Recommendations for Developing a Telemedicine Strategy for Botswana: A Meta-Synthesis
Abstract
:1. Introduction
eHSDF Summary
2. Method
2.1. Overview
2.2. Data Collection and Sampling
- Perceptions of healthcare workers and patients. Although research and pilot projects have been reported in Botswana, for example, by Ndlovu et al. [22], Chavez et al. [23], and Littman-Quinn et al. [24], little was known about perceived telemedicine knowledge, practices, and needs of healthcare workers and patients. A recent survey and key informant-based research provided that insight [13,14]. Surveys of healthcare workers (HCW) and patients in three regions of Botswana had identified their perspectives on priority HRI [14].
- Published telemedicine research from Botswana. Following the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, studies were identified from searches of four electronic databases (PubMed, Scopus, Web of Science, and Academic Search Complete), searched from 1 January 1990 to 31 December 2022 in April 2023 [25]. The search string was deliberately broad and used specific terms (Botswana, telemedicine, telehealth, ehealth, e-health, mobile health, mhealth, m-health, digital health) linked with the Boolean operators AND or OR. The PubMed search string was (“Botswana” [All Fields] AND (“telemedicine” [All Fields] OR “telehealth” [All Fields] OR “ehealth” [All Fields] OR “e-health” [All Fields] OR “mobile health” [All Fields] OR “mhealth” [All Fields] OR “m-health” [All Fields] OR (“digital” [All Fields] AND “health” [All Fields]))). Inclusion criteria were: addressed eHealth or telemedicine use in Botswana; English language. Titles and abstracts of identified resources were independently reviewed by all three authors for relevance and appropriateness as defined by the inclusion criteria. The full papers of those that met the inclusion criteria were obtained and independently reviewed by all authors to identify the HRI addressed and assess if of national concern (i.e., impacting many Batswana).
- Government reports, policy, and strategy documents. Desktop searching of Government of Botswana websites and broader searching used Google and Google Scholar was completed during April 2023. Botswanan specific eHealth and telemedicine-related material were identified and downloaded for review (e.g., government health reports; WHO reports).
- Reports from global entities. Using the authors’ prior knowledge, websites of the WHO and the Institute for Health Metrics and Evaluation were searched for Botswana-relevant documents. Each identified report was downloaded and reviewed.
- Sustainable Development Goals. These were adopted by all United Nations Member States in 2015 and are acknowledged global targets. They are intended to combat many of the most urgent issues facing mankind, and are recognised targets embedded within many of the goals of the Botswana government.
2.3. Data Analysis
2.4. Ethics
3. Findings
3.1. Sources of Health Related Issues
- Scientifically-based reports from global entities. Two reports were retrieved and reviewed [26,27]. These were the country profile for Botswana from the Institute for Health Metrics and Evaluation Global Burden of Disease Study for 2021 [26], and the WHO Country Cooperation Strategy—Botswana [27]. From the former, the top 10 causes of mortality, morbidity, and risk factors were identified. Issues for mortality and morbidity were the same (although the order changed), while some of the risk factors could be aligned with some of the mortality and morbidity issues.
- Perceptions of healthcare workers and patients. The list of 14 HRI identified in a previous study [13] was applied to the current study, with the exception of the need for a Laboratory Management Information System which is already addressed in the National eHealth Strategy.
- Government reports, policy, or strategy documents. The current versions of seven health-related documents were retrieved and reviewed: Botswana Domesticated SDG Indicators (2018) [28]; National Health Policy 2011 [29]; World Health Organization—Non-communicable Diseases (NCD) Country Profiles, 2018 [30]; Integrated Health Service Plan (IHSP)—A Strategy for Changing the Health Sector for Healthy Botswana 2010–2020 [31]; Vision 2036—Botswana [32]; National Development Plan (NDP) 11—2017–2023 [33]; National Strategic Framework on HIV and AIDS (NSF III) [34]. Each was independently and collectively reviewed for national HRI.
- Botswana telemedicine literature. After removal of duplicates and application of the inclusion criteria, 71 resources were identified. Each was independently and collectively reviewed. Of these resources, 24 provided clear evidence to indicate the issue(s) they addressed was of national significance [22,23,24,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55].
