The need for a telemedicine strategy for Botswana? A scoping review and situational assessment

Abstract

Background: Health, healthcare, and healthcare system problems within the developing world are well recognised. eHealth, the use of Information and Communications Technologies (ICT) for health, is frequently suggested as one means by which to ameliorate such problems. However, to identify and implement the most appropriate ehealth solutions requires development of a thoughtful and broadly evidence-informed strategy. Most published strategies focus on health informatics solutions, neglecting the potential for other aspects of ehealth (telehealth, telemedicine, elearning, and ecommerce). This study examined the setting in Botswana to determine the need for a telemedicine-specific strategy. Methods: A situational assessment of ehealth activities in Botswana was performed through a scoping review of the scientific and grey literature using specified search terms to July 2018; an interview with an official from the major mhealth stakeholder; and benchtop review of policies and other relevant Government documents including the country's current draft eHealth Strategy. Results: Thirty-nine papers were reviewed. Various ehealth technologies have been applied within Botswana. These include Skype for educational activities, instant messaging (WhatsApp for telepathology; SMS for transmission of laboratory test results, patient appointment reminders, and invoicing and bill payment), and robotics for dermatopathology. In addition health informatics technologies have been used for surveillance, monitoring, and access to information by healthcare workers. The number of distinct health information systems has been reduced from 37 to 12, and 9 discrete EMRs remain active within the public health institutions. Many infrastructural issues were identified. A critical assessment of the current draft ehealth strategy document for Botswana showed limitations. Many telemedicine services have been introduced over the years (addressing cervical cancer screening, teledermatology, teleradiology, oral medicine and eye screening), but only one project was confirmed to be active and being scaled up with the intervention of the Government. Conclusions: Botswana's draft 'ehealth' strategy will not, in and of itself, nurture innovative growth in the application of telemedicine initiatives, which currently are fragmented and stalled. This lack of focus is preventing telemedicine's recognised potential from being leveraged. A specific Telemedicine Strategy, aligned with and supportive of the pre-existing ehealth strategy, would provide the necessary focus, stimulus, and guidance.

Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems

“… [ 30 ] Perspective Botswana Oral health, dermatology, radiology, and cervical cancer screening Malfunctioning of mobile devices due to different technical and connectivity problems. Cultural misalignment between IT and healthcare providers [ 31 ] Cross-sectional Botswana Teleconsultation Low levels of computer literacy, unstable electrical power, lack of clinical and technical expertise, poor acceptance of the services by the users. [ 32 ] Review Africa Teleeducation, teleconsultation, teledermatology, teleradiology, telecardiology, teleophtamology, teleoncology, and telepsychiatry Technological, organization barriers, legal and regulatory barriers, financial barriers such as limited medical budget, high cost of telemedicine and ICT infrastructure, high tariffs on telecommunication and import duties, and high cost of electricity supply, maintenance cost, high cost of telemedicine services and lack of funding.…”

“…[ 45 ] states that telemedicine has been used for teleconsultation with COVID-19 patients with mild symptoms. Teleconsultation service has been prominently utilized in various countries in sub-Saharan countries such as Botswana [ 31 ], Gambia [ 25 ], Uganda, Kenya, Ethiopia [ 39 ], Cameroon [ 44 ] and South Africa.

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“…Several reviews, perspectives and commentaries included in this study show that telemedicine can potentially transform health systems to reduce the burden on healthcare professionals and also minimize the risk of exposure to the virus. Virtual healthcare services such as otolaryngologic practice during COVID-19 [ 26 ], teledermatology [ 31 ], tele-education, teleconsultation, teleradiology, telecardiology, teleophtamology, teleoncology, and telepsychiatry [ 32 ], teleneurology [ 35 ] and telerheumatology [ 51 ]. Virtual health care alleviates the shortage of personal protective equipment through virtual telecare, reducing nosocomial infection due to reduction of clinic visitation especially in COVID-19 management units, protecting medical personnel from virus infection, and re-establishing undergraduate medical students clinical observership and medical care participation that has been halted due to the pandemic [ 53 ].…”

“…The successful adoption of virtual health care requires the availability and reliability of underlying technologies like the Internet, ICT infrastructure, and reliable electricity supply. Technological barriers to the adoption of virtual health in Africa include poor internet connectivity [ 54 ], unreliable electricity supply [ 22 , 31 , 55 ], insufficient or unavailability of ICT infrastructure, inadequate or inappropriate virtual health infrastructure [ 49 , 56 ] and high cost of telecommunication equipment [ 36 ]. Additionally, malfunctioning of computing devices due to technical problems is a hindrance to the utilization of telemedicine and telehealth [ 30 ].…”

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic

“…In response to the COVID-19 outbreak, the rapid development and deployment of point-of-care (POC) diagnostics for screening have shown to help slow the spread of the disease ( 110 ), demonstrating that telemedicine can be used as a means of surveillance. For example, Botswana is using telemedicine to control patients remotely ( 111 ), and obstetric departments in the US are monitoring coronavirus patients ( 112 ). Rapid deployment of an in-patient telemedicine response is feasible across many settings in response to the COVID-19 pandemic ( 113 ).…”