Digital Services for Tele-Health Solutions
Digital Services for Tele-Health Solutions
Business Model Description
Invest in client-based tele-health services and mobile applications that offer remote clinical services, including online consultations, self-assessment tools, access to test results, 24-hour emergency response and online solutions for storing patient and healthcare provider data.
Expected Impact
Improve access to quality health care services especially for underserved patients and rural populations.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Eswatini: Hhohho
- Eswatini: Manzini
- Eswatini: Shiselweni
Sector Classification
Health Care
Development need
Eswatini has the highest HIV prevalence in the world, affecting 27% of its reproductive population. High levels of maternal and child mortality and stunting, and non-communicable diseases (NCDs) further burden the sector. (1) Access to doctors is among the lowest in the region (3), with 0.096 physicians per 1,000 people in 2016 (2).
Policy priority
The Government's policy instrument in the sector is the National Health Policy, implemented through the National Health Sector Strategic Plan 2019-2023 (1, 3). The National Development Plan (2019-2022), the Economic Recovery Master Plan and the Post COVID-19 Economic Recovery Plan list health as a key sector for investment (4, 5, 6).
Gender inequalities and marginalization issues
Women are disproportionally affected by the limited health service capacity and lack of access to essential sexual and reproductive health products (7). The country experiences high maternal and neonatal deaths due to the failure to provide high-quality, responsive care to pregnant women and their babies (1).
Investment opportunities introduction
Investments in preventive care, pharmaceutical manufacturing, equipment upgrades, hospital infrastructure, ICT integration and developing human capital for healthcare workers offer promising opportunities in Eswatini.
Key bottlenecks introduction
High involvement of public bodies limiting competitiveness of private operators, high prevalence of HIV limiting availability of human capital, limited water, sanitation and hygiene infrastructure and small population limiting scale potential are key challenges in health care activities.
Health Care Providers
Development need
Hospitals in Eswatini have a limited service profile and quality of delivery is generally low. The sector is also burdened by a shortage of specialists and an outdated skill mix. Delivery of essential services is hampered by lack of functional equipment and stockouts of essential medicines (7). Total government spending on health stands at 10.1%, below the 15% commitment (3).
Policy priority
The 2019 Second Quarter Performance Report of the Ministry of Health lists improving access to essential, affordable and quality health services as one of its policy objectives (8). The National Health Sector Strategic Plan aims to modernize the health system to achieve better quality care (1).
Gender inequalities and marginalization issues
The Covid-19 pandemic decreased women's access to sexual and reproductive health products, such as contraceptives, antenatal and postnatal care due to supply chain disruptions (9). Women are also more vulnerable to infection given they serve as the primary caregivers in most households.
Investment opportunities introduction
As the government is aiming to upgrade and develop existing hospital infrastructure (10), opportunities exist for investments in medical equipment, ICT integration and hospital infrastructure.
Key bottlenecks introduction
Performance of healthcare delivery is hampered by outdated and weak legislation, the health care sector is overcentralized and limited human capital is available.
Health Care Delivery
Pipeline Opportunity
Digital Services for Tele-Health Solutions
Invest in client-based tele-health services and mobile applications that offer remote clinical services, including online consultations, self-assessment tools, access to test results, 24-hour emergency response and online solutions for storing patient and healthcare provider data.
Business Case
Market Size and Environment
< USD 50 million
1,211,894 mobile cellular subscriptions; only 1.66 health care workers per 10,000 people
Total investments into telemedicine start-ups in Africa amounted to USD 40.152 million by the end of Q1 2020 (15). The global tele-health market size is anticipated to reach USD 636.8 billion by 2028, and exhibit a compound annual growth rate of 32.1% during this period (13).
Eswatini's mobile cellular connectivity reached 1,211,894 connections in 2021, presenting potential customers for tele-medicine services (39).
Eswatini's density of doctors, nurses and midwives per 10,000 population stood at only 1.66 in 2019 (43), exemplifying the need for innovative solutions to deliver health care services.