- Sustainable development goals (SDGs). The original listing of SDGs [56], as well as the previously identified Botswana Domesticated SDG Indicators (2018) document [28] were used. Attention was given to directly health-related SDGs (Goal 3—Good Health and well-being) and to indirectly health-related SDGs including all Goal 6 targets (which related to WaSH programmes; Water, Sanitation, and Hygiene), and 5.2 (which related to interpersonal violence).
3.2. Recommended Telemedicine Solutions
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Lists of Abbreviations
HCW: | Healthcare Workers |
HRI: | Health-Related Issues |
ICT: | Information and Communications Technologies |
eHSDF: | eHealth Strategy Development Framework |
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Global Buden of Disease a | HCW/Patient Opinion b | Government of Botswana Documents c | Botswana Telemedicine Literature d | SDG Target e | # Sources | |
---|---|---|---|---|---|---|
Morbidity | Risk Factors | |||||
HIV/AIDS | Unsafe sex | - | √ | HIV/AIDS (delayed CD4 results) | 3.3, 3.7 | 5 |
Tuberculosis | Tobacco | - | √ | TB | 3.3, 3.9, 3a | 5 |
Ischemic heart disease (infarction) | High blood pressure; Tobacco; High BMI | - | √ | Lack of blood pressure screening | 3.4, 3.9, 3a | 5 |
Stroke | High blood pressure; Tobacco; High BMI | - | √ | Lack of blood pressure screening | 3.4, 3a | 5 |
Diabetes | High fasting plasma glucose; High BMI; Dietary risks | - | √ | Diabetic retinopathy detection | 3.4 | 5 |
Diarrhoeal diseases | WaSH; Malnutrition; Dietary risks | - | √ | Monitoring water quality | 3.9, 6 | 5 |
HRI | Clinical Service | Education | Behaviour Change |
---|---|---|---|
HIV/AIDS | IM-based teledermatology, teleradiology, and telepulmonology; e-prescription | IM-based messages (awareness/education) | IM-based messages (medication/appointment reminders; sexual practice) |
Tuberculosis | IM-based teleradiology, telepulmonology, and treatment/management; e-prescription | IM/e-mail-based messages (Patient: disease awareness/education) (HCW: in-service skill development/training) | IM-based messages (Patient: TB-DOTS medication reminders/reducing spread) |
Ischemic heart disease | IM-based ECG interpretation | IM/e-mail-based messages (disease awareness/education) | IM-based messages (Patient: diet, blood pressure control, exercise) |
Stroke | IM/e-mail-based teleconsultation (treatment/management) | IM/e-mail-based messages (Patient: healthy lifestyle, blood pressure control, diabetes control, diet) | IM-based messages (Patient: healthy lifestyle, blood pressure control, diabetes control, diet) |
Diabetes | IM/e-mail-based treatment/management; e-prescriptions | IM/e-mail-based educational material (disease awareness/education) | IM-based messages (medication/appointment reminders) |
Diarrhoeal diseases | IM/e-mail-based on-call teleconsultation/referral | IM-based educational material (WaSH awareness/education) | IM-based messages (WaSH awareness) |
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Ncube, B.; Mars, M.; Scott, R.E. Recommendations for Developing a Telemedicine Strategy for Botswana: A Meta-Synthesis. Int. J. Environ. Res. Public Health 2023, 20, 6718. https://doi.org/10.3390/ijerph20186718
Ncube B, Mars M, Scott RE. Recommendations for Developing a Telemedicine Strategy for Botswana: A Meta-Synthesis. International Journal of Environmental Research and Public Health. 2023; 20(18):6718. https://doi.org/10.3390/ijerph20186718
Chicago/Turabian StyleNcube, Benson, Maurice Mars, and Richard E. Scott. 2023. "Recommendations for Developing a Telemedicine Strategy for Botswana: A Meta-Synthesis" International Journal of Environmental Research and Public Health 20, no. 18: 6718. https://doi.org/10.3390/ijerph20186718