Project Kgolagano Harnesses Telemedicine to Plug the Gaps in National Healthcare Service Delivery

Telemedicine

The World Health Organisation (WHO) prescribes the highest attainable standard of health as a fundamental right of every human being. The UN agency advocates for a human rights-based approach to health, this approach advances the right to health in international law and international development processes. The approach further stipulates that the right to health includes access to timely, acceptable and affordable healthcare of appropriate quality in order to achieve the best health outcomes.

The reality however is that rural communities and people of low socioeconomic status face barriers that make it difficult to obtain basic healthcare services. Vulnerable and marginalized groups in societies tend to bear an undue proportion of health problems. Poor access to healthcare comes at both a personal and societal cost as people who do not receive vaccinations, may become ill and spread diseases to others increasing the burden of disease for society overall in addition to the burden borne individually.

The scenario in Botswana is no different as demonstrated by the fact that while government has instituted a robust primary healthcare policy and invested substantially in building health facilities all over the country, quality healthcare and service utlisation remain a challenge outside urban centers. Medical care is rudimentary in rural areas mainly as a result of inadequate skilled health professionals and the logistical and economic challenges of delivering quality medicines to peripheral regions.

Botswana is an average sized country of just over 2 million people. The country is one of the most sparsely populated nations in the world with a density of 3.9/km². Around 10 percent of the population lives in the capital city, Gaborone. With a thinly spread population sitting on a vast plateau that is divided into two distinct topographical regions comprising a hilly bush country and grassland eastern region, and the Okavango Swamps and the Kalahari Desert in the west, service delivery and infrastructure development are a logistical and economic challenge.

To remove the obstacle that deny rural communities access to quality and affordable healthcare, Botswana Innovation Hub in partnership with some of its stakeholders is leveraging science, technology and innovation to help solve social and epidemiological problems that remain a hindrance  to the country’s healthcare service delivery. The company is harnessing the rapid spread of digital technologies to transform healthcare work and service delivery.

In its World Development Report of 2016, The World Bank Group defines the broader development benefits from using these technologies as digital dividends. These returns to digital investment have boosted growth, expanded opportunities and improved service delivery. The report’s, co-author Tim Kelly says, “It is widely acknowledged that the adoption and use of ICT’s for government and trade by countries can contribute significantly to the development and renovation of established economic and social sectors by reducing unemployment, especially among the youth and boosting efficiencies in service delivery.” 

In its drive to develop advanced science and technology innovation capital and activities that advance the country’s productivity and contribute to its competitiveness, Botswana Innovation Hub offers a unique platform for scientific, technological and indigenous knowledge-based innovation. In the process, the company has identified ICT as one of its focal sectors. “The company’s focal sectors were defined by national needs and opportunities to fuel economic diversification and job creation, as well as support the exploration and advancement of solutions to pressing national and global issues,” states ICT and Marketing Director, Tshepo Tsheko.

Tsheko says, investment in science, technology and innovation is essential for economic development and social growth. He says one of the Botswana Innovation Hub flagship programmes, the pilot project on TV White Space (TVWS) broadband access service has been hailed as a resounding success one year after it was launched. Project Kgolagano as the project is officially known, was launched on 12^th March, 2015 at Tsopeng Clinic in Lobatse and is already lauded for enhancing service delivery, through telemedicine and bridging the digital divide.

In telecommunications, TVWS denotes unused spectrum on the frequency range commonly used to deliver television channels. The frequencies allocated to a broadcasting service but not used locally enable the delivery of broadband using dynamic TV spectrum access. Project Kgolagano uses TV White Space technology from the free dynamic TV spectrum to provide hospitals and clinics with access to broadband internet and telemedicine services that facilitate a remote diagnosis network and support local healthcare service delivery.

“The project delivers online healthcare services to regions in Botswana with limited access to broadband and adequate specialized healthcare services using cutting edge technology for the delivery of broadband,” states Manager of the Microsoft Innovation Centre (MIC), Patel Barwabatsile. “Project Kgolagano connectivity enables access to specialised medicine in Gaborone and other locations around the world, with a specific focus on specialised healthcare services such as maternal medicine; cervical cancer screenings; dermatology screenings; HIV screenings and consultations; tuberculosis screenings and consultations; adult pediatric care and internal medicine consultations,” he says.

Kgolagano, is a Setswana word which means “to be connected or networked.” The project is a collaboration between Botswana Innovation Hub; Microsoft Corporation; University of Pennsylvania (UPEN); Global Broadband Solutions; Vista Life Sciences; Botswana Fibre Network (Bofinet) and USAID-NetHope. Barwabatsile states that the project is made possible through the support of the Botswana Communications Regulatory Authority (BOCRA) to transmit on TV White Spaces, and the collaboration of the Ministry of Infrastructure, Science and Technology and the Ministry of Health representing government.

