eStrategies Africa 2015

eStrategies AFRICATIME FOR PHAKISA ICT? Group to work with a new sense of urgencyClear plans agreed for SA’s digital revolution

Contents4eServices RoundtableSharing of telecommunications platforms for thedevelopment and implementation of all eServices10The National eStrategy RoundtableThe role of the private sector in South Africa’sNational eStrategy18eHealth RoundtableConnectivity at the core of eHealth success28Connectivity RoundtableIncreasing spectrum for faster, more affordablebroadband roll-outProfessor Hlengiwe Mkhize, Deputy Minister, Ministry ofTelecommunications and Postal Services attended allsessions of the event, chairing two roundtables

ForewordeStrategies Africa 2015 took place in CapeTown where we brought together again thepeople who have been working on deliveringa roadmap for ICT development through theeStrategies platform for many years. Thesedelegates were joined by some new facesfrom the public and private sectors andProfessor Hlengiwe Mkhize, Deputy Minister,Ministry of Telecommunications and PostalServices, helped drive the agenda over both days.Four round table sessions took place focusedon speeding up the implementation ofeSevices and eHealth solutions as well as ameans to improve broadband roll-out andconsolidate the National eStrategy.Discussion was focused on developing someconcrete outcomes and a set of clear actions.Consensus was reached and plans weredrafted and we will now be looking to setabout implementation with renewed vigourand a real sense of urgency.Each round table chair and rapporteur workedclosely with eStrategies Africa immediatelyafter each session and the resulting reportis what we are publishing now in this specialdigital edition of the magazine.eStrategies Magazine will be published againearly next year, when we will also be speakingto key stakeholders involved in this process tomonitor the progress being made before we allmeet again in Cape Town in July.

Cape Town 2015 eStrategies’ChrisHullandWilliam Davisworkonthisreportwiththe tworapporteursQuentinWilson (blueshirt)andNtsibane Ntlatlapa eServices Round Table Edited highlights of the eStrategies forum focusing on the development and implementation of eServices across all sectors. This report includes a set of recommended follow- up actions that were established through consensus reached during the sessions with input from the panel members and interjections from the expert audience2 eStrategies

The Panel Chaired by Professor Hlengiwe Mkhize,Deputy Minister, Ministry of Telecommunications and Postal Services Rapporteur Ms Loren Braithwaite ProfessorHlengiweMkhize Mr Lubabalo Dyantyi Kabosha Deputy Minister, Ministry Public Sector Executive MEADr Ntsibane Ntlatlapa CEO SACF of Telecommunications Group, Dimension DataNetworks and Media and Postal ServicesCompetency,CSIR Meraka InstituteMs Juanita Clark Ms Puleng Kwele Ms Makhotso MoiloaCEO, FTTH Council CEO, Executive ManagerSouth Africa Broadband Infraco Operations, USAASA 3

