In your own words, tell us who Kagiso Ndlovu is
A Computer Science Lecturer and Coordinator for the eHealth Research Unit at the University of Botswana (UB). I have a background in Health Informatics, with specific training and expertise in Socio-Informatics, Computer Science and Project Management. I am certified as a Health Informatics Specialist with John’s Hopkins University. Since 2012, I have been working on health informatics research and capacity building initiatives in Botswana. My work has particularly focused on Telemedicine and health informatics initiatives within resource-constraint environments. I previously served as a Project Manager in 2014 for the implementation and scale-up of the first Mobile Telemedicine solution (also known as Kgonafalo) under the Botswana Ministry of Health and Wellness, a Research Lead in 2015 on a telemedicine project funded by Microsoft Corporation, utilizing Television (TV) White Space technology to augment traditional broadband internet connectivity within healthcare facilities in Botswana and a research coordinator for a national school eye screening program (PEEK Vision) which was piloted on over 12,000 school going kids in Botswana. I am part of a team that completed the President's Emergency Plan For AIDS Relief (PEPFAR) funded Grant for Informatics and Telemedicine in Botswana where we built Capacity and Sustainable Programs in Health Informatics and Mobile Telemedicine through the implementation of sustainable national scale-up models for telemedicine solutions as well as sustainable capacity building. I have actively participated in health informatics curriculum development and teaching of the Health Informatics course at the University of Botswana. Currently, I am doing my PhD in Telemedicine focusing on interoperability frameworking for linking mHealth applications to eRecord systems (EMR. EHR, PHR etc).
Please tell us what your job entails
Other than teaching in the Computer Science department at UB, I apply computing principles and concepts at the eHealth Research Unit towards addressing practical health problems. I have served as a Technical Consultant and Strategic Advisor in a number of projects aimed at improving health service delivery through the use of Information Communication Technologies (ICT) for health, or in short, eHealth innovations. My current engagement is with a US-based company, VisualDx, where we are nearing the end of a national pilot project utilising a mobile decision support system across 27 health facilities in Botswana, targeting dermatology clinics, where we currently have a shortage of specialists nationally.
I work with various teams that support data management activities across various health projects for diverse specialities such as cancer, HIV/AIDS, dermatology, and non-communicable diseases among others. From 2019 to 2020, I have been involved in supporting COVI-19 data capture and management activities through various projects including the Sentinel Surveillance Study.
I also lead a team that set up the first research electronic data capture (REDCap) instance in Botswana in 2016, https://ehealth.ub.bw/redcap. Since then, I have coordinated REDCap usage for research, operational support and quality improvement projects for both national and international projects and collaborations, including REDCap user training, technical support and management of the REDCap platform. I have supported diverse REDCap projects, from simple to very complicated projects in terms of workflows and currently host 367 national and international projects and collaborations, with a combined total of over 100, 000 records and support over 700 users.
My passion for health informatics has resulted in my continued capacity building initiatives locally and being invited as a speaker at various international forums. I have organized and facilitated the 2017 and 2018 eHealth workshops themed “eHealth in Botswana – Where Are We Going?” and “The Promise of Open Source Technologies to Sustainable eHealth Solutions“, respectively. In August 2021, I hosted a virtual Digital Health symposium in collaboration with the Department of Biomedical and Informatics at the Children’s Hospital of Philadelphia (11-13 August 2021). I led a local team that organized the 12th Edition of the Health Informatics in Africa (HELINA) international conference under the theme “From Evidence To Practice: Implementation of Digital Health Interventions In Africa For The Achievement Of Universal Health Coverage (UHC)” (20-22 November 2019) at the UB Conference Center. The HELINA conference attracted local, regional and international audiences and speakers to Botswana and most importantly, it played a significant role in advocacy for digital health literacy and eHealth system adoption in Botswana.
I have been nominated to serve as a Strategic Advisor to the Botswana Health Information Management Association (BoHIMA) and appointed the Chairperson of the Digital Health Technical Working Group (TWG) under the Ministry of Health and Wellness from 2020-2022.
What motivated you to pursue eHealth as your research focus area?
I’ve always wanted to pursue medicine in my ‘other life’. When that couldn't happen, I studied Computer Science at the University of Botswana, did my Honors Degree in Informatics at Stellenbosch University and later on MSc Computer Science. I have worked for a Health Institution (IHS) before where I was an IT officer, worked for an NGO as a Health Informatics Coordinator, and later on Health Informatics Manager. I saw the gap in this relatively new but exciting field, especially in the context of Botswana. As fate would have it, Computer Science met Medicine, that is what Health Informatics is all about. I have coordinated, spoken, published research articles, contributed to strategies and curriculums in the field. The passion and the drive led me to be a Health Informatics expert. My ongoing PhD in Telemedicine focusing on the development of an interoperability framework for linking various eHealth systems across the health sector is also aligned to the passion I have in the field.
