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
12th 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.
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