United Nations Public Service Awards Case Studies

1. INTRODUCTION
1.1 Initiation of the Mobile Technology Pilot Projects

[The Centre for Public Service Innovation (CPSI) is a not-for-profit body established by the Minister for Public Service and Administration to identify, nurture and support innovation in public services. Launched in June 2002, the CPSI has a mandate to actively identify and develop new ideas and areas of application that assist in improving service delivery and the overall functioning of the public sector]

Improving the delivery of services to the majority of South Africans is a key challenge faced by the South African government in the second decade of democracy. Information and communication technologies (ICTs) are an enabler that can enhance the ability of the public service to adequately address service delivery backlogs, while providing citizens with a range of more creative options for accessing services. Amongst the many ICT options available to government to improve the efficiency and effectiveness of its delivery process, mobile and wireless technologies offer some exciting opportunities for a low cost, high reach service.

There is strong evidence that mobile technologies could be instrumental in addressing slow response rates of government to citizen requests, poor access to services, particularly in under-serviced rural areas and limited ability of citizens to provide feedback on services to government. In addition, mobile technologies offer significant opportunities for improving the back-office operations of government. At the level of both network utilisation and application development, there are major opportunities to harness the power of technology for greater efficiency and effectiveness in government.

Within this context, in 2003, the CPSI partnered with the State Information Technology Agency (SITA) and the Council for Scientific and Industrial Research (CSIR) to conduct research to identify the opportunities presented by mobile and wireless technologies to government. The research process resulted in a FutureWatch report entitled ‘Government Unplugged: Mobile and Wireless Technologies in the Public Sector’. The report put forward a strong case for further examining the possibilities offered by this technology for the public sector.

1.2 Selection of the pilot projects

Based on the strong motivation for further testing mobile and wireless technologies in improving service delivery arising out of the research process, the CPSI and the Research and Development division of SITA agreed to conduct a series of pilot projects to practically test the value of the technology to government. The partners therefore approached the Meraka Open Source Centre based at the CSIR to become a joint partner in implementing the pilots, in order to ensure that all issues relating to the use of open source software could be effectively addressed in the pilot projects. Finally, the CPSI and SITA approached the Open Society Foundation for Southern Africa for funding to implement the pilot projects.

The first project to commence with implementation, the Dokoza project, was implemented in the health care sector and showed remarkable results within a short period of time. This study focuses on the Dokoza project, its approach and impact, and the potential for the broader health care sector.

What is the initiative about? (the solution)
In the South African context medical institutions – hospitals and clinics – operate on different systems for gathering and maintaining patient information. Many primary health care clinics located in the rural areas do not have any electronic systems and continue to operate paper-based systems, resulting in patient records being kept by patients themselves. The impact of the use of multiple systems is that it is difficult and costly to develop a national overview of patient statistics. On a more basic level, it is extremely difficult for individual health institutions to share information between each other. One of the clearest examples of this is to be found in the sharing of laboratory results. Currently in most instances, this only takes place through manual exchange. The CPSI identified the Dokoza project as one that could enable electronic data-sharing in a manner that enhances the ability of health care professionals to function effectively, and directly improves services to citizens. Dokoza proposed to introduce a new advanced mobile to web system which has also been patented and developed in SA. Dokoza involves the powerful use of cell phone and SMS technology for secure data and transaction exchange for medical services, in particular making accessible real-time interactive confidential communication, authorisation and administration via cell phone and SMS technology. Dokoza has the base proprietary technology and expertise, which allows for cheap accessible information sharing, whereby an authorised user will send an SMS to a database for interrogation and instant intelligent reply. The project is aimed at resource-poor environments which do not have any internet access, to enable doctors to check prescriptions against nationally determined protocols and to obtain blood test results, for example. The pilot was launched at 2 government sites; the HIV/AIDS clinics at Helen Joseph and Johannesburg General Hospitals. [Dokoza was also implemented at Tugela STD (Sexually Transmitted Disease) Clinic in KwaZulu Natal. This pilot in the private sector was fully funded by Dokoza] Whilst Dokoza is able to expand this platform to treatment for other conditions; we believed that it was expedient for the pilot to focus on HIV/AIDS, TB and STD. For example, through the Dokoza system, clinicians were able to do the following on their cell phones in a secure and confidential manner, and in real time: - obtain patient information, including treatment history - register patients on the electronic file of the Health Department - access to laboratory results - access to data on past patient medication Dokoza provided for the following user interfaces, 1. Web 2. SMS 3. Fax 4. Email Using the following mobile devices, 1. Lap top 2. Cell phone 3. Palm top / PDA / Smart phone Dokoza offered health workers a key suite of real-time data and transaction exchange functionality via all of the above tools. During the pilot, the following applications were demonstrated: 1. Real-time data and transaction exchange 2. Capacity building 3. Authorisation 4. National patient tracking/surveillance for existing systems 5. Common platform with the National Laboratory 6. Confidential communication with patients