Over the course of almost 7 years in eHealth research, you have been involved in various important and critical eHealth projects like Kgonafalo and PEEK among others. Please take us through these and your role in their implementation
These were groundbreaking projects in Botswana and are surely worth highlighting. The Kgonafalo project involved a store-and-forward mobile Telemedicine solution supporting 4 medical specialities (Oral, Dermatology, Radiology and Cervical Cancer screening), all of which involve a visual inspection. Kgonafalo was the first mobile Telemedicine project to reach a national scale in Botswana and 24 clinicians were trained and the initiative successfully contributed to the management of 643 complex medical cases. The Portable Eye Examination Kit (Peek) project offered a comprehensive eye health programme that identified school children with vision problems and linked them efficiently and accurately to appropriate eye health services. This was made possible using the latest public health research and evidence-based solutions from Peek Vision, which has been working in Botswana since 2014. A total of 835 school going children received glasses, 94 were medicated, 63 referred using the solution and overall 992 children benefited from the Peek project.
All of these initiatives involved the utilisation of low cost but high impact solutions to address the pressing global need of making healthcare more accessible, better, faster, and cheaper. I served as a Project Manager for the Kgonafalo project working closely with the projects and informatics teams at the Ministry of Health and Wellness. I also played the role of a Strategic Advisor. During the pilot implementation of the Peek Vision system, I served as a local research coordinator for the project where we published several research articles and presented research posters based on the work done in Botswana.
Your latest publication is titled “Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar”. Please tell us more about the research project itself as well as any interesting conclusions you arrived at
It goes without saying that research on eHealth interoperability has now become part of my daily routine as I am sometimes referred to as the ‘interoperability guy’. The paper in question is part of my PhD in Telemedicine with the University of KwaZulu-Natal (UKZN), Durban South Africa. It’s a build-up from the earlier paper which was a review of review articles on eHealth interoperability, specifically those reviews addressing linking of mHealth applications to eRecord systems (EHR,EMR,PHR etc.)
The objectives were to conduct an assessment of Botswana’s eHealth interoperability landscape and identify challenges as well as opportunities for achieving interoperable mHealth applications and eRecord systems across the public and private sectors. Of note was that eHealth interoperability is non-existent within or between health facilities or sectors in Botswana, despite the opportunities of systems using widely accepted interoperability standards, data formats and APIs. Identified challenges include the lack of efficient eHealth legislation and governance structures, inadequate infrastructure, inconsistent data standards, security measures and non-uniform unique patient identifiers between the public and private sectors. Also worth noting is the inadequate eHealth capacity across the public and private sector health personnel.
The COVID-19 pandemic has shown the need to improve Botswana’s healthcare systems so that they can better adapt to sudden public health disasters. What role do you think eHealth solutions can play in aiding this adaptation?
Indeed, the COVID-19 pandemic has changed the perception of how healthcare can be delivered. The lockdowns, social distancing, shielding and fear of infection have led to widespread uptake of the delivery of healthcare at a distance using information and communication technologies – Telemedicine. Botswana has not been left behind in this transition as evidenced by the recent launch of the national eHealth Strategy (2020-2024) and considerations to develop a Telemedicine Policy and Programme for Botswana. The benefits of eHealth such as improved operational efficiency, higher quality of care, and a positive return on investments are well documented even in the context of Botswana. Tapping into already existing technologies such as mobile devices and telecommunication technologies could have a great impact on the fight against the COVID-19 pandemic. A smartphone is capable of communication by audio - phone call, video – video-call using Facetime or similar applications, or other Internet-based video programmes e.g., Zoom, Skype etc., text messaging with or without attached image or sound files – email, WhatsApp, We Chat etc., data capture – still photographs, videos, sound files, bar codes, and sensors; all of which could capture pertinent health data at a distance and relay the message to a healthcare provider. In addition, there are almost half a million medical applications that can be loaded onto a smartphone to aid both patients and healthcare workers in decision making.
Most tech innovation in the country currently seems to be focused on providing fintech and payments solutions. From your research work, what are some areas in eHealth that developers can look to create solutions for?
