environment-human linkages can influence the outcome. Environment, and environment-human linkages, influence most interactions between SDGs. Our action-focused assessment enables decision makers to focus environmental management to have the greatest impacts, and to identify opportunities to build on synergies and reduce trade-offs between particular SDGs. It may enable sectoral decision makers to seek support from environment managers for achieving their goals. We explore cross-cutting issues and the relevance and potential application of our approach in supporting decision making for progress to achieve the SDGs

Big Ideas for Small Business Report

Big Ideas for Small Business is a national peer network led by the National League of Cities (NLC) that aims to accelerate efforts by local governments to support small businesses and encourage entrepreneurship.  This direct peer-to-peer engagement expands the capacity of city staff to explore common challenges, share proven strategies, and collaborate on new approaches for creating a more business-friendly city.  The Big Ideas for Small Business toolkit discusses important strategies for how local leaders can be better advocates for small businesses. Our report provides guidance on creating ecosystems that support small business growth; reorganizing city resources to better meet the needs of small businesses; and providing business owners with access to new sources of capital. Specific strategies highlighted in this report explain how to:Connect Small Businesses to Information and ResourcesEstablish a Small Business Resource Center Advocate for Small Businesses via Community-Led Councils or CommitteesProactively Engage the Local Business CommunityProvide Platforms for NetworkingCreate Incubator SpacesCelebrate Successful BusinessesDevelop One-Stop-Shops and Express Lanes at City Hall Streamline City Regulations and the Inspection ProcessHelp Small Businesses Build a Web PresenceSupport Microlending and CrowdfundingEncourage Local Small Businesses to Bid for City Contracts