Who proposed the solution, who implemented it and who were the stakeholders?
The actual pilot monitoring period ran for 6 weeks over November and December 2004. [October 2006 - Dokoza project was nominated as one of the top ten finalists at the Commonwealth Association for Public Administration and Management (CAPAM)--International Innovations Award 2006 held in Sydney Australia]

Describe how and when the initiative was implemented by answering these questions
a. What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
4.1 Real-time mobile technology for effective roll-out of anti-retroviral therapy (ART): Background Dokoza involves the powerful use of cellphone and SMS technology. All cellphones capable of sending a normal “read” SMS are able to interact with Dokoza. The system uses plain text messaging and therefore does not require special additional software for the cellphone. Dokoza is easily interfaced with other existing hospital systems (such as the National Laboratory) and can also be accessed via PC web, lap top, PDA, Palmtop and is able to interact with email and fax. There are various levels of encryption and other security measures such as user PIN. Dokoza does not display HIV sensitive documents on the web. 4.1.1 Focus of pilot The pilot was implemented at the HIV/Aids Adult Clinics at Helen Joseph and Johannesburg General Hospitals in Gauteng. [Other Implementation Sites Tugela STD Clinic, KwaZulu Natal] The pilot demonstrated some of the following applications: i. Real time data and transaction exchange: The system allows for real time interactive online information sharing. For example health practitioners were able to, - Register a patient - Access laboratory results - Submit a specific patient diagnosis - Obtain a history of patient medication ii. Capacity building: allows healthcare practitioners to access records of their individual patients’ treatment protocols, with the appropriate security built in. In other words, the practitioner’s questions could be answered for a particular patient, taking into account his/her full medical history, as captured initially and updated in real time on the back-end system. iii. Authorisation: requests for authorisation of particular treatment may be made, should there be a need for such an authorisation system. For instance, based on the latest pathology results of a patient, a new medication regimen may be authorised electronically. iv. National Patient tracking/surveillance: Dokoza is able to update registered patient information from interfacing with all existing local systems. Medical patient monitoring and evaluation would be done at a national level allowing patients, who are commonly mobile, to access services in any public facility countrywide, and also that patients may receive appropriate care as the health care practitioners in different facilities are aware of treatment already provided to patients. v. Common platform: Dokoza was able to interface with the local hospital systems and interface with the National Laboratory. This allowed both parties to exchange information cheaply and efficiently to perform effectively. vi. Confidential communication: the use of mobile technology greatly enhanced disease management capacity, to the extent that patients were automatically reminded to take medication, for example. 4.1.2 Analysis of the pilot The pilot ran for 6 weeks over November and December 2004. 192 people made use of the pilot, providing a basis for reasonably assessing the value of the technology to improving healthcare. A wide range of data was captured. 4.1.3 Outcomes Principle findings: a) Easy to use b) Integrates easily with existing hospital systems, but changes to workflow processes required c) Potential direct benefits for patients and clinicians d) Offers government value for money

b. What were the key development and implementation steps and the chronology? No more than 500 words
There are multiple systems in public hospitals and clinics, automated as well as manual processes, the aim of Dokoza was to link available systems at the pilot sites and build up capacity as far as possible. Dokoza set out to prove that mobile technology is able to provide improved access to critical services and facilitate e-democracy. The project was initiated with 3 principle goals: 1. To improve access to critical services (such as lab results) especially in resource poor environments where computer hardware is limited. 2. To ease the duties of the individual health worker by offering mobile interaction for patient data, easily accessible with quick responses. 3. To offer alternative e-methods for health workers who do not know how to use computers and facilitate e-democracy. The purpose of the Dokoza project is to set the standard for any future mobile interface to all public health services.

