E-healthcare solutions
E-healthcare solutions
Business Model Description
Upscale provision of e-health services, such as online consultations, telemedicine and self-diagnosis services, together with a system for gathering and sharing patients' medical data with healthcare personnel.
Expected Impact
Provide access to high quality healthcare especially for communities living in remote areas.
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
- Uganda: Central
- Uganda: Karamoja
- Uganda: West Nile
- Uganda: East Central
Sector Classification
Health Care
Development need
Uganda has a major challenge with SDG 3 - Good Health and Wellbeing, particularly indicators such as high maternal and neonatal mortality rate.(I) The index for inequality-adjusted life expectancy within the Human Development Index (HDI) framework is only 0.481, positioning Uganda as 160th in the HDI country ranking.(II)
Policy priority
Through the National Development Plan, government has increased spending on social sectors namely healthcare and education. However more investment will be required to provide basic but high-quality social services, especially in healthcare. Uganda plans to devote USD 7 million for human capital development which includes healthcare.(IV)
Key bottlenecks introduction
Uganda has achieved 75% geographical coverage of the population living within a 5 km access of any facility providing health services for communicable diseases. However, the functional coverage is much lower in reality. This is caused by insufficient coverage of comprehensive services, especially specialty and diagnostic services.(IV)
Health Care Distributors
Pipeline Opportunity
E-healthcare solutions
Upscale provision of e-health services, such as online consultations, telemedicine and self-diagnosis services, together with a system for gathering and sharing patients' medical data with healthcare personnel.
Business Case
Market Size and Environment
35 million Ugandans live in rural areas distant from hospitals.
In Uganda, 75% of the population lives within 5 km of a primary health facility (IV). However, the majority of the population (around 35 million people) live in rural areas, which are distant from hospitals and professional healthcare specialists.(16)
In Uganda, a survey of health sector professionals revealed 70% of them were aware of telemedicine and 41% of them had used it in the past.(46)
Survey respondents who were aware of telemedicine concluded Uganda has the capacity and is ready to adopt telemedicine at public health facilities.(47)
Indicative Return
20% - 25%
Benchmark statistics for the e-healthcare sector estimate a return rate of 21% to 25%. This rate is a benchmark calculated as a cost of equity with a country risk premium, reflecting an average return required by investors.(40)
Based on a case study from Kenya, implementing a telemedicine solution saved up to USD 500,000, compared with health workforce travel costs incurred by a private medical company.(41)
The available cases indicate hospitals introducing telemedicine can increase profit by USD 1-3 million by investing around USD 100,000.(42)
Investment Timeframe
Short Term (0–5 years)
On average it takes 5 years to achieve a return on telemedicine investments, but small standalone solutions require even lower timeframes to achieve returns.(43)
However, a large-scale digital healthcare project is expected to have a medium-term payback period of 9 years.(43)
Market Risks & Scale Obstacles
Business - Business Model Unproven
Market - Highly Regulated
Market - Volatile
Impact Case
Sustainable Development Need
Universal health coverage (UHC) index of service coverage of only 45.0 is a major challenge (0 being the worst and 100 being the best).(4) The subjective wellbeing of Ugandans ranked only 4.3 on a 1 - 10 scale (1 being the worst and 10 being the best).(5)
Hospitals admissions indicator is low and fell from 7.3 per 100 population in 2018/19 to 7.2 per 100 in 2019/20.(6) Another challenge is also the number of physicians, with coverage of 0.168 per 1,000 population in 2017, compared with the 1 per 1,000 minimum recommended by WHO.(44)
In rural Uganda, it is common to be referred more than three times to different health centers and hospitals. The system results in delays in receiving consultations and treatment.(7)
Gender & Marginalisation
Mortality rate under 5 years of age is still a significant challenge (46.4 per 1,000 live births). Tuberculosis and Human Immune Virus (HIV) infections also remain major challenges in Uganda. Telemedicine could be applied for diagnostics, therapeutic services, preventive care provision and education.(8),(9)
Expected Development Outcome
Improved healthcare delivery, improved access to healthcare for communities living in remote areas, improved level of diagnosis for diseases and access to medication
Improved quality of human capital, and increased access to preventive medicine and healthcare services, positively impacting the number of visits and need for secondary and tertiary healthcare services.
Decreased number of non-emergency consultations in secondary and tertiary healthcare facilities due to online consultations, impacting positively the time and cost for healthcare facilities, workers and patients.