The list is endless. I’d say solutions could start from when someone is born (automating the paper-based child welfare card and immunisation schedules), to medical emergency solutions at home/community level, to educating communities on healthy living, queue management systems at hospitals and clinics, apps that promote interactions among patients as they learn and support each other. The same applies to solutions that empower healthcare workers (decision support systems) utilising machine learning and artificial intelligence algorithms. This is just the tip of the iceberg!
When it comes to healthcare, inclusivity is vital. With most rural areas not having internet access, how do we ensure that eHealth solutions do not just benefit urban dwellers and leave rural dwellers behind?
Indeed the WHO strongly advocates for inclusivity through universal health coverage (UHC), ensuring all people and communities have access to quality health services where and when they need them, without suffering financial hardship. This is where prioritising already existing low cost but high impact innovations comes in. Telemedicine has been proposed as having a great potential to address problems such as inadequate access to specialised care and the provision of care to underserved rural populations. It can be classified according to the following categories; office or hospital-based telemedicine, which is an interactive substitute for face-to-face encounters utilizing live video conferencing with a medical doctor. The other type is what is commonly known as store-and-forward telemedicine, which is purely asynchronous, that is, non-real-time encounter. The asynchronous type of telemedicine is more suitable for low-resource settings because of the slow bandwidth challenge. The other telemedicine category is home-based telemedicine which entails monitoring of patients at their homes or in a nursing care facility. The solution choice and strategies should always match the setting/environment. Public-Private Partnerships (PPP) are vital in achieving this.
Most of the time, creating an effective eHealth solution requires the collection of significant amounts of personal data. With Botswana currently not having a personal data privacy protection Act, how can we strike a balance between the protection of personal data while also promoting the development and use of eHealth solutions?
Oh, the Data Protection Act of 2018 exists, https://www.bocra.org.bw/sites/default/files/documents/DataProtectionAct.pdf. Perhaps its implementation and guidance towards eHealth solutions in Botswana is what is lagging behind. Compliance with the Botswana Data Protection Act (“the DPA”) could improve the necessary safeguards towards the right to privacy of individuals and the collection and transfer of their personal data from eHealth systems in Botswana and across borders. Consequently, compliance monitoring and accreditation of eHealth systems should be regularly conducted.
The BeSafe app is an example of an eHealth solution that has helped the country in the fight against the pandemic but unfortunately, not many other significant solutions have been developed. What do you think needs to be done to accelerate and increase innovation in eHealth?
Is BeSafe an eHealth solution? Perhaps it isn’t! In terms of not having many other similar solutions after BeSafe, I think that could be addressed by intensifying capacity-building efforts on eHealth solution development or adaptation to our context. There is no need to reinvent the wheel. Tonnes of eHealth solutions already exist and are already endorsed by WHO as interoperable and proven to work elsewhere - these are termed digital health global goods - solutions adaptable to different countries and contexts. Global goods offer inexpensive access to proven solutions, adhering to privacy laws, standards and best practices. No specific global goods are most relevant to Botswana as each could be adapted to suit a specific implementation scenario. Strengthening capacity towards customization and adaption of these tools to our context could contribute to increased innovation in eHealth. We have seen recently, the DHIS2 platform (one of the global goods), being advocated for and adapted by the Ministry of Health and Wellness to support aggregate data reporting of key health indicators.
Please share with our readers any exciting projects in eHealth that you are currently involved in
Currently, i am working on the VisualDx platform, a well-received medical clinical decision support system (MCDSS) amongst healthcare workers in Botswana. The solution has the potential to upskill and empower clinicians to do more at the point of care. Through the widespread use of VisualDx globally, it could be reasonably hypothesized that benefits such as improved patient outcomes, reduced stress on the medical system through reduced need for referrals, and improved continuing medical education could be realized. The ability to access information quickly and without requiring a network connection is crucial to the success of MCDSS tools in remote clinics and other facilities with limited resources. Select enhancements to the app may further increase the feasibility of VisualDx in the Botswana context. Knowledge gained from the pilot in Botswana will inform the next steps for a broader rollout or further research related to VisualDx as an MCDSS tool in Botswana and similar developing countries.
A promising upcoming project involves the use of Machine Learning algorithms to predict the probability of mortality and recovery for COVID-19 patients in Botswana. The project is motivated by the recent advances and applications of machine learning and AI in evaluating and monitoring the impact of the COVID-19 pandemic.
Lastly, please share your contacts with our readers who might be interested in learning more about your work in eHealth
Email: ndlovuk@ub.ac.bw or kaygndlovu@gmail.com