The purpose of this round table reluctance to invest in infrastructure in rural areas. In terms of financing the development andThe first round table discussion of the 2015 eStrategies implementation of eServices, a clear financial model isForum, held in Cape Town on November 23, brought needed that determines where finance is coming from,together key stakeholders from the public and who is providing it and what it is being invested in. Theprivate sectors to focus on the development and panel addressed this in an effort to establish clarity.implementation of better eServices in South Africa.With this aim, the delegates addressed the following Access to broadband services is a priority, particularlyagenda. in schools and healthcare centres. The panel looked to establish clarity on how this access will be achievedIt is widely accepted that any eStrategy is only as good in all areas of South African society including ruralas the infrastructure on which it is built. One of the key areas and under-serviced urban conurbations. Whatobjectives of the discussion was to determine the roles framework will be adopted to accelerate this processand responsibilities of government and private sector in and what are the key drivers involved?the deployment of this infrastructure. A focus will also be made on applications. South AfricaDeploying infrastructure is a capital intensive is rightly focused on broadband and free wi-fi but littleexercise and, whilst the private sector accepts that is being done in the areas that make the differenceit has a responsibility towards under-serviced areas, – applications. The panel wanted to establish a clearclarification is needed on what is already being planned understanding of how government could partner betterand by whom to avoid duplication of infrastructure. It with the private sector at a level that benefits theis particularly important to clarify the role of Telkom as nation and all citizens.the lead agency in this regard. Without this, short-termapathy amongst industry players may arise leading to aRapporteur’s StatementFollowing inputs from each of the panel members as well as lively interaction anddiscussion from attending delegates, the following highlights emerged from the session.eStrategies a valuable platform for We have the talent in South Africa to at the moment and the lack of clarity ismultiple stakeholders to work together, produce good apps. We need to harness creating uncertainty. Better engagementwith shared roles and responsibilities and this potential by working together and will enable industry to help deliver thewe need to develop this approach. across the key question is how to finance government’s development goals.all areas of ICT development. the development of these apps and eServices. Foreign investment is a gamble forGovernment is committed to developing industry – they assess which country willits digital programmes, which is to There is a lot of infrastructure provide the biggest ROI and then invest.include all those not currently benefiting development taking place – cables, SA is missing out here because of a lackfrom the digital revolution Central to this fibre, networks, F2H, F2B. – but we need of clarity by Government.is broadband roll-out, which will provide the content to fill those pipes. Withoutaccess to opportunities. content, all we have is a good internet Many cities are moving into managing experience. It should provide much more their services through the internet, butThe roll of the South Africa Post Office and not just for the rich as it is the rural there are no standards in place to make(SAPO) is central to this. If we can communities who stand to benefit most. this management more efficient. Betterdigitize the post office, then we can get coordination of effort is required.the internet everywhere. There has been massive investment in broadband and this will continue. The fragmented approach toWe need to focus on applications – and Industry needs to engage with development hampers our abilitythey need to be appropriate for each government more about what to get to execute efficiently, leading tolocation and appropriate for the users. out of this investment. And information inefficiency and waste.So, unique content, developed by local needs to be shared by Government withdevelopers, for the villages, the areas, for industry or they won’t continue to invest. Industry wants input into policy toAfrica. Government not sharing information avoid bottle necks forming. Government4 eStrategies

The ICT Policy Review is a key pillar of this discussion and the outcomes from this session will feed directly into the national eStrategy. The private sector must align with government policy, so share your frustrations and influence planning – and then let’s work together. Deputy Minister, Ministry ofTelecommunications and Postal Services 5

We need to breakthe cycle of nottalking to eachother. We needto be open andhonest and worktogether to getthings doneDrNtsibaneNtlatlapashould provide guidance on how The digital divide is expanding and services is low. MTN is doing this andindustry can have this input. it must be addressed now by both will still get a RoI within 2-3 years. public and private sectors. If it is justThere is space for this interaction and government going to rural areas it will There is money to be made in under-the Government wants industry’s input create a them and us situation. Urgency serviced areas, but industry needs toand for industry to throw its weight. is required here. pick up the challenge. USAASA is there to help.All government services will sit on the In 2014 USAASA produced a reportinternet, so as well as providing all on universal access that concluded With Telkom holding 84% of existingcitizens with the ability to connect, they that money was being invested in infrastructure, it makes sense formust know what to do when they are infrastructure but not where it is most Government to work with the companyconnected. Digital literacy is a priority. needed. Industry associations need that to see how it can be used. information to share with industry andRegulation must be more agile - we are with investors. We should be encouraging andcurrently being regulated by litigation. supporting SMEs to provide servicesWe need different connectivities - fibre, The sharing of all available data on the - they will be providing the serviceswireless, TV white space. This must be state of ICTs in South Africa is vital. But and creating the jobs, but until weconsidered from both a policy point of the data needs to be accurate and up connect the front and back offices,view as well as a regulatory point of to date for it to be useful and to tell us we will always be calling for moreview. what is needed and where. We need to infrastructure. work together on getting this data.Yes, there is lots of infrastructure, but it We need to adopt specific standards,is elitist, so investment must go to where There is a need for different finance and not simply adopt those usedpeople need it - in rural areas and it models for areas where there is little elsewhere. At the same time, ourmust be technology agnostic. money and affordability of devices and standards and legal framework need to6 eStrategies

