Dudzai Mureyi
An unsystematic study of Zimbabwean funerals has revealed to me that the most senior female bereaved member of the family present at the wake at any given time, does not wail and keen and become downright obstreperous with the others. Rather, she is generally seized with the business of consoling others, presenting an image of fortitude and making administrative and logistical plans…until a more senior family member arrives. Then you start to hear things like, ‘You are here, now I can weep,’ coming out of her mouth. While I’m loath to equate Zimbabwe’s health system to a funeral, the situation is well known to be quite dire and, since the 2nd of August, we have a President with a fresh mandate from the people. He has ‘arrived’ at the wake and the rest of us can start to collapse at his knees, with our petitions.
Last week I promised to write for the whole month of August, about E-health, the use of digital technology tools for health-related processes- this includes everything from basic mobile feature phones to sophisticated artificial intelligence-powered systems. I said I’d write about how digital technology interventions can be instrumental in healthcare delivery and improve health outcomes while being financially lucrative private business too. I’m a woman of my word. Today’s is the first instalment in that series and I would like to begin from a what can be mistaken to be a grim perspective. I write about the challenges that lie in wait to ambush private sector E-health businesses in our backyard. I do this not because I’m a pessimist – in fact, my optimism stands and teeters dangerously close to the boundary with naivety. I start this way, presenting the six reasons why e-health endeavours may fail in Zimbabwe, in order to alert all interested parties to the [avoidable] pitfalls and [mitigatable] challenges – to show that a cause exists, for private sector and health-tech start-up champions, to lobby the new president and his incoming team of lieutenants for conditions that can unlock possibilities for the relatively nascent local business opportunity that is E-health. So, here goes:
- Capitalising the business
Ideas come a dime a dozen. It is usually hindered access to capital that erects entry barriers to any trade, e-health included. In Zimbabwe, the cost of developing a mobile health app that runs on Android and iOS smartphones, depending of course on functionality, can set one back close to twenty thousand dollars. The recent telemedicine pilot project commissioned by the government in Manicaland recently, is reported to have cost 300 000 dollars.
- Data must fall
In the United Kingdom, for as little as $38 per month, one can get from a mobile service provider, unlimited data (including 30 Gigabytes for tethering other devices), unlimited voice calls, unlimited texts and discounts at partner restaurants, cinemas, travel agents etc. Free wi-fi in public spaces like parks, buses and trains, makes the internet access ubiquitous and by extension, internet-based businesses, accessible. Zimbabwe telecommunication service tariffs and data costs were recently slashed the cost of out-of-bundle browsing by approximately 60% after having the third most expensive mobile data tariffs in Africa for years. But $38 still gets one a meagre 38 gigabytes in mobile data daily bundles in this part of the world. The price of transacting on the internet and telecommunication platforms is an obvious determinant of participation both for customers and entrepreneurs.
- Legal matters
E-health has proven to be a disruptive voice to the way we’ve always done healthcare delivery. Its advent presents a challenge for regulatory institutions even in highly advanced countries. Laws and regulatory frameworks that players in Zimbabwe’s health sector have to abide by, were penned before digital technology and the impact it has on daily life was envisioned and reforming them can take years of engaging with bureaucratic processes. These laws are quite broad and even include provisions about who’s qualified to be a majority shareholder of a healthcare institution. Some of the regulations that govern the way healthcare practice is conducted in Zimbabwe were gazetted as far back as 1989 and haven’t seen an amendment since. Several things that E-health private business could find profitable and indeed beneficial to engage in, are, going by these archaic laws, illegal.
- The stuff of staff
Having secured capital and a sustainable business model supported by a market able to access and pay for services, some E-health private sector players are impeded by the quality of their hires. Employees who know what they’re doing both in terms of delivering healthcare and understanding the esoteric nitty gritty aspects of digital tech can prove to be hard to pin down. Depending on the complexity of the technology that is at the heart of the business, a steep learning curve must be endured by employees – who will need to be retained after the investment in their training has been made. The reliability of tech vendors to deliver timely and provide constant IT support is also a big factor to consider.
- Power is power
Uptime-the amount of time the system is up and running is an important profitability-determinant for an e-health business. Every minute the system stays down is not only money lost, but a dent in the business’ reputation as far as customers are concerned. The erratic and in some cases limited, nature of electricity supply in Zimbabwe, like the cost of data, limits the number of customers for ehealth businesses and threatens the viability of small health-tech businesses because it powers the devices necessary for operations.
- Business Models
The unconventional nature of conducting healthcare business in a virtual space demands more creativity in working out how money will be made. Issues of how revenue can be collected in a virtual space and how operations can be conducted while complying with draconian regulatory provisions that are consistent with the Zimbabwean healthcare sector must exercise the minds of those who venture into this field. E-health products that serve the country’s middle-class demographic, or those that can be subsidised by government or charities to serve those with a less ability to pay for them, are key. I promise that the picture is not as grim as it sounds in this article. As with any business enterprise, spoils lie ready for the taking, for those that apply their minds towards developing ways to circumvent the challenges for E-health business profitability that I’ve just outlined.
Dudzai Mureyi is a pharmacist skilled in health policy analysis, currently pursuing doctoral studies in Global Health. Find her on Twitter: @BonnieDudzai or email her at: dudzai8787@gmail.com.