Indicative Return
15% - 20%
AfroCentric Investment Corporation, listed on the Johannesburg Stock Exchange, with an investment portfolio focusing on health care related businesses, including patient care software solutions, with operations in Southern Africa, including Eswatini, recorded a return on investment of 14.68% in April 2022, trailing 12-months (46).
The Clinic Group, a private healthcare provider in Eswatini that has three clinics across the country and offers tele-medicine services, has recorded USD 20.76 million in annual sales (40).
According to the IFC, the average IRR for investments in Africa's health care sector is 9.6% (12).
Investment Timeframe
Short Term (0–5 years)
Small-scale and stand-alone digital health delivery solutions can be delivered in a short time frame, yet many solutions require around 5 years to reach net benefits, as investments in digital health require not just technology but human capacity, governance, standards and usability (14).
Ticket Size
USD 500,000 - USD 1 million
Market Risks & Scale Obstacles
Business - Supply Chain Constraints
Capital - CapEx Intensive
Market - Volatile
Impact Case
Sustainable Development Need
Eswatini's health services do not reach populations in remote areas who heavily rely on community support. Only 46% of household respondents reported ever having been visited by a rural health motivator (RHM) and only 15% by non-RHM community health workers (20, 37, 38).
Eswatini has the highest HIV prevalence in the world standing at 27%. Despite the high rate of HIV testing and counselling (92%), issues like long queues and inconvenient clinic hours deter large-scale testing (18). Unavailability of transport in a period of lockdowns, limited stocks of antiretroviral treatment (ART) and viral load (VL) tests (21) further constrain HIV detection and treatment.
Eswatini suffers from a lack of health workers, with only 0.096 physicians per 1,000 people (2). Quality and performance of health care delivery is also low, where for example 63% of health facilities providing antenatal care do not have workers trained on the service (7).
Gender & Marginalisation
Eswatini's women experience limited health service capacity and lack of access to sexual and reproductive health products, such as contraceptives, antenatal and postnatal care (8). Up to 13% of women aged 15-49 years are not receiving a health check or a post-natal visit within 2 days after delivery (16).
The spread of COVID-19 and strict lockdowns have prevented the holding of in-person HIV prevention sessions for women. Lack of medicines and contraceptives as well as difficulties in accessing ART and testing made women especially vulnerable to unintended pregnancies and gender-based violence (17, 18, 22).
Expected Development Outcome
Digital services for tele-health solutions improve access to remote counselling with medical professionals, provide early diagnostics, offer family planning services, and reduce transportation costs for remote communities (19).
Tele-health solutions allow initiation of confidential HIV testing or treatment, provide information and notify about ART and prophylaxis pickup locations as well as offer psychological support to affected individuals (12).
Digital services for tele-health solutions improve access to medical professionals for Eswatini's general population and can help reduce the shortage of medical personnel especially in rural areas (24).
Gender & Marginalisation
Tele-health solutions support constant availability of medical professional services for mothers and their infants, as well as counselling, remote examinations, and prescriptions along with informing on maternal neonatal child health equipment and supplies (4, 8, 19).
Digital services for tele-health solutions promote access to and uptake of integrated sexual and reproductive health services, including ART, amongst young girls and women, as over half of people living with HIV are females (12, 17).
Primary SDGs addressed
3.8.1 Coverage of essential health services
3.c.1 Health worker density and distribution
General health services’ readiness of 66% (36).
0.096 physicians per 1,000 people in 2016 (2).
N/A
N/A
5.6.1 Proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care
48.9% in 2007 (41).
N/A
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Corporates
Public sector
Indirectly impacted stakeholders
Planet
Corporates
Public sector
Outcome Risks
The improper content and low quality design of applications for tele-health services may disrupt family planning programmes, leading to unintended pregnancies and increase in home deliveries (23).
Tele-health services are vulnerable to digital security risks. If tele-medicine delivery is improperly established and delivery, it poses a confidentiality risk, which is critical for people living with HIV and AIDS (25).
Impact Risks
Poor internet connectivity and low digital literacy of the rural population may prevent targeted stakeholders from receiving the required health care access, which may limit the expected impact (26).
