The woman behind South Africa’s Covid electronic vaccination data system – EVDS, launched during the pandemic – is spearheading another mammoth project, a digital patient registration system for NHI.
Milani Wolmarans, chief director of health systems in the national Health Department, is at the heart of it all, an Afrikaans woman who recalls the first year of the pandemic with a kind of survivor’s pride, writes Sean Christie for Bhekisisa.
“When Covid came in March 2020, we were briefed by then Health Minister Zweli Mkhize, and afterwards I called my team and said: ‘Are you ready to do everything in your power to assist the country to deal with the pandemic, from an information perspective? I’m in’.”
Five days later, Wolmarans and her team moved to offices on the campus of a Tshwane-based scientific and technology research organisation and started collecting data: “Hospital admissions, the status of hospital and ICU beds, equipment stock levels, and so on.
“We gathered all of that in a month from both the public and private systems and proceeded to develop the dashboards people came to know so well. We worked seven days a week for the first month, 18 to 20 hours a day.”
On the first workday of 2021, Wolmarans was called by her new director-general, Sandile Buthelezi, who asked if she could, within a month, develop a patient information system for Covid vaccinations.
“I said: ‘I will try my best and let you know how it unfolds.’ That’s my modus operandi – before quitting, first give it a try.”
‘Nothing is impossible’
A month later, 7 500 vaccinators were digitally trained on the use of the system. Today, almost 39m vaccination events have been recorded on the EVDS, Wolmarans says, which has been down for just 5½ hours since going into production.
“My team has this philosophy that nothing is impossible,” she says, but Petro Rousseau, a long-term colleague, says this is one of the mantras inculcated by Wolmarans.
“It’s a very diverse team … everyone is on the same page and working towards the same goals, and I think that speaks to her leadership.”
Wolmarans said she has her parents to thank, “especially my father, my greatest mentor”.
“He used to say things like, ‘How do you deal with something that seems humanly impossible? Well, you just start.’ So ja, I think I have problem-solving in my genes.”
Humble upbringing
Wolmarans grew up with her brother and their parents in the gated diamond mining community of Alexander Bay in the Northern Cape. Like Oranjemund on the opposite bank of the Orange River, Alexander Bay lay within a sperrgebiet, or forbidden area.
“Nobody was allowed their own vehicle, and everything you needed – furniture, groceries – was provided by the mine, through the Staat Alluviale Delwerye (State Alluvial Diggings, now Alexkor).
“We always laugh because there was one shop, and if the shop sold orange dresses, then we all wore orange dresses, there was no alternative,” she recalls.
“Have you ever been to the Richtersveld? It’s just nothing in every direction, so we made up our own games. It was a humble upbringing, but I would not exchange it for anything.”
Her experiences of growing up in Alexander Bay informed communitarian beliefs.
“I learned that I am not alone, I am part of a community, and as much as I give to other people, I will receive back,” says Wolmarans, who found it difficult to leave the Northern Cape to attend high school at La Rochelle Girls High in Paarl, “1 000 kilometres away”.
Holding one of the most complex digital portfolios in the government today, she said: “I don’t really know how I ended up doing what I do,” but of course there is a story.
From Stellenbosch to Mpumalanga
After matriculating, Wolmarans attended Stellenbosch University and studied occupational therapy, qualifying in 1986. She practised as an occupational therapist in what was then Eastern Transvaal but in 1994, her life changed course.
“I was pulled into the then strategic management team that guided the formation of the Mpumalanga Health Department, bringing together five different former homeland administrations,” she says.
In 1996, she was appointed deputy director of rehabilitation and disability services, and for the next two years made it her business to engage with people with disabilities in every community in the province.
“I spent days talking to people with disabilities, from all walks of life, to understand what their needs are and what their lives look like.”
What she witnessed and learned spurred Wolmarans to develop one of the country’s first community-based rehabilitation programmes, led by disabled people contracted as consultants to identify potential beneficiaries in their communities and to then provide peer support and counselling as well as information on disability rights, to reduce stigma.
“It was never going to be enough in this context to simply deliver supportive devices. You can deliver a wheelchair and weeks later it isn’t being used, and that’s where the consultants came in, because they were relatable and they provided support and information, and broke the mindset of ‘I can’t’.”
‘A lot I know is self-taught’
Rousseau believes Wolmarans’ chosen occupation taught her the lessons that have helped carry her to the highest levels of decision-making in public healthcare.
“To be an effective therapist you must see the patient within their context, and one of the things Wolmarans consistently tells her team is that the patient’s context really matters.
“She has a habit of visiting clinics wherever she goes and sitting in the waiting room until it’s her turn to see the professional nurse … she will then ask for a few minutes to talk about their experience of practising in that clinic and community,” Rousseau says.
Effective people do not remain unnoticed for long, and alongside her official role Wolmarans was soon being asked to help with aspects of primary healthcare, and “district development”.
She was then appointed director of planning in Mpumalanga, and when the role of director of strategic planning opened up in the national health department, applied and was appointed.
Director-general Precious Matsoso learned of Wolmarans’ zeal for taking decisions based on meaningful information, and asked her to spearhead various digital projects, including the development of the health patient registration system. Ultimately, she was seconded to work on digital health solutions.
“A lot that I know today is self-taught, and stems from jumping in the deep end,” Wolmarans said, adding she has always followed several simple principles.
“Be open to people’s input, always. Engage very honestly, and admit when you don’t know the answer.”
Her dream: the same system for everyone
In 2019, President Cyril Ramaphosa launched the country’s Presidential Health Compact, a vision of health system reform divided into nine work areas, with the goal being the achievement of universal health coverage.
Pillar nine (there are now 10 – an extra pillar was added after the second presidential health summit in May this year) is: develop an information system – taken to refer to the development of the so-called health patient registration system that would synchronise existing provincial and private sector patient registration systems.
In fact, Wolmarans and her team are working on something far more ambitious.
“We want to create a medical biography for each individual, detailing all your medical events and important tests, from birth to where you are now, with access controlled by you.
“This would improve quality of care, restore trust in our system, and bring in massive efficiencies. It will also prevent diseases and mortality.
“That’s my dream,” she says, “and it needs to be available for everybody, not only the privileged.”
See more from MedicalBrief archives:
Right to Care: SA exceeding vaccination targets, thanks to highly advanced EVDS
Vaccine cheats try to game the vaccination registration system
Ramaphosa’s presidential health compact now electronically available
Ramaphosa promises 'health revolution' as summit sets 10 key targets