The Green Report analyses the initiatives, trends and politics in e-health care in South Africa. With its finger on the pulse of developments in the industry the Report brings you timely information and analysis to assist you in your business life.

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This months stories:
The Ministry of Health and Information Technology
Can health care web sites make money in South Africa?
Rational AIDS debate online - at last
Privacy of personal health information online

The Ministry of Health and Information Technology
In his opening address to parliament president Mbeki announced the establishment of a committee to advise and guide South Africa into the information age. Essentially he committed the country to pushing forward to take maximum advantage of the new economy. In this light The Green Report (TGR) felt that it would be useful to catch up with the Ministry and Department of Health to hear if the they were planning to put 'e-health' on the agenda in any way. Does the Ministry have any view on e-health at all, or are more basic requirements needing to be met before the Internet becomes a focus area?

TGR called the Ministry to request an interview. "No problem ... just e-mail through a request and your questions and we will make the arrangements" was the response. A week after sending the e-mails there was no response, so a further call to the Ministry was made. "We haven't received any request for an interview - what e-mail address did you use?" TGR quoted the two e-mail addresses supplied by the Ministry a week earlier. "No, those are the wrong addresses, try this one .... actually, our e-mail isn't working, could you fax through the request please?"

After a brief trip to the local fax bureau (I mean who uses faxes these days - right?) TGR called to confirm receipt of the fax. "No, no faxes have been received, the fax machine is not working." TGR expressed gratitude that at least one bit of communication technology (the telephone) was working and vowed to continue to make the effort to get the request for the interview through. Watch this space.

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Can health care web sites make money in South Africa?
drkoop.com makes an instructive (and scary) case study for South African health web sites. drkoop.com is no slouch in terms of popularity - it was the fifth most popular health web site in the United States in January 2001 (1.4 million users generating 14.4 million page impressions in the month). In addition the first available advertising spaces on drkoop are in August 2001, so it seems that all, or most of those 14.4 million page impressions are income generating.

Last year drkoop.com raised (in a third round of funding) in excess of US$27 million and laid off more than half of it staff in an effort to get to profitability. In the quarter ending December 2000 the company had still not shown a profit and is said to be rapidly running out of cash again. What chance have South African health care web sites got when users and page impressions in South Africa are measured in tiny fractions of those in the USA?

Some South African health sites will succeed. Most will fail. We have seen a number come and go already, and we will see many more die in a blaze of red ink. Many local sites seem to think that, because some words are spelt differently and some medicines have different brand names, they need to recreate much of the content already easily available to South African Internet users. This content comes at great expense and, because it is local content, it is of limited value to Internet users outside of South Africa. A TGR prediction: most, if not all of those health care web sites that are burning cash on staff and content right now will crash and burn within two years.

Which ones will succeed? Those that are rooted in business other than Internet business are good candidates. Even with these sites the companies are going to have to look hard for the value added to their businesses by the money spent on their web sites. For some time the value is not going to be on their bottom line. Those sites that do not try to re-invent the wheel and look for ways of providing things that are not available elsewhere on the web will eventually do well. Not only will they provide a compelling reason for South African Internet users to come to their site but, if their site provides truly unique content and/or services, they can start tapping into more lucrative international markets.

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Rational AIDS debate online - at last
Online debates on HIV and AIDS have generally been characterised by a rapid degeneration into name calling and accusations of hidden agendas by both parties. It seems that at last we can access some rational and well thought out discussion on the issue which isn't as clear cut as either side would have it. At http://news-gap.com two respected scientists, both active in the field of AIDS research discuss the issue (somewhat slowly) online. We can read and the discussion, and if moved to comment, can post our views in a separate and open forum. I suspect that the open forum will degenerate into name calling soon, but you can ignore that and track the science in the main (and closed) forum.

This forum has not been well publicised. Even the Mail and Guardian (bastion of the liberal press) had to be forced by the Appeal Panel of the Press Ombudsman to publish an article with this web site's details in it. Seems that nobody really wants to delve into the core issues around AIDS. Is there a belief that only the accepted dogma around AIDS will save us all from this pandemic?

Note: At present, access to the Mail & Guardian website is restricted to MWEB and iafrica subscribers, if you are not one of these then you can still get access to the site via www.anonymizer.com

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Privacy of personal health information online
Concerns regarding the privacy of health care information held online are reaching something of a fever pitch. A small and growing number of South African companies have indicated their intention to start collecting and storing personal health information online. Privacy concerns are proving to be a stumbling block to all of them.

A useful perspective to maintain is that privacy concerns are not new and are not limited to the Internet. The British Medical Journal of 24 February 2001 reports on privacy of patient information disputes going back to 1910. The Internet changes the landscape in that potential breaches of privacy reach further more quickly than leaving a patient's folder open in the waiting room. This point not withstanding, privacy issues have not changed much over the past 100 years or so.

The Internet is forcing us to re-look and rethink privacy issues. One point that is emerging around the world is that individually identifiable health information is (no surprises here) sacrosanct. Points of difference come up with the storage and use of grouped (or non-individually identifiable) data. The European Union is in the process of establishing rules that are more stringent than those under development (and imminent implementation) in the USA. The main difference is that the USA relies on a mix of legislation, regulation and self-regulation and the EU relies on legislation which is binding on all 15 member states. This has resulted in the US Department of Commerce issuing draft legislation whereby US organisations can apply for Safe Harbour designation. Once thus designated they will be deemed to comply with EU legislation.

This hardly raises confidence that your private information will not become the topic of a busy chat room discussion - does it? British consumers remain concerned. A British patient advocate grouping is busy trying to organise an "opting out" of any data collection in any form (even paper based records). Epidemiologists will certainly be unhappy with this approach.

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