Peek Vision Botswana - odess.io

Field survey carried out by StartupBRICS for the e-health

Observatory in the Southern countries of the

PEEK VISION

THE APP IN PARTNERSHIP WITH THE

GOVERNMENT FOR AN

INTEGRATED NATIONAL OPHTHALMIC

SERVICE

Charlotte Burrier, StartupBRICS

April 2017, Gaborone, Botswana

The ActuTech and Startup of the Emerging Countries

Gaborone, capital of Botswana, 11 April 2017. Meeting with two key players in the

implementation of the Peek Vision Botswana project, the US national Ryan Littmann-Quinn

and the Botswana national Keitumetse Thamane. The latter will lead StartupBRICS in the

FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017

meeting with Dr Mokgacha, a representative of the Botswana Department of Health and

Welfare's E-Health Department, and Ms Lehasa, the coordinator of the National Ophthalmic

Health Programme, also a key member in the implementation of the Peek Vision Botswana

project. This will be followed by numerous visits to schools in Botswana, around Good Hope,

a rural area where the first phase of the Peek Vision Botswana project was launched between

1 July 2015 and 30 June 2017. Peek Vision Botswana completed this first of four phases of its

project, comprising a screening of 12,877 children and adolescents in 49 schools, sorting

2,065 children and adolescents in 3 sorting camps and 24 schools, to arrive at the issue of

853 pairs of glasses, the prescription of relevant drugs in 94 cases, and directing 63 cases of

children to specialist ophthalmologists. How would Peek Vision Botswana ensure an effective

national eye health programme for all in Botswana? What are the stages up to then? What

were the obstacles to overcome? What are the ambitions of Peek Vision in Botswana?

Discover this promising project at the heart of Botswana e-health.

All conditions met

Peek Vision was created in 2013 by the British national Andrew Bastawrous during a

trip to Kenya. The project he launched includes independent editions in several countries,

including Kenya, India, Namibia and Botswana. Each edition has its own resources, its

local team, its exclusive partnerships - the entire project is not dependent on the initial

entity, so each project is built independently and in accordance with local conditions. The

implementing partner of Peek Vision Botswana is UPenn, University of Pennsylvania (USA).

Charlotte Burrier, representative of StartupBRICS (left) and three

members of Peek Vision Botswana including Keitumetse Thamane

and R Quin Littman


The initial postulate of Peek Vision according to the motto Seeing is believing is seize

mobile technology to improve the health of the target populations. How has this been made

possible in Botswana? The first meeting took place in February 2016. Everything was

brought together very quickly thanks to the conditions exclusively met at this precise time.

The EPI Expanded Provision of Immunisation was to be launched later in July 2016. This

was a national programme in partnership with the World Health organisation (WHO) in to

distribute medical immunisation care targeted against rubella and measles in educational

establishments in certain rural areas. By means of this programme, the logistics of the

nursing teams as well as the district chiefs is already in place and financed by the Ministry

of Health and Welfare to be launched in July and August.


Peek Vision Botswana thus seized this opportunity and obtained the support of the

Ministries of Education and Skills Development and of Health and Welfare to carry out

its own project in parallel with this programme of immunisation. The Peek Vision Botswana

screeners' training courses took place in the same place and site as the training of nurses and

other staff from the educational environment around the EPI programme. At the end of the

training of the staff in charge of the implementation of the two projects, the registration of the

children and teenagers cared for took place in the institutions, followed by the screening

operated by Peek Vision Botswana and finally by the injection prescribed by EPI.

The essential contribution of the government

In 2007, the government of Botswana decided that its policy must now take advantage

of Information and Communication Technologies (ICTs). The President demands the

development of a national cross-sector strategy which takes ICTs into account. Various

pillars for such a national strategy are identified, including ECommerce, E-Business, E-

Education, E-Agriculture and E-Health.

Botswana is the first African country to launch a national e-health strategy. The

International Telecommunication Union (ITU) and WHO have joined this initiative and three

other African countries have now adopted such a national strategy. Botswana has 969 health

facilities, 28 main hospitals, 3 referral hospitals and 1 tertiary centre of excellence including a

research service and attracting national medical tourism. Currently, all Botswana hospitals

are now electronically linked and on 13 June 2017, an EMR (Electronic Medical Record)

system will be launched nationwide on the basis of which all hospitals will operate.

The E-Health pillar itself is develops in several subsections. How can the ICTs

improve the use and quality of public health? How can they contribute to a harmonisation

which relates both to better patient care and better outcomes, while improving general access

to information?

The ambition of the national E-Health strategy is to overcome the digital divide.


The Eye Health for all programmes is in the

division of the combat against disease of the

government’s general Health programme. The main

focal point is to eliminate blindness as the non-

correction of refraction defects (that is the need to

wear corrective eyeglasses) was revealed to be one of

the main causes of blindness between birth and the

age of 15. It was in order to combat this plague that the

government sought to develop a strategic plan

monitored by strategic partners including the ICEH

(International Centre for Eye Health in London). It was

here that Peek Vision Botswana has intervened. The five

year plan includes a first screening phase of filtering

young Botswanans in order to identify those young

people who need monitoring; the second phase

comprises the use of another tool developed by Peek

Vision whose function is to examine the retina in order

to diagnose the absence of a diabetic complication

The functioning of Peek Vision in Botswana

The Peek Vision Botswana implementation team

Peek Vision Botswana today employs three full time staff and has a certain number of

student trainees attached to the government engaged part time. The team has trained groups

of three persons per screened filtered school, that is the institution chief, the department head

and the pupil advisory teacher. In all, at the time of the training team, the Peek team is

training 144 school staff and 30 health staff.

