In 2009, the National Health Council (NHC) of South Africa resolved to halt acquisition of software solutions until an eHealth strategy was finalised.
The resulting strategy document of this vital move lists “building on what already exists in both the public and private sectors” and “look for early wins in implementations” as some of its set of adopted principles.
This eHealth strategy is partly an answer to a resolution by the World Health Assembly made in May 2005 to have member states draw up long-term eHealth strategic plans. This resolution too urges member states to encourage public and private partnerships. 194 member states were affected by this including most African countries.
The strategies from each member state are bound to have timeline uniqueness but the end-goal highly similar. Differing degrees of success will result from the implementation machinery they’re put through. In the case of South Africa, I'm confident that we can achieve what's on paper with some minor tweaks to the existing procurement model.
The South African government acquires products and services through a tendering process which is well known for fraud and corruption, albeit implemented within complex regulation.
Besides corruption, the tendering process is not optimized for governments to work with the right calibre of service/product providers.
The process includes an element of redressing inequalities that came with the past regime by giving preference to certain businesses. This, however, isn’t adequate reason for the below-par products and services government receives. Without doing away with the redress programme, the process can be improved to ensure good quality suppliers and delivery.
One problem experienced implementing the eHealth strategy is “Lack of interoperability and fragmentation”. This points to issues of standardization and partnerships, and the control thereof.
Who Is Currently Involved?
iAfrikan studied the tender awarding data made available on the Department of Health (DoH) provincial websites. Unfortunately, there were not enough listings of tenders that were related to the acquisition of software solutions. We however, discovered a pattern from other ICT related tenders and those also in line with the eHealth strategy.
Tenders were mostly awarded to big consulting organizations or small businesses that were willing to take on any job that government puts on the table.
The level of passion to deliver or passion for the subject matter is questionable in both cases.
Information on most of the DoH provincial websites was outdated or useless for our study. The overall design of the websites or the presentation of the information was highly concerning. This led to questioning the type of service providers used for the design and/or maintenance of these websites. We’ve parked that for future studies. I've however included a summary of our findings on these sites in the table below.
|Limpopo||Little to no information about previous or awarded tenders.|
|Mpumalanga||Shambles. A High-school HTML project could have produced a better product.|
|North West||No information on tenders awarded before 2014 and the information presented doesn’t reflect the amount of activity in that province. The website was down for more than a week during our study.|
|Northern Cape||No domain found. Some general information about the department can be found on a number of piggyback pages like www.provincialgovernment.org. What is meant to be the official provincial website was down throughout this study.|
|Gauteng Province, Eastern Cape and Western Cape||Organised and up to date pages. Eastern Cape was a surprising guest. Data from these provinces was used extensively.|
|KwaZulu Natal||No info about awarded tenders.|
|Free State||Badly organised list of tenders with including who the tender was awarded to. No description of tenders in the list and therefore we had to go through each link. Each link directs you to a Microsoft Word/Excel document. Painful exercise.|
Existing eHealth Tech Startups
One doesn’t need an extensive online search to find the plethora of startups in the eHealth industry.
I met up with a co-founder of an electronic health records (EHR) startup, CenHealth, earlier in 2015, Puseletso Mompei, who is also in charge of new business development at CenHealth, co-founded it after having personally experienced the pain points that the startup aims to address.
Her best friend had a complicated pregnancy. When her doctor moved to Turkey he left with her medical records. Her friend had to find another doctor without her medical history. As if that wasn’t enough to get her going, Puseletso says
“My mom had a hip-replacement which didn’t go well. On wanting to switch doctors, she found that the previous 18 months of medical history was unavailable for her.”
I believe there’s a different level of passion between someone who builds this EHR platform from concept or problem definition phase, and someone who responds to a government call to address the issue.
This is partly why someone would put a lot of work into a free service from the early stages. Puseletso said
“monetization will come in Phase 2. Right now we have a freemium model with basic features to build a profile up to at least 2GB storage space.”
Government Shouldn't Disturb Tech Startups
There is a need to re-use and standardize some of the work done by startups. More so, governments can extract value from lessons learnt by these startups.
This article doesn’t insist on governments acquiring products from startups but propounds that a certain level of consulting could be of value to both parties.
There is a growing argument that governments should stay out of the startup ecosystem. It suggests that governments, especially those of developing countries, only serve as a distraction and compromise the quality of products that come out of its ecosystems.
An iAfrikan article, by Arthur Mwai, suggests that African startups need to be pragmatic and make money as soon as possible. It can be argued that early focus on profits can compromise the quality of tech startup products, just as we suggest for governments' involvement.
Most African startups are affected by this cash-flow problem, so much that they often deviate completely from their initial ideas. I’m not referring to the customer informed startup pivot. This is more the "tools down; let's go sell bananas" pivot. This move rarely results in the founders returning to their initial dream.
Governments could help lessen this cash-flow pain without startups having to give up equity. With more knowledge of their startup ecosystems, governments could invite consultative services/guidance from startups to ensure quality and re-use lessons learnt throughout the tendering process.
These short-term projects, whose scope or subject matter is similar to what the startup would be already working on, could result in less complete failures of tech startups as a result of chasing early-years cash-flow. A more plugged-in government to its startup ecosystem could benefit us all.
Parliament Building, Cape Town | Robert Cutts