The objective of the project is to demonstrate the efficacy of the cutting edge technology of TVWS equipment and service, assist the regulator BOCRA to come up with the licensing framework for the dynamic spectrum access and use of TVWS as well as deliver the telemedicine health programme through low cost and long range broadband over TVWS. The telemedicine programme allows medical staff to consult with patients in remote locations, with the primary objective to increase the potential scale and reach of health services across Botswana. Furthermore, the project aims to lay the groundwork for future low cost internet access that can assist in increasing education, healthcare, access to markets and small business empowerment throughout Botswana.

The Director of Microsoft’s Technology Policy Group, Paul Garnett says, “Using TVWS for broadband internet connectivity has several distinct advantages which include the technology’s ability to cover greater distances and penetrate common obstructions, with greater efficiencies and reduced implementation costs. The technology is ideal as it can work in areas where there is no electricity, and it can lower the cost of an access base station by a factor of 10. This is a cutting edge technology that has the potential of providing cheaper broadband internet connectivity to areas that were not connected before.”

Garnett goes on to say, this technology uses location-aware devices and online databases to deliver low cost broadband access and other forms of connectivity to consumers. The approach is rooted in the idea that devices with greater knowledge of their surroundings can opportunistically use available radio spectrum. There are many TV broadcast channels that are unused in nearly every location in the world, these empty channels (blocks of spectrum) are what is used in this internet connection.

Following the launch at Tsopeng clinic in Lobatse last year, the pilot project was later extended to run in Francistown and Maun. The hospitals connected to the service are Athlone Hospital in Lobatse, Nyangabwe Hospital in Francistown, and Letsholathebe II Memorial Hospital in Maun. In addition to these, Tsopeng clinic in Lobatse, Donga clinic in Francistown and Moeti clinic, Boseja clinic, Maun clinic, Sedie clinic and Maun General clinic were also connected. 

ICT and Marketing Director, Tsheko is excited at the positive outcome of the pilot project and believes that telemedicine will transcends Botswana’s rough terrain and socioeconomic barriers to make quality and appropriate healthcare services affordable and accessible to all. He said while the pilot phase is focused more on the health sector, sectors such as education, agriculture, tourism and security services will all benefit immensely from this technology in future once it is rolled out. 

In his post pilot project report, Barwabatsile concludes that Project Kgolagano has been successful in delivering broadband internet over the TVWS and in the process delivered healthcare services to the pilot sites and their catchment areas. He said the telemedicine programme included a monitoring and evaluation function that documented the socioeconomic impact of the project on the communities involved. The results clearly indicate that the communities reaped economic and social benefits from the pilot project.

“In order to move beyond pilot projects towards sustainable commercial deployments, the report recommends that BOCRA should come up with a regulatory framework for the adoption of the TVWS or dynamic spectrum access,” he says. Barwabatsile goes on to say recognition of the broadband technology will assist in speeding up the commercialization of the TVWS service as most organisations and government entities are willing to adopt or use the service if it is covered by a regulatory framework. 

Botswana Poised to Reap the Benefits of the Transformative Potential of the Digital Revolution

Digital technologies have spread rapidly in much of the world, transforming the worlds of business, work and service delivery. The World Bank Group’s, World Development Report of 2016 defines the broader development benefits from using these technologies as digital dividends. These returns to digital investment have boosted growth, expanded opportunities and improved service delivery.

The report titled, Digital Dividends, states that, “Countries that complement technology investments with broader economic reforms reap digital dividends in the form of faster growth, more jobs and better services.” However, it observes that in countries where the fundamentals are weak, digital technologies have not boosted productivity or reduced inequality.

Presenting the report at Botswana Innovation Hub earlier this month, co-author Tim Kelly said, “It is widely acknowledged that the adoption and use of ICT’s for government and trade by countries can contribute significantly to the development and renovation of established economic and social sectors by reducing unemployment, especially among the youth and boosting efficiencies in service delivery.” 

The report advises that for countries to reap the full benefits of the digital dividends they must promote competitive business environments, increase accountability and upgrade education and skills-development systems to prepare citizens for jobs of the future. 

In Botswana where the economy has historically been agriculture driven until 1967 when diamonds were first discovered, it has now emerged that over reliance on narrow volatile external markets has proved unsustainable and it is forecast that mineral revenue will decline substantially over the next two decades. For this reason economic diversification continues to be promoted, and the values of free enterprise economy encouraged through the drive to create a more competitive and investment friendly environment in which the private sector can flourish.

Government initiated structural and strategic shifts that will take the country beyond its mineral endowments and shape it into a knowledge-based economy. The government has, as a result, put a lot of effort into creating an enabling environment through sound macro-economic policies and an increased budgetary provision for sectors that are targeted at diversifying the economy as well as creation of sector capacity through skills development, access to land and capital, and low tax rates and exchange control liberalisation.

Permamant Secretary in the Ministry of Infrastructure, Science and Technology (MIST), Dikagiso Mokotedi is adamant that government has laid a solid foundation to enhance technologies and reap benefits of the transformative potential of the digital revolution.  

Mokotedi says, “In creating an enabling environment, the Government of Botswana developed the first Science and Technology Policy in 1998 which was followed by the establishment of the Ministry of Communications Science and Technology in 2003, with the mandate to establish strategies for harnessing Science Technology and Innovation for economic development.”

