The True Cost Of e-Health In A Global Pandemic

As South Africa enters its fourth week of COVID-19 lockdown, the rise of infections runs parallel to an increase in nation-wide anxiety.  We are faced with myriad challenges. The novel coronavirus has constrained millions to their homes – some alone, others to abusive environments and others still tending to ailing loved ones. Even for those of us whose domestic conditions are more favourable, there is still the startling reality of income loss, the loss of interactions with friends and coworkers and the stress of living in a confined space for interminable periods of time. This coupled with concerns about a stagnating economy, a large immuno-compromised populace and the general existential dread of an unknown future has prompted a rise in the use of technology to help those suffering from mental illness.  

IT enthusiasts have extolled the benefits of online psychotherapy, particularly its convenience and accessibility, in recent years with the proliferation of online applications. The prohibitive cost of therapy remains prohibitive for millions of South Africans even while many therapists have turned to telemedicine to provide their clients with psychosocial support during this pandemic. According to the South African Depression and Anxiety Group (SADAG) as many as one in six South Africans suffer from anxiety, depression or substance-abuse problems but less than 16% of sufferers receive treatment for mental illnesses. Moreover, over 80% of South Africans cannot afford health care and black South Africans have significantly lower access to medical aid cover, according to Statistics SA’s (Stats SA) 2019 Inequality in Trends South Africa report. These numbers don’t account for those recently unemployed because of the outbreak or the thousands of undocumented immigrants whose already precarious livelihoods have been threatened.

These statistics are exacerbated by the excessive cost of data and limited connectivity in the country. Almost half of the South African population does not have direct access to the internet and on average South Africans pay around $5.78 for 1GB of data. This amounts to six times the cost of data in other emerging economies. While the Competition Commission has recently announced cuts of up to 30% on data prices as of the 1st of April, charges are still high and remain a significant hurdle to accessing mental health care services remotely. Local telephone helplines like LifeLine and the National Counselling Line offer free telephonic support, but such assistance is generally intended as a once-off or time-limited intervention.

South Africa’s apartheid past and its ongoing struggle with violent crime and gender based violence suggests a high level of trauma exposure in the general population. We are also reminded that traumatic memories affect not only those who have personally experienced conflict and violence, but also future generations through what is known as intergenerational transmission of trauma. Traumatic stress, already a major burden of disease in lower and middle income countries,  is made worse by the current global crisis. The South African state has done much to mitigate the worst of the pandemic, but the government’s response plan alone is not enough to meet the psychosocial needs of its most vulnerable confined citizens. 

The private sector and social enterprises are uniquely positioned to help bridge the digital divide and support the establishment of ICT infrastructure that can be used and shared for health. The provision of free Wi-Fi hot spot services, the creative use of satellite technology and the use of wireless community networks may go some way to lowering costs. Additionally, the government may consider using the Solidarity Fund and other donations to invest in e-health infrastructure and to subsidise the cost of telemedicine for the poorest patients. Crucial attention must also be paid to policy implementation. The Mental Health Policy Framework (MHPF) for SA and the Strategic Plan 2013 – 2020 highlights building infrastructure and capacity of facilities as well as the use and innovative mental health technology as key objectives. MHPF stipulates that there will be equality and consistency in the financing of mental health, but provincial mental health plans have yet to be developed and implemented. Consequently, there is an ongoing need to emphasise the importance of mental health at a provincial level.

Though the Coronavirus has revealed vast cracks in our digital infrastructure, it may present an opportunity for South Africa to explore more equitable e-health and digital solutions long before the next emergency. 

Sarah Lubala is a Congolese-born South African writer based in Johannesburg. Her work has been published in the Mail & Guardian, Brittle Paper, Apogee Journal, Entropy and elsewhere.

The views expressed here are the author’s personal opinion and do necessarily reflect the editorial policy of The Daily Vox. 

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