Gender & Marginalisation
Preventative medicine options to reduce household impact of disease, especially benefitting women.
Primary SDGs addressed
3.1.1 Maternal mortality ratio
3.7.1 Proportion of women of reproductive age (aged 15–49 years) who have their need for family planning satisfied with modern methods
3.c.1 Health worker density and distribution
1.a.2 Proportion of total government spending on essential services (education, health and social protection)
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
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Corporates
Public sector
Indirectly impacted stakeholders
Corporates
Outcome Risks
Possible systems fragmentation, poor communication and poor interoperability (19)
Security, privacy and confidentiality issues may arise (risk of data security and privacy breaches) (20),(21)
Impact Risks
Possibility of digital and cost barriers hindering most affected communities and individuals from accessing services
Impact Classification
What
Positive impact on society by addressing problem of limited access to healthcare services in distant, rural areas
Who
Communities inhabiting remote areas that are aggrieved due to poor access to hospitals and medical care, high costs of reaching hospitals and increased mortality rate
Risk
High connectivity costs and insufficient interoperability of the e-healthcare systems. If privacy and confidentiality are not assured, the level of trust in the solutions may decrease.
Impact Thesis
Provide access to high quality healthcare especially for communities living in remote areas.
Enabling Environment
Policy Environment
Health Sector Development Plan 2015/16 - 2019/20: This plan identifies e-health innovations projects (with Health Information Systems and Research being a strategic orientation) as a core for the sector development and achievement of the policy targets. The plan focuses on building a harmonized and coordinated national health information system covering a routine health management information system (HMIS): surveillance, vital statistics, research, surveys and innovative e-health solutions. It aims at applying innovative e-health technologies in all aspects of the health information system.(11)
National e-Health Policy 2016: This policy recognizes and describes the potential of information and communications technology (ICT) in healthcare delivery transformation. It enables information access and supports healthcare operations, management and decision making.(12)
National ICT Policy 2014: This policy aims to promote information and communications technology (ICT) for development by introducing mechanisms to implement ICT applications and embracing e-government, e-commerce, e-learning, e-health, e-employment, e-environment, and e-agriculture.(13)
ICT Sector Strategic and Investment Plan 2015/16 - 2019/20: This plan aims to enhance integration and automation of e-government services in prioritised sectors (including e-health).(14)
National ICT Initiatives Support Program 2017: This program facilitates the creation of a digital ecosystem and marketplace for exposing innovative digital products through interventions.(15)
Financial Environment
Fiscal incentives: Compliant taxpayers receive a 6% Withholding Tax (WHT) exemption for the period of 6 months renewable.(38) All taxpayers receive a 100% deduction for training expenditure.(38) Eligible businesses can carry forward losses; the loss is deducted from income tax in the following financial year.(38)
Other incentives: The Ministry of Health expresses willingness to enter public-private partnerships with investors to contract out services.(36) The Uganda Investment Authority aims to facilitate investment by granting licenses to foreign investors, as well as promoting, enabling, and supervising investments.(37)
Regulatory Environment
NITA-U Act 2009: This Act establishes the National Information Technology Authority, and describes its functions and powers. These powers include its mandate to provide first level technical support and advice for critical government information technology systems.(27)
Computer Misuse Act 2011: This Act assures the safety and security of electronic transactions and information systems to prevent unlawful access, abuse or misuse of information systems.(28)
Registration of Persons Act 2015: This Act harmonizes and consolidates the law on registration of persons, and establishes a National Identification Register as well as the National Registration and Identification Authority.(30)
The Ministry of Health is responsible for policy development and health sector activities supervision. It sets standards and assures quality, health equity and fairness in contribution towards the cost of healthcare.(33)
The Ministry of ICT and National Guidance is responsible for ICT-related legal and regulatory environment and secure ICT access for the citizens.(34)
Marketplace Participants
Private Sector
Medical Concierge Group (TMCG), Kaaro Health, Teheca Ltd, ClinicMaster International
Government
Ministry of Health, Ministry of Information and Communications Technology, National Council of Science and Technology (NCST), National Information Technology Authority - Uganda (NITA-U)
Multilaterals
International Monetary Fund (IMF), European Union (EU), European Investment Bank (EIB), African Development Bank (AfDB), World Health Organization (WHO), World Economic Forum (WEF)
Non-Profit
KfW, Agence Française de Développement (AFD), United States Agency for International Development (USAID), German Corporation for International Cooperation (GIZ)
Target Locations
Uganda: Central
Uganda: Karamoja
Uganda: West Nile
Uganda: East Central
References
- (I) Sachs, J., Schmidt-Traub, G., Kroll, C., Lafortune, G., Fuller, G., Woelm, F. (2020). The Sustainable Development Goals and COVID-19. Sustainable Development Report 2020. Cambridge: Cambridge University Press. (II) United Nations Development Programme. Briefing note for countries on the 2019 Statistical Update: Uganda. (III) Government of Uganda (2016). Review Report Of Uganda’s Readiness For Implementation Of The 2030 Agenda. (IV) National Planning Authority. National Development Plan III (NDPIII) 2020/21 – 2024/25.