The infrastructure required for tele-health solutions requires continuous attention and maintenance, and is exposed to natural hazards, which may limit the expected impact over time (27).
Impact Classification
What
Digital services for tele-health solutions improve access to quality service provision especially for underserved patients and rural populations.
Risk
While the model of digital services for tele-health solutions is proven, accessibility for target stakeholders and infrastructure maintenance requires consideration.
Impact Thesis
Improve access to quality health care services especially for underserved patients and rural populations.
Enabling Environment
Policy Environment
National Health Policy, 2006: Sets a goal to venture into tele-medicine to ensure efficiency in disease diagnosis and outlines the structural and legislative organs to be responsible for implementing tele-health solutions (30).
National Health Sector Strategic Plan, 2019-2023: Includes the objective to improve and roll-out tele-medicine as part of the government priority of infrastructure, investment and innovation (43).
National Development Plan, 2019/20-2021/2: Indicates investment in IT infrastructure as an important area of intervention. The equipment for detection, forecasting, monitoring and dissemination of information are strategic goals, including for health care purposes (4).
Financial Environment
Fiscal incentives: Companies located at Special Economic Zones (SEZ) receive 20 years of corporate tax exemption, followed by a charge at a rate of 5%. Special R&D and training deductions that do not exceed 5% of taxpayer’s taxable income for expenditure incurred in scientific research apply (33, 34).
Other incentives: The Health System Strengthening for Human Capital Development programme with a USD 20 million commitment from World Bank seeks to increase the coverage and quality of health services in Eswatini through various interventions, including digital support tools (1).
Regulatory Environment
Public Health Bill, 2012: Seeks to promote, protect and enhance good health of the public, entails measures for preventing and treating diseases, defines duties and responsibilities of health personnel and establishes a Health Service Commission (31).
Nurse and Midwives Act No.16, 1965: Establishes the Swaziland Nursing Council, which regulates nursing practices and education in the country, and monitors registry of nurses and nursing education (45).
Swaziland Communications Commission (Consumer Protection) Regulations, 2016: Deals with issues of privacy and provides that a supplier must respect consumers' privacy in collecting and handling consumers' personal data (28).
Electronic Communications (Quality of Services) Regulations, 2016: Establishes norms and quality parameters for electronic communications services, provisions assessment of the quality of services, and defines obligations of service providers (29).
Marketplace Participants
Private Sector
The Clinic Group, Together Realizing Ubuntu Eswatini (TRUE), Africa Health Holdings, Quro Medical, Life Healthcare, Kena Health, WebRock Ventures.
Government
Ministry of Health, Ministry of Information, Communications and Technology, Health Service Commission, Swaziland Nursing Council, Swaziland National Nutrition Council, Medical and Dental Council Eswatini.
Multilaterals
World Health Organisation (WHO), World Food Programme (WFP), European Union (EU), World Bank (WB), UNICEF, European Bank for Reconstruction and Development (EBRD).
Non-Profit
Government of Japan, Government of Taiwan, Eswatini Pharmacy Association, Family Life Association, Swaziland Infant Nutrition Action Network (SINAN)(Nutrition), The AIDS Information and Support Centre (TASC), Clinton Health Access Initiative (CHAI).
Target Locations
Eswatini: Hhohho
Eswatini: Manzini
Eswatini: Shiselweni
References
- (1) World Bank Group. May, 2020. Health System Strengthening for Human Capital Development in Eswatini Project. https://documents1.worldbank.org/curated/en/841851589033182678/pdf/Project-Information-Document-Health-System-Strengthening-for-Human-Capital-Development-in-Eswatini-P168564.pdf
- (2) World Bank Group. 2016. Physicians (per 1,000 people) - Eswatini. https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=SZ
- (3) UNICEF. Health Budget Brief 2018/2019. https://www.unicef.org/esa/media/2481/file/UNICEF-Eswatini-2018-Health-Budget-Brief.pdf
- (4) Ministry of Economic Planning & Development. National Development Plan 2019/20 – 2021/2. http://www.gov.sz/images/CabinetMinisters/NDP-2019-20-to-2021-22-final.pdf
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