1. "mHealth: Utilizing mobile technology
to expand accessibility of government
health and education
services beyond urban areas"
Cynthia Antwi, PMP
Mobile Telemedicine Program Manager
Botswana-UPenn Partnership
Ryan Littman-Quinn
Director of Mobile Health Informatics
Botswana-Upenn Partnership
6th Annual E-Gov Africa Summit
March 5-7
Gaborone, Botswana

2. Contents
• Overview of Botswana-UPenn Partnership (BUP)
• BUP Informatics and Telemedicine Background
• Mobile Telemedicine: The Botswana Story…
• Partners and Roles
• Telemedicine Program Outline (Project Kgonafalo)
• Access to Medical Resources
• Lessons Learnt
• Other great mhealth projects

3. Botswana-UPenn Partnership: 10
years in the making...
• Government of Botswana, the University of Botswana
and the University of Pennsylvania
• UPenn is taking a broad interdisciplinary approach to
train healthcare personnel throughout Botswana in
prevention and treatment of HIV/AIDS and its
complications

4. Botswana-Upenn Partnership: 10
years in the making...
• To develop outstanding post-graduate training programs
at the University of Botswana
• Development of Treatment Guidelines
• Has the following main programs being:
o HIV Care & Prevention
o Women's Health Clinic
o Adult TB program
o Paeds TB: Contact tracing, Gastric Aspirate
o Health Informatics & Telemedicine

5. BUP Informatics and
Telemedicine Background
• Dr. Carrie Kovarik launched teledermatology in 2007
• Facilitate & Foster local partnerships between public and
private sector
• Provide Technical Assistance and consultation on the
implementation of Telemedicine projects
• Health Informatics Capacity Building
• 24 publications (journals/conferences)
o Including comprehensive "mHealth in Botswana"
papers/workshop at IST-Africa Conference 2011

6. Mobile Telemedicine : the Botswana
Story
• Challenging IT
infrastructure &
Internet
Availability
• Severe shortage of
healthcare
workers...

7. = 10 people
In Botswana, there are roughly 5 doctors for
every 12,500 people
Diagram concept courtesy of UPenn Museum

8. Mobile phone revolution

9. % of world's
population covered
by mobile signal:
2003: 61%
2009: 90%

10. % of mobile
devices owned
by citizens in
developing
countries:
2000: 25% of 700 million
2009: 75% of 4 BILLION

12. Partners and Roles
University of Botswana
Orange Botswana
Ministry of Health of Botswana

13. Telemedicine Program Outline
Access to Specialty Care (“Project Kgonafalo”)
• Mobile Oral Telemedicine
• Mobile Cervical Cancer Screening
• Mobile Teledermatology
• Mobile Teleradiology
Access to Medical Resources
• National Treatment Guidelines SMS Query
System
• Mobile Telementoring

14. Access to Specialists: Project
Kgonafalo
• Mobile Oral Telemedicine
• Mobile Cervical Cancer
Screening
• Mobile Teledermatology
• Mobile Teleradiology

15. Mobile Oral Telemedicine
Operations at a glance:
• 6 Locations
• 13 Clinicians Trained
• 107 Successful Cases

16. Mobile Cervical Cancer Screening
Operations at a glance:
• 1 location
• 2 nurses trained
• 356+ patients seen
o (96 part of a study)
• Dependent on Visual
Inspection with Acetic
Acid (VIA) in Botswana...

17. Mobile Teledermatology
Operations at a glance:
• 2 locations
• 3 nurses trained, 2
dermatologists with
phones
• 126 successful cases
o (mostly part of study)

18. Mobile Teleradiology
Operations at a glance:
• 2 locations
• 4 radiographers trained
• 54 successful report requests

19. Before...

20. ... After

21. After (cont.)...

22. Government Ownership Strategies
• Public Awareness Posters
• Specialty coordinators phone trainings
(Train the Trainer approach)
• Ongoing Monitoring and Evaluation to better
improve the service.
• “User Buy- In” through educational
workshops for healthcare workers

23. Public Awareness Posters

24. Specialty Coordinators / Training

25. Specialty Coordinators / Training

26. Specialty Coordinators / Training

27. Educational Workshops

28. Educational Workshops

29. Educational Workshops

30. Access to Medical Resources
• National Treatment
Guidelines SMS Query
System
• Mobile Learning
(mLearning) with
University of Botswana
School of Medicine
(UBSOM) Residency
Program

31. SMS Query System
Operations at a glance:
• 80 Participants in focus
group
• Technological setbacks
prevented growth
• Big plans for revival,
including transitioning to
USSD

32. UBSOM mLearning
Operations at a glance:
• Android phones with medical
and drug information apps:
o e.g. Dynamed, Archimedes,
Medscape, ePocrates Rx, and 5-
Minute Clinical Consult
• Phone users by residency
program:
o Internal Medicine: 8
o Paediatrics: 8
o Emergency Medicine: 4
o Family Medicine: 8
o Faculty: 5
o Total: 33

33. UBSOM mLearning Training

34. 2012 and Beyond...
• 2012 planned scale up:
o Remote consultation
 We are in the process
or rolling out the M&E
framework on those
sites
 40 devices
 25 new locations
o UBSOM (potential)
 50+ devices
• Wharton and UB Business
School collaborations
Explore more specialties
o IT and integration

35. Lessons Learnt
• Lean on the expertise in the various specialities, to
better develop the solution
• Partnerships between public and private sector
• Stakeholder engagement and continuous
communication
• Continuous Monitoring & Evaluation

36. Conclusion…..
• Mobile technologies can also be applied to other
areas like agriculture and provision of public services
• Continuously growing industry
• Mobile technologies can better connect a
government to its citizens and improve government
services throughout the country.

37. Thanks!