- (1) Uganda Bureau of Statistics (2020). Statistical Abstract 2020. https://www.ubos.org/wp-content/uploads/publications/11_2020STATISTICAL__ABSTRACT_2020.pdf
- (2) Worldometer (2020). Uganda Population (2020). https://www.worldometers.info/world-population/uganda-population/#:~:text=Uganda%202020%20population%20is%20estimated,of%20the%20total%20world%20population
- (3), (7) Pulitzer Center (2020). Uganda: Looking At An Under-Resourced Healthcare System. https://pulitzercenter.org/projects/uganda-looking-under-resourced-healthcare-system
- (4), (5), (8) Sachs, J., Schmidt-Traub, G., Kroll, C., Lafortune, G., Fuller, G., Woelm, F. (2020). The Sustainable Development Goals and COVID-19. Sustainable Development Report 2020. Cambridge: Cambridge University Press. https://s3.amazonaws.com/sustainabledevelopment.report/2020/2020_sustainable_development_report.pdf
- (6) Ministry of Health (2020). Annual Health Sector Performance Report. FY 2019/20. Republic of Uganda. https://www.health.go.ug/cause/annual-health-sector-performance-report-financial-year-2019-20/
- (9) Rangasamy, M. (2011).' Role Of Telemedicine In Health Care System: A Review', International Journal of Recent Advances in Pharmaceutical Research. https://www.researchgate.net/publication/267917413_Role_of_Telemedicine_in_Health_Care_System_A_Review
- (10) Uganda Bureau of Statistics (2020). Statistical Abstract 2020. https://www.ubos.org/wp-content/uploads/publications/11_2020STATISTICAL__ABSTRACT_2020.pdf
- (11) Ministry of Health (2015). Health Sector Development Plan 2015/16 - 2019/20. Republic of Uganda. https://health.go.ug/sites/default/files/Health%20Sector%20Development%20Plan%202015-16_2019-20.pdf
- (12), (16), (17) Ministry of Health (2016). Uganda National eHealth Policy. Republic of Uganda. https://health.go.ug/sites/default/files/National%20eHealth%20Policy%202016_1.pdf
- (13) Ministry of ICT and National Guidance (2014). National ICT Policy. https://ict.go.ug/wp-content/uploads/2018/11/ICT_Policy_2014.pdf
- (14) Ministry of Information and Communications Technology (2015). ICT Sector Strategic And Investment Plan 2015/16-2019/20. https://ict.go.ug/wp-content/uploads/2020/02/ICT-Sector-SIP.pdf
- (15) Ministry of Information Communication Technology and National Guidance (2017). National ICT Initiatives Support Program. https://ict.go.ug/wp-content/uploads/2019/06/NIISP-Program.pdf
- (18) DataReportal – Global Digital Insights (2020). Digital 2020: Uganda. https://datareportal.com/reports/digital-2020-uganda
- (19) Piette, J., Moura, L. and Lun, K. (2012). Impacts Of E-Health On The Outcomes Of Care In Low- And Middle-Income Countries: Where Do We Go From Here? World Health Organization. https://www.who.int/bulletin/volumes/90/5/11-099069/en/
- (20) Zriquat, I. and Altamimi, A. (2016). 'Security And Privacy Issues In eHealthcare Systems: Towards Trusted Services', International Journal of Advanced Computer Science and Applications, vol. 7. https://www.researchgate.net/publication/308803282_Security_and_Privacy_Issues_In_eHealthcare_Systems_Towards_Trusted_Services
- (21) Sahama, T. and Simpson, L. (2013). 'Security And Privacy In eHealth: Is It Possible?', Healthcom. https://www.researchgate.net/publication/269329631_Security_and_Privacy_in_eHealth_Is_it_possible
- (22), (23), (24), (25), (26) Ministry of Health (2016). Uganda National e-health Policy. Republic of Uganda. https://health.go.ug/sites/default/files/National%20eHealth%20Policy%202016_1.pdf