Member of the Ministry of Health and

Welfare handing over a pair of sight

glasses to a young female student filtered

by Peek Vision Botswana.


The screening operated by the staff trained by Peek Vision Botswana inside a school establishment

The project is translated by the screening filtering of 12,877 children and

adolescents within the 49 school establishments. Of these children and adolescents, 2,065

have been identified as being potentially in need of monitoring; they are “sorted” into 3

triage fields and 24 schools, from which results the issue of 853 pairs of eyeglasses, the

prescription of the relevant drugs in 94 cases and the referral of 63 cases of children to

ophthalmological specialists. the delivery of pairs of glasses is made the programme of the

Ministry of Health and Welfare – a body which supplies pairs of glasses free of charge to

every young Botswanan aged less than fifteen whose eye health requires it.


How does the screening work? The staff who operate it begin by filling in the information

concerning the school concerned: name of the school, region, how many pupils the school

houses in total, etc. The information about the student to be filtered follows: name, age,

sex (stage 1). The application then indicates the screening instructions to the user, who in

turn explains them to the student (stage 2). The screening is set to last a maximum of two

minutes: the student must simultaneously cover the left eye, then the right eye, while the

user of the app will be two metres away from him, and will show him the phone screen,

which displays the capital letter E (stage 3). The student must indicate the direction towards

which the 'legs' of the letter E tend; whilst the screening progresses, the size of the letter E

decreases. The result of the screening is simple to decipher: it is either positive or negative.

If it is negative, the student will be subjected to a second test in the next stage, the "sorting"

stage, performed by professional optometrists, at the end of which each young person will

have a corresponding official medical diagnosis of a solution to his problem.

Stage 1 Stage 2

The root of the problem

The ratio of public optometrists per Botswana inhabitant is extremely low: there are

only two public optometrists for 2.3 million inhabitants. However there are 45 private

optometrists, which puts Botswana above the WHO average in terms of optometrists per

million inhabitants. However this is, without a programme of national coverage, access to

this type of specialist health service is extremely limited, all the more so because the

public awareness of the population towards ophthalmological problems is still little

developed.

Stage 3


The benefits of Peek Vision Botswana


Pupils having been able to have access to a pair of corrective glasses

adapted to their sight thanks to the screening of Peek Vision Botswana

StartupBRICS visited five schools which were screened by Peek Vision Botswana,

was able to interview the screening players and was also able to maintain relations with the

programme’s official optometrist partner. The pairs of glasses were distributed a few

months after the filtering and triage, between 6 March and 11 April 2017.

Charlotte Burrier, representative of

StartupBRICS (left) the official doctor

partner optometrist of Peek Vision

Botswana

Charlotte Burrier, representative of StartupBRICS (left); Farouk, a member

of the Ministry of Development and Skills Development, Keitumetse, a

member of the implementation of Peek Vision Botswana; the Head of the

Lejwana primary school; Kabontle Otlaadisa, teacher (right).


Thanks to Peek Vision Botswana:

1. The project has been able to raise the awareness of the rural population targeted to

issues related to eye health.

2. Children and adolescents in rural areas, who do not have access to expensive health

services, were able to be cared for and receive adequate care, without which their

refractive errors would not have been corrected (which could eventually lead to

blindness).

3. Concentration, reading and therefore the learning abilities of students who have

received a pair of glasses has improved considerably, reflecting in better school

results.

4. The project created and consolidated links between the communities in

collaboration: school and health staff, the players of the Ministries of Education and

Skills Development as well as the Health and Welfare teachers from different schools

and Heads of Schools. This opens the door for future constructive collaborations.

5. Rural school teachers have had access to technology and school leaders have seen the

positive impact of introducing innovation into their practices.

Official handing over of a pair of glasses to

a pupil.


Oganeditse Gaonyadiwe, teacher (left); the Head of the

Good hope establishment, Charlotte Burrier, representative

of StartupBRICS (left); Farouk, a member of the Ministry of

Development and Skills Development (siting, centre)

Financing

Peek Vision Botswana relies on the essential collaboration between various key

players. Its funding is shared by these various partners: the main financier is Standard

Chartered Bank Botswana, with Pula 1.34 million (approximately equivalent to 124,000

dollars); the University of Pennsylvania, the Ministry of Health and Welfare, and the

Ministry of Education and Skills Development.

The essence of this multi-partnership lies in the agreement between Standard

Chartered Bank and the Ministry of Health and Welfare which after start of the pilot project,

in the event of a successful operation, the project would be launched and financially

supported by the ministry at the national level with the aim of a global impact. The

ministry is committed to replicating the project nationally.

Before the completion of the pilot project, however, the release of public funds is

extremely long and tedious, which slows down the project and compromises its success.

Peek Vision Botswana is therefore in a critical phase of its deployment to ensure the success

of the project and its development of national scope.


Ambitions

Peek Vision Botswana's ambition goes hand-in-hand with the government's goal: the

2020 Vision plan for Blindness Prevention, established in 1999, provides for the screening of

all primary and secondary school students by 2020. Peek Vision Botswana has mapped all

the schools involved in order to achieve this goal.


Conclusion

The calculations of the Peek Vision Botswana team come to the conclusion of an

impact cost of 117 pula (about 10€) per screened child, and 1,380 pula (or 124 €) per child

treated. A minimal cost for an impact on a complete lifetime. Peek Vision Botswana offers

an integrated solution targeting young people from remote areas who do not have the means

to access this solution, which the Botswana government has already approved.

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