The Permanent Secretary goes on to say that, “A strategic blueprint, the Botswana National Research Science and Technology plan (BNRST) document that lays down the foundations for an implementation strategy for Science, Technology and Innovation was completed in 2005. This identified key areas to focus research and innovation aligned to the then existing research and development institutes.”

He says under the current National Science, Technology and Innovation Policy of 2012, and its implementation plan, there is a specific provision for setting up appropriate administrative structures, research and development funding instruments and strategic projects that lay down a strong future foundation in Science, Technology and Innovation through a number of key interventions.

Government’s initiative to establish new institutions such as Botswana Innovation Hub, Botswana International University of Science and Technology (BIUST) and research institutes like Botswana Institute for Technology Research and Innovation (BITRI), the University of Botswana’s new teaching hospital all bear testimony of governments strategic initiatives to promote research, technology transfer and innovation with commercial emphasis and relevance to Botswana.

Mokotedi says commercialisation of Research and Innovation is essential for economic growth. He however says it also requires funding, “Researchers burn money to generate knowledge and Business burn knowledge to generate money”. Therefore, with this synopsis of the policy setting for Science, Technology and Innovation, the government is facilitating creation of synergies among government, academia, private sector, industry and businesses through the Botswana Innovation Hub. Government is facilitating for policies that support commercialisation of research and innovation and Botswana Innovation Hub, which is set up to contribute to the country’s development and competitiveness, offers a unique platform through which the low hanging fruits of the digital revolution can be harvested to allow citizens to enjoy the bountiful harvest of digital dividends.

Intellectual Property is the Currency of Innovation and Creative Works

Intellectual Property (IP) is defined as a creation of the mind, an intangible asset that accords creators, authors, artists and inventors an incentive to invent. Some IP is protected by law, to give statutory expression to the moral and economic rights of creators in their creations. The World Intellectual Property Organization (WIPO) states that, “By striking the right balance between the interests of innovators and the wider public interest, the IP system aims to foster an environment in which creativity and innovation can flourish.”

An expert in business development and innovative products and services commercialisation, Ambrose Makgonatsotlhe states that a study conducted by the Southern African Innovation Support Programme (SAiS) concluded that, “Intellectual Property is critical in unlocking value from an inventive and innovative product, service or process. In knowledge intensive economies IP provides the platform for competitive and comparative advantage. It also focuses the innovator to operate entrepreneurially especially in the early stages of the product and business life cycles.”

Makgonatsotlhe observes that for Botswana to effectively leverage intellectual property assets, there is need for integration and convergence of components that lie within the IP value chain such as policy, special purpose instruments, funding, IP policing etc. He said, “It has been observed that IP rights in Botswana lacks coherence and remains largely fragmented with gaps in the overall IP support services.”    

To close these gaps, the government of Botswana established the Register of Companies and Intellectual Property (ROCIP) and the Companies and Intellectual Property Authority which provide a structural and strategic framework to promote and enable the full protection of the rights of investors and right-holders. As a key player in the innovation and creative works space, Botswana Innovation Hub in partnership with the Southern Africa Innovation Support Programme and the University of Botswana established the National Technology Transfer and Intellectual Property Office.

The office is staffed with a Technology Transfer Officer (TTO) who is responsible for the identification and commercialisation of intellectual property arising from research, innovations, indigenous knowledge and technology developments.

The incumbent officer, Samuel Gaborone says, “The role of the TTO entails giving advice on commercial issues in contracts, identifying and protecting intellectual property and taking a leadership role in commercialising the IP through licensing and/or the creation of start-up companies.” 

Located within the Botswana Innovation Hub’s flagship technology entrepreneurship development programme, First Steps Venture Centre (FSVC) currently resident at River Walk Mall in Gaborone, the National Technology Transfer and Intellectual Property Office provides local entrepreneurs and innovators with the required tools to develop, protect and monetize their innovations.

Gaborone says the TTO offers specialized expertise services to facilitate the technology transfer and intellectual property which contribute towards generating knowledge-based job opportunities for the country. He said the office operates on a three pronged approach with a focus on IP Awareness and Capacity Building, IP Registration and Management, and IP commercialisation strategies.

Presently, the TTO is engaged in an awareness and capacity building drive and recently hosted the Intellectual Property Training Seminar in partnership with Chilume and Associates law firm. “The seminar which was attended by 20 FSVC clients focused on IP law, interrogation of IP presence in inventions and ideas, drafting, filling and management of IP portfolios for clients,” said Gaborone.  

Going forward, Gaborone said they will run awareness and capacity building campaigns focused on patents, copyright and trademarks, which enable people to earn recognition or financial benefit from what they invent or create. He said, “IP advisory services that help our clients leverage social and economic benefit for their inventions and creative works range from literary and artistic works; designs; and symbols, names and images used in commerce.”

Gaborone states that IP advisory services are an important component of a well-functioning Science, Technology and Innovation ecosystem that Botswana Innovation Hub is currently building.