- (27) Government of Uganda (2009). NITA-U Act 2009. https://www.unwantedwitness.org/cyberpolicy/wp-content/uploads/2018/02/NITA-U-Act-Act-No.-4-of-2009-1.pdf
- (28) Government of Uganda (2011). Computer Misuse Act 2011. https://www.nita.go.ug/sites/default/files/publications/Computer%20Misuse%20Act%20%202011%20%28Act%20No.%202%20of%202011%29.pdf
- (29) Government of Uganda (2015). NITA-U (National Data Bank Management) Regulations 2015. https://www.nita.go.ug/sites/default/files/newsfiles/DRAFT-%20NATIONAL%20INFORMATION%20TECHNOLOGY%20AUTHORITY%20UGANDA%20%28NATIONAL%20DATA%20BANK%20MANAGEMENT%29%20REGULATIONS%2C%202015.pdf
- (30) Government of Uganda (2015). Registration Of Persons Act 2015. http://www.mia.go.ug/sites/default/files/download/The%20Registration%20of%20Persons%2C%20%20Act-2015.pdf
- (31) Government of Uganda (2011). Electronic Signatures Act 2011. https://www.nita.go.ug/sites/default/files/publications/Electronic%20Signatures%20Act%202011%20%28Act%20No.%207%20of%202011%29.pdf
- (32) Government of Uganda (2019). Data Protection And Privacy Act 2019. https://www.nita.go.ug/sites/default/files/publications/Data%20Protection%20and%20Privacy%20Act%20No.%209%20of%202019.pdf
- (33) Ministry of Health (2020). Departments And Division. https://www.health.go.ug/programs/ministry-departments/departments-and-divisions/
- (34) Ministry of ICT and National Guidance (2020). About Us. https://ict.go.ug/about-us/
- (35)National Information Technology Agency (2020). NITA-U Establishment. https://www.nita.go.ug/nita/nita-u-establishment
- (36) Sandin, C. (2013). Uganda Health Sector and Partnership Opportunities. https://www.swecare.se/Portals/swecare/Documents/Uganda-Health-Sector-and-Partnership-Opportunities-final.pdf
- (37) U.S. Department of State (2020). 2020 Investment Climate Statements: Uganda. https://www.state.gov/reports/2020-investment-climate-statements/uganda/
- (38) Uganda Revenue Authority (2019). A Tax Incentives Guide for Investors in Uganda. https://www.ebiz.go.ug/wp-content/uploads/2020/03/TAX_INCENTIVES_GUIDE_FOR_INVESTORS_IN_UGANDA_October_2019.pdf
- (40) PwC analysis based on Prof. A. Damodaran data, 2020.
- (41) Barbor, M. Building Improved and Sustainable Health-Care Systems Through Telemedicine.
- (42) Marks, J., Augesnstein, J. et al.(2019). A Framework for Evaluating the Return on Investment of Telehealth, Manatt Health Strategies, LLC.
- (43) Drury, P., Roth, S., Jones, T., Stahl, M. and Medeiros, D. (2018). Guidance for Investing in Digital Health. Asian Development Bank.
- (44) World Bank database. https://data.worldbank.org/
- (45) GSMA (2015). Mobile for Development - mHealth country feasibility: Uganda. https://www.gsma.com/mobilefordevelopment/wp-content/uploads/2017/05/mHealth_Uganda_R.pdf
- (46), (47) Kiberu, V., Scott, R. and Mars, M. (2019). Assessing Core, E-Learning, Clinical And Technology Readiness To Integrate Telemedicine At Public Health Facilities In Uganda: A Health Facility – Based Survey. BMC Health Services Research. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4057-6
- (48) Liveri, D. and Sarri, A. (2015). Security And Resilience In eHealth Security Challenges And Risks. ENISA. https://www.enisa.europa.eu/publications/security-and-resilience-in-ehealth-infrastructures-and-services/at_download/fullReport