• Concerns have been raised over the country's data reporting mechanisms, hindered by old infrastructure, as well as a decentralised reporting system.
• While the Western Cape has created data reporting which allows for comprehensive and automated data reporting systems, experts say reporting needs to be resolved in other provinces.
• The NICD said it collects data from 75% of hospitals in the country and, while there are delays, most hospitals do so consistently.

Experts and medical professionals have raised concern over the country’s Covid-19 data reporting mechanisms, saying old infrastructure, as well as decentralised reporting systems, hinder the process.

The Western Cape is said to have set the gold standard for Covid-19 data reporting through comprehensive data systems which allow for daily reporting, however, elsewhere in the country data systems urgently need to be resolved.

Dr Angelique Coetzee, the chairperson of the South African Medical Association (SAMA), explained that outdated hospital infrastructure seemed to be the source of reporting problems.

"The provinces are still on a paper system. We are in the fourth industrial revolution, but our healthcare system is still in the first industrial revolution," Coetzee said. 

The problems tend to happen after a positive Covid-19 test is received from the labs. 

While patient information should be submitted to the National Institute for Communicable Diseases (NICD) at this stage, it is sometimes not submitted because of poor leadership.

Western Cape 

According to some experts, the Western Cape has set the "gold standard" for Covid-19 data reporting. 

The province's health department spokesperson, Mark Van Der Heever, said they had an automated data system in the department which allowed for daily reporting to the national Department of Health and citizens.  

A few components of the system include the so-called Bed Bureau system, patient registration systems and the provincial health data centre.  

The Bed Bureau system is unique to the Western Cape and was developed for the Covid-19 outbreak.

"Bi-daily reports are entered into an automated system which is able to generate 12-hourly reports on a range of data points which include: hospital occupancy, bed availability, number of Covid-19 patients, number of ventilated patients and a host of other data.  

"We are able to use this system to generate reports on operational activities across the province," he explained.  

An automated patient registration and discharge system allows for generation of a range of data, including patient diagnosis, deaths, admissions and comorbidities. 

The Provincial Health Data Centre integrates data from various systems to generate a wide range of reports, Van der Heever explained.  

"It is important to strike the right balance between reporting and operational work and the Department of Health makes great efforts to limit the reporting burden on staff," he said.  

News24 also sent questions to the Gauteng and Eastern Cape health departments, but no responses were received.

Data collection 

The NICD, which assists government in collecting Covid-19 data, gathers it from about 75% of hospitals across the country.

According to interim director of the NICD, Professor Lynn Morris, there are some delays in reporting, however, "most hospitals reporting through the DATCOV system do so consistently."

"The NICD collects data from selected hospitals through the DATCOV hospital sentinel surveillance programme.  

"This programme collects clinical, treatment and outcomes data on approximately 75% of hospitals. Daily and weekly DATCOV reports are available on the NICD website," Morris said. 

Since Covid-19 is a notifiable disease, all public and private laboratories are legally required to report results to the NICD, Morris said.  

She added that patient demographics were collected at the time of sample collection, however, the completeness of the data varied between labs.  

"There are continual and ongoing efforts to improve and expand hospital reporting through the DATCOV system," Morris said.  

Underreporting

In its report on the state of the public healthcare system released earlier this week, the National Education, Health and Allied Workers' Union (Nehawu) said members had questioned the accuracy of government Covid-19 statistics, particularly on the rate of infection and deaths per district.  

"Almost in all institutions, it was commonly held that there was a deliberate under-counting, especially with regard to the recorded and reported incident and causes of deaths," the report said.  

It added that challenges stemmed from there being no uniform method to collect data in health institutions, especially data regarding healthcare workers. 

"The challenges faced by the [National Institute of Occupational Health] NIOH’s Healthcare Worker’s DATCOV Surveillance System in gathering data validates this view in that there seems to no uniform or standardized method of data collection across the institutions."

The report said only 18 public healthcare facilities cooperate with the NIOH in submitting their data weekly, while private health institutions were generally cooperative. 

"In itself this underscores the absence of proper oversight by the health districts as the managers of the institutions seem to be able to influence the records of the Covid-19 death toll in such a way that it may be distorting the actual extent and scale that the country faces of this epidemic," it said. 

Centralised reporting 

Professor Alex van den Heever, chair in the field of Social Security Systems Administration and Management Studies at Wits University, said there needed to be a uniform system of reporting.

"That just simply hasn't been done," he said.

He explained that a lack of data would impact the ability to properly interpret existing data and create trends for the virus over time.  

Both experts called for the data to be made public, to allow for better decision-making and analysis of the trajectory of the virus. 

According to Department of Health spokesperson Popo Maja, the department has developed data collection tools which are being deployed to create a uniform system of data collection.

"The national Department of Health has developed the reporting indicators and format in the Covid-19 National Indicator dataset which serves as the requirement for provincial reporting and frequency. Data collection tools for this purpose has been developed and is being deployed," Maja said.  

A Covid-19 centre at the department has been functional since the start of the epidemic using existing platforms.

It processes transactional data 24-hours a day to support the Covid-19 response.

Maja explained that the department receives a Covid-19 laboratory testing from the NICD daily, called the patient line list.

"This line lists contains demographic details of all persons tested and the specific breakdowns are analysed where relevant at a National and Provincial level to inform the epidemic responses," Maja said. 

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