be the same for the entire country.There is a need for the demand side tobe considered - what does the end userneed and want. This will provide themarket for eServices and the businesscase will follow.Sweden example is worth consideration.There, a Broadband Council wasestablished to consider the end userperspective and jointly found solutionsfor broadband roll-out. Meanwhile,operators cooperate together in thesame area.Western Cape will have broadband toall Government buildings by 2017. Theytake the fibre to the door and the privatesector can sell services on that. A long-term agreement with ISPs will make thiscommercially viable.Sharing infrastructure makessense. Multiple ISPs sharing needs 7

management, however, to avoid There are bodies that exist to drive duplication and wastage. If Government change. But, the National Broadband is paying, then it should be available to Advisory Council hasn’t met since all. 2014 and its role is unclear, while the National ICT Forum is not being used as What the best equipment to adopt for it should be. We need a new platform each specific area should be considered for engagement and industry must be on a case-by-case basis - and the involved. knowledge gained should be shared. The knowledge economy is happening The regulator needs to be faster - but in South Africa and graduates for the it will never be fast enough. So, with 21st century are emerging. Can industry services developing without regulation, leverage these highly able people or will we need to find what works and learn they do things the old way? from them. We need to break the cycle of not talking The regulator needs to create an enabling to each other. We need to be open and environment, but needs the tools to be honest and work together to get things able to do so. done.8 eStrategies

USAASA is hereto stimulateinvestment andenable services toprovide benefits tocitizens. The rest isup to the privatesector but we haveproved that thebusiness model doeswork and you willmake moneyMs Makhotso Moiloa, USAASA

Cape Town 2015 ChairpersonDrRosemaryFoster andRapporteurDrAndrew Robinsonpreparethisreport immediatelyafterthedebate The National eStrategy Round TableEdited highlights of the eStrategies forum focusing on The National eStrategy.This was a follow-up session to the morning discussion that looked at how theideas developed for delivering more and better eServices can be fed into the National eStrategy for digital development and for closing the digital divide. Private sector involvement in this process was at the heart of the debate2 eStrategies

The Panel Chaired by Professor Hlengiwe Mkhize,Deputy Minister, Ministry of Telecommunications and Postal ServicesRapporteur Mr Henry Adams Mr Sheldon Quarmby Mr Lionel Benting Country Manager, Founder and CEO, Director DGITO Health, SocialDr Quentin Williams Intersystems Interfile Development and RegionalStrategic Research Services, Western CapeManager,CSIR Meraka InstituteMr David Mphelo Mr Gary Martin Ms Vanesha Palani ProfessorHlengiweMkhizeGeneral Manager Public Enterprise Business Head of Transaction, Deputy Minister, MinistrySector, MTN Development Manager, Forex & Deposits, of Telecommunications Intel Corporation Nedbank and Postal Services 11

The purpose of this round tableThis session followed the first debate focused oneServices and was designed to establish how the ideasgenerated to improve eServices in South Africa couldfeed into the National eStrategy. In doing this, thedelegates discussed a wide range of issues designed tolead to clear outcomes.As with all eStrategies Africa events, there was a mixof public and private sector stakeholders involved. Thisprovided with the perfect opportunity to seek to clarifyhow both can work together. How, for example, doesthe government intend to involve the private sector inimplementing its eStrategies, how will this relationshipbe maintained on an on-going basis and through whichchannels will government specify the contribution itexpects the private sector to make?Meanwhile, it was important that an appropriateframework for the National eStrategy was discussed -what are its key drivers and priorities, how will thesebe executed and how should they be monitored andreviewed? To ensure we make sensible decisions in thisregard, the panel discussed what the shortcomings were(if any) of the current National ICT Policy and examinedthe progress being made of the key success factorsfor the future IT industry as documented under theInformation Technology section of National ICT Policy,namely ubiquity, affordability, reliability and speed.The state agency who will take full responsibility for custodian of financial inclusion and delivery of digitallythe delivery of this suggested National eStrategy was assisted eGovernment) is not supported. SARSeFiling,also discussed with the aim of establishing a clear uFiling, e-Tshwane, e-Siyakhokha, for example, are allindication of the proposed milestones and actions success stories but each is a separate initiative. Thereand how continuous feedback to the public will be is substantial opportunity for SITA and the Post Officeconducted. The panel wanted the private sector to to improve service delivery and revenue collection. Theassist government in delivering their objectives. In this panel discussed how they can take advantage of whatregard, the panel debated the notion of how some sort private sector has to offer.of regular meeting between the vendor communityand relevant government actors and other stakeholders Key questions were also addressed surroundingcould take place. finance, specifically around the issue of Public Private Partnerships and the government’s approachThe assumption was clear at the start that the to them amid reports that they are no longer inGovernment requires a common eStrategy with defined favour. Similarly, questions about the Public Financeobjectives and real deliverables so another clear purpose Management Act have arisen relating to the fact thatof the session was to help to shape this. In doing this, companies that provide input into planning processesthe panel also took into account the fact that at the may not then respond to any subsequent tender and aremoment each Ministry and department (including disqualified from being awarded business on the samedepartments within a Ministry) have their own strategy. subject matter. The panel looked for clarification onEach attempts its own version of eGovernment without this matter.reference to what others are doing, how they couldbenefit one another and what could be shared or re-used. SITA does not take advantage of what is alreadyavailable, local government does not share solutions,and the Post Office (which should clearly be the12 eStrategies

Rapporteur’s StatementWith inputs from each of the panel members and interaction from the floor, the debatemoved on from eServices to the overal eStrategy, with the following highlights emergingThe National eStrategy is critical for the There are three pillars to the digital It is difficult to innovate while beingprosperity of the country. By 2030 ICT vision. Infrastructure - needs to be in constrained. We need to be brave andwill underpin our inclusive society. That place, use - services and applications our strategy should promote innovationvision is quite clear. that are affordable and useful need to be and that risks of non-compliance do not developed and skills, digital literacy - is hamper invention.We need to work together to implement vital so people can use services and buildthis vision and that means establishing them. SARSeFiling is 15 years old and a successclear roles and responsibilities, creating - but we are doing noting to share thisplatforms to enable closer working The Western Cape Broadband Initiative across government. Government, in fact,together of multiple stakeholders, is a good example of how the vision can is putting multiple systems in place,defining clear objectives and deliverables be delivered. Lessons can and should be without sharing best practice.in the plan and developing workable learnt. But guidance is also needed at thefinance models to ensure that national level, where leadership should An omni-channel approach works,implementation can be paid for. be clear and a common goal shared. using mobile, web and kiosks to deliver eServices. SITA and the Post Office areThis stakeholder involvement model is It is difficult to recruit and retain in the best placed to deliver these services tokey, but in eHealth it is broken in South ICT sector - there are not the skilled citizens.Africa and it must be fixed - as it must people available. This needs to be part ofbe in all sectors. the strategy. The Post Office has country-wide 13

presence and the ideal footprint to be Focus on the three able to deliver services. The digital Post Cs - Coordination, Office is ready to deliver but is being Communication and held up by bureaucracy. Meanwhile, banks are being paid to process certain Cooperation applications, when the state-owned Post Office could be doing the same job, Mr Lionel Benting which in turn would help finance the organisation. The fact is that many people in South South Africa needs to ensure it can Africa remain unconnected. Whatever exploit this, preparing now for the we do, we need to be more inclusive and Internet of Things. that includes Government departments talking more to each other. We need to build a catalogue of value-added services that improve as If we are not all talking to each other and they develop. So, instead of multiple agree that we should be, we will need to providers duplicating services, we need address the issue of how we do it. We to be replicating services and adapting can improve communication vastly by them for different requirements, using organising quarterly multiple-stakeholder different channels - mobile, kiosk, web. meetings from which concrete plans should emerge. Cyber security needs to be made a priority. South Africa is third in the list The pathology service is a good of global targets for cyber fraud and we example of a successful eService and need a strategy to deal with this more lessons should be fed into the National effectively. Strategy. It is a standardised platform and available online. It produces half a Banks understand the need to grow million reports a week and patients are the middle class in South Africa and to benefiting. do this, they need to understand the consumer, the communities and the After the PFMA Act, the tendering markets. process needs clarification in terms of allowing those who provide information Improving access to finance will help for the tender being allowed to submit people access services. bids to do the work. There is confusion here. We should not force people to do things digitally when they don’t want to. Some Trust needs to be built over tendering. people prefer digital, others don’t! Are all bids considered or is there an element of box-ticking? The lack of Banks have to tread a fine line between communication here builds mistrust. innovation and the need for a very compliant and regulated framework. The Mobile penetration is huge in South need to innovate must not be forgotten. Africa. We need a roadmap of what services can be provided over mobile and We need to promote local companies and these can be supplied quickly. We don’t break global monopolies in South Africa. need to reinvent the wheel, but use what Home-grown talent will create home- we already have and adapt it. grown wealth, jobs and deliver what South Africa needs and wants. We need to be looking for quick wins and the Post Office can deliver. Technology has advanced quickly, but We need to be pushing the boundaries consumers are advancing faster in terms of smart - delivering excellent content of what they are demanding - so we through continuous connection. That is must improve access and cost efficiency where we need to be an the technology to ensure delivery. needs to evolve to make this possible. It is important to provide simple services14

to encourage saving and to ensure people need to establish a reporting matrix tocan save small amounts and can see those ensure delivery.small amounts grow. Industry associations need to be involvedPeople don’t trust mobile for financial in any quarterly meetings that may beservices - so education is key and trust set up, hosting, facilitating and bringingneeds to be built. the right people to the table as well as disseminating information to relevantWhy is mobile money functioning in industry stakeholders.Kenya, but not in South Africa? The qualityof the banking sector could be the cause, While government departments needbut CSIR could be a coordination group for to communicate better, industry alsomobile money to change perceptions. needs to be better coordinated. Leverage opportunities for this through the SouthAny National Strategy needs to maintain African ICT Industries Association Forum.its focus on the key areas of health,education and government services, while An inter-ministerial committee has beeninteroperability should be at the heart of set up to drive the ICT Policy Review,things. Systems must be able to work with but no committee can run a successfuleach other nationally - and this requires programme. Has the DTPS got the powerbetter communication and planning. to drive the programme?While the need to share information is Prioritise and focus on the issues - weparamount, we also need to define the need a digital champion for South Africa.information that will be shared, what we This person can present the country’sare going to do with that information and digital vision and be responsible for itswhat we are trying to achieve. We also delivery. 15

Agreed follow-up actions Following deliberations by the panel and interventions from the audience, the following six follow-up actions were agreed based on the day’s two round tables – eServices and The National eStrategy. eStrategies will monitor these developments and publish a report in early 2016 to measure progress being made. 1 A new Digital Office to be run by the DTPS will be formed The Digital Office will specify the key objectives of the digital agenda and be responsible for driving that agenda. It will provide thought leadership and coordinate all stakeholders in this sector. The Digital Office will require a figurehead, who will become the Digital Champion for South Africa. The Digital Office will also: l Bring all stakeholders involved in eSkills and digital literacy together to drive a coordinated agenda. This ensures that eSkills development will facilitate digital inclusion through a coordinated national programme for eSkills and digital literacy l Facilitate and drive an eServices standardization and interoperability framework 2 Further meetings to take place to improve communication between public and private sectors Quarterly meetings were suggested as a possible way for public and private sectors to work better together and track deliverables. Under current agreements, eStrategies is comitted to the Cape Town event for the next five years. Increasing the number of events is something that is possible but would require clear partnerships with the Associations, state-owned enterprises, public sector and the continued support from the private sector. 3 The DTPS will consult relevant stakeholders to revisit the mandate to make SAPO part of the delivery mechanism for eServices This recommendation is designed to ensure eServices are made available to all areas of South Africa in the most efficient and cost-effective way. 4 The DTPS will publish its core values These values include scalability, sustainability, inclusiveness, affordability and collaboration. Further Actions As well as these key actions. eStrategies Africa agrees to the following actions to be published in eStrategies magazine in print and online in early 2016. eStrategies commits to publishing the opinion of private sector stakeholders involved in eStrategies Africa in relation to what they want fed into the National eStrategy. Issues will include, amongst others, cloud, IOT and digital literacy. Further interviews with key participants will be published in early 2016 as a way to monitor progress on actions from this event eStrategies will publish and promote the DTPS’s core values16 eStrategies



Cape Town 2013 ChairpersonDrRosemaryFoster andRapporteurDrAndrew Robinsonpreparethisreport immediatelyafterthedebateCape Town 2015 eHealth Round Table Edited highlights of the eStrategies forum focusing on eHealth and the potential of ICT to speed up the development of effective eHealth solutions and the provision of better healthcare. The discussion reflected on the progress made since eStrategies Africa 2014 and worked to gain concensus on a number of further actions2 eStrategies

The Panel Chaired by Professor Paula Kotze Chief researcher, CSIR Meraka InstituteRapporteur Dr Gene Elliott Mr Gerrit HenningMr Ian de Vega Physician Executive, Executive Director, Health Intersystems Systems TechnologiesDirector InformationManagement, WesternCape Department of HealthDr Louis Rossouw Mr Martin Weiss Mr Siraaj Adams Professor Paula KotzeCEO, Senior Technical Officer, Executive Manager, Chief researcher,eHealth Foundation MRC-PATH Global Health Metropolitan Health CSIR Meraka Institute Innovation Accelerator 19

The purpose of this round tableHealthcare is one of the key priorities of any nationand it is a service which benefits enormously fromthe implementation of good technology in the rightplaces. In essence, good eHealth strategies are essentialfor better healthcare. Of course, there are proventechnologies and systems that we know work, which iswhy this debate focused on the areas that will ensurethese systems are implemented quickly, appropriatelyand that those who need to use them are able to do so.After examining progress made since the lasteStrategies event in 2014, the panel examined theissues from the clinical perspective, in other words theactual use of the technology by the doctors and nursesand healthcare managers. Who needs to use eHealth,how will it integrate into specific environments,address specific challenges and what are its limitations?Debating this clinical perspective, the panel addressedthe need to ensure that this aspect of any eHealthstrategy and implementation will not be forgottenabout in the future and also address the issues thatneed to be addressed in ensuring all stakeholders areinvolved in the process.Another key focus for the panel was the need for level, were highlighted and its structured approach tomore integrated and holistic device management in eSolutions in Health (and other departments), whichSouth Africa. Monitoring medical devices can impact have guaranteed particular successes for the province,decision support for the DoH, operational staff as well were explored.as technical maintenance staff in remote clinics andthere is a need for some form of equipment register and Of course, we have an eHealth strategy in South Africa,this should now be included in eHealth policy making. delivered in 2012 and due to see us through to 2017.A single management platform will significantly The formal eHealth Strategy was published in 2012,help the DoH reduce operational costs and provide and was meant to provide a roadmap from 2012 todevice visibility at a national level. This information 2017. Delegates debated how to review progress andwill aid the future deployment of devices and tests achievements against this strategy, determine whereand provide the ability to track trends and manage there is lack of progress, determine if there is a need tosupport infrastructure and technical staff deployments. refresh or update or review parts of the strategy andThey looked to gain an understanding of the current planned to advise accordingly.strategy for connected devices - not in relation topatient information, but to operational information and The panel also discussed how we, collectively becomedecision support. It also examined how a DoH network more effective in implementing the eHealth strategy.could be established to enable communication with How do we ensure equitable deployment of systemstheir health workers as well as to manage their devices. across all levels of care and across all geographic locations? How do we ensure access to patientAs with all areas of eDevelopment, central to the information across the public private divide, and whatsuccess of any eHealth policy is the need for the needs to happen before ICT automation? And how dopublic and private sectors to work together on issues we leverage off private sector infrastructure to benefitof interoperability, integration, infrastructure and the public health objectives related to improved clinicalsharing of information in the public domain. There decision support and quality of care. In relation to thisare many areas of debate here so the group worked to aspect, the panel addressed the need to implement theshine a light on these issues with a view to delivering normative standards framework.shareable recommendations for our evolving healthcareinfrastructure. In doing this, lessons learned in theWestern Cape, which is ahead of the curve at national20 eStrategies

Rapporteur’s StatementWith inputs from the panel members and interaction from the floor, a number of viewswere expressed from which the rapporteur has collected the following highlightsWe must review the eHealth Strategy, A standards agency for eHealth has yet The Western Cape re-imagined thepublished in 2012. It is not a live to be established and one is needed. future with its Information Managementdocument and many things have There is also a lack of a full enterprise ICT Application Space and there arechanged in the three years since it architecture for eHealth. important lessons to be learned. It is awas devised. Is it still relevant? What patient-centred approach that deliversprogress has been made? How should There is little use of shared infrastructure continuity of care and integrated care. Itit be updated to reflect changes in and no roll-out plan at the national was based on a clear vision for deliveringthe technology and infrastructure level and no data model for the shared an optimal experience for the patient,landscape? Someone needs to own the national health record. with a clear understanding of how thedocument and drive the strategy. patient flows through the system. There is work being done on the national The exercise resulted in a clearMore publicity of the overall vision is patient master index, but with no access understanding of the need forrequired. People don’t know about it and to national population registers, this everything to integrate with the EPMI,not all stakeholders are on board. Tasks, work is limited in its scope. This needs to with clinicians having the ability todeliverables, milestones and activities be remedied, perhaps by starting from interface with the system.need to be defined, communicated and the bottom up by collecting data at themonitored. clinics. The exercise required patient profiling, effective costing and, by being able toThere is no interoperability roadmap - There is a need to register everyone map disease, interventions can be betterand we need one. using medical aids. planned. 5

There are still many challenges there are several case studies that to overcome, due largely to demonstrate their commercial connectivity issues. The metro viability. areas are well served, but things deteriorate in the WC up the west The DoH started using a private coast. sector app, with specific additions. It went from a decision support WC strategy has been aligned to tool to a full operational tool and the national strategy and the 2020 was adopted by health-workers, vision, which includes the roll- with 9,000 downloads. The DoH has out of all informations systems, three apps now. replacing ageing infrastructure, The adoption of these private sector developing a single platform for apps works in the public sector. the integration of all information, They can be monitored and are implementing good BI systems, sustainable by being funded by conducting operational reporting, the DoH and not limited to specific focusing on good governance projects. and growing ICT capacity. This all informed implementation planning More of these patient-centred and included milestones. solutions will be rolled out including those for immunisation and child If this approach is adopted, it must services. be aligned to standards. The HNSF helped the WC and was used in Private sector need to show public alignment, but there are still gaps sector what solutions are available, that need to be filled. that there is a need they meet, that they show value for money, that The Western Cape has an eHealth they have been used and work, they Champion. There is a need for such are scalable, have proven capacity a champion at the national level. and they can be a established partner. Public sector should be The Western Cape has been asked open to this approach. It needs to share its patient master index coordination and standards, but it at a national level based on the works. normative standards. This shows clearly that the normative standards With proper device management work and this is a big step forward and registration, the cell phone since last year. can be used as an effective eHealth device. A national device There is also a lack of highly-skilled registry will also compel the device individuals to drive progress, with manufacturer to comply with a a reliance on the private sector to single protocol. Could a normative implement and that drives up costs. standard for medical devices work? There is a real need for good BI There is a need that South African systems to manage the data and companies are encouraged to provide high-value outputs for any develop eHealth solutions and they eHealth system. need to be supported to do so. Engage with health workers and The Internet of Things will have a other staff when embarking on any dramatic impact on medical devices, eHealth implementation - they are with attention paid to issues of amazing and understand the need privacy. for everything to be done for the good of the patient. Change management is key to effective uptake of eHealth There appears to be a shift towards solutions by health workers. mobile technical solutions and Upskilling the workforce is crucial.22 eStrategies

In countries where there is a single not obvious for all to see and therepurchaser (national health) things is a lot of duplication and wastagemove a lot faster. So, National and with an increasing diseaseHealth Insurance could be the burden, our health system cannotsaviour of national health in South cope.Africa. The models of delivering publicIndividual practitioners cannot care no longer work and need re-participate in the eHealth space. The designing. eStrategies Africa canonly way clinicians can do so is if support and promote these changesthey act collectively. as well as measure them and monitor progress.All eHealth implementation needsto be sustainable, scalable and be The DoH is obliged to reportof sufficient quality. This requires information about the Southcoordination and standards. The African health service to theNormative Standards are limited WHO. It cannot do this effectivelyto electronic health systems. So manually and so needs systemsfurther standards are required. in place to meet international standards.There is a need for better impactinvestment. The CSIR is funded but People do not like logging on toa commercial, venture capital model different systems, so we need towould deliver more commercially develop a seamless experience orviable solutions. A big shift but it people simply will not use it.does work. Don’t just send gadgets intoThe more integrated the system, the hospitals and clinics and expectmore collaborative it can be. Private people to use them. They needclinics have huge traction and can