c. What were the main obstacles encountered? How were they overcome? No more than 500 words
The next step requires thinking on a wider and more strategic level. The outcomes of the individual cases need to be scaled to a level where the impact can be generally felt. This entails a partnership between the network operators, public sector institutions, and application developers, to identify what government requires of the technology, and to implement the solutions in the most cost effective and efficient ways possible. Currently in South Africa public sector institutions largely engage with mobile solutions in an isolated and case-specific manner. There is no comprehensive strategy guiding choice around the usage of mobile technology; hence solutions are limited in impact. The development of an m-government strategy is currently being discussed in South Africa. The strategy will ensure that the public sector can use its spending power and leverage far more strategically, and hence extend access to services. The strategy development process requires a high degree of consultation across the public sector initially, and then with network operators and solutions developers. Through the process it is hoped that government can deliver in full on the promise suggested in these small but meaningful pilot projects.

d. What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
a) Dokoza has jointly tendered in 3-major bids as an integral part of the overall solution, providing mobile services to the South African Department of Health for the National Electronic Patient Health Record. At the time of writing, the tender has not as yet been awarded. b) Dokoza is involved in a major bid to provide mobile services to the National Health Laboratory Services, who are the sole provider of laboratory services to the public health sector. The mobile services including SMS with fax and email capability is a mandatory request. At the time of writing, the tender has not as yet been awarded.

Is the initiative sustainable and transferable?
The principles developed in this project can be used in any context where there is a need for interaction with Government systems, and it can be done in real time. The infrastructure is already there to apply such mobile and web interface technology in many different contexts. For instance, for Government officials, Dokoza can provide access to data and within defined circumstances allow officials to process information in a manner that is convenient to them. All of this is done with a full audit trial of every interaction with the technology, and with complete security, and without the need to invest in new IT systems. Hence, we can: send reminders, send customised information as a response to a query, process transactions and obtain information, all in a secure and confidential manner, where every transaction is tracked, and using fax, e-mail, Internet and cell phones. The applications of this system in administering payments (such as tax, Unemployed Insurance Fund, traffic fines etc.), information provision and collection and ensuring compliance, are numerous. Sustainability is a key challenge. Part of the responsibility lies with public R&D institutions such as the CPSI and SITA to ensure that maximum benefit is derived from piloting and that good ideas do not get left unattended because of regulatory constraints.

What are the impact of your initiative and the lessons learned?
A number of important lessons were learnt during the implementation of the Dokoza pilot project: I. Even though mobile technology is simple to apply, it does take time to ensure that all participants understand what is required from them, and buy-in to the process of introducing new approaches. II. All funding provided for the pilots came from sources external to the departments involved. If the departments contribute funding, they are likely to take the outcomes from the pilots forward more aggressively, because they have more direct accountability for effective usage of the funding. III. The health care sector presents great opportunity for innovation and experimentation, despite large components of it still being effectively paper-driven. Health-care professionals, while sceptical of possible fads, are receptive to solutions that will improve and reduce administration and bureaucracy, enabling them to focus on improving health care delivery. IV. The outcomes of the pilots, such as Dokoza, need to be marketed widely, so that other possible uses of the technology can be identified. It is very easy for pilot projects to be neglected once the first phase of implementation has been completed. V. More attention needs to be given to supporting emerging IT SMMEs, to ensure that they do not have to deal with unnecessary amounts of bureaucracy, and can focus on their core strength – application development. REFERENCES Centre for Public Service Innovation, 2003, Government Unplugged – Mobile and wireless technologies in the public service, Tshwane, South Africa Dokoza, 2005, Report on the Evaluation of the Dokoza Pilot Project, Johannesburg, South Africa. OFS-CPSI Case Study 2006, by Glenda White –Former Executive Director of the CPSI.


Institution Name:		Dokoza
Institution Type:		Other
Contact Person:		Jessie Dias-Alf
Title:		Project Owner
Telephone/ Fax:		+27 82 480 5842
Institution's / Project's Website:		+27 11 791 3817
E-mail:		jessieda@dokoza.co.za
Address:		PO Box 130892, Bryanston
Postal Code:		2021
City:		Johannesburg
State/Province:		Gauteng
Country:		South Africa

The Problem

Solution and Key Benefits

Actors and Stakeholders

(a) Strategies

(b) Implementation

(c) Overcoming Obstacles

(d) Use of Resources

Sustainability and Transferability

Lessons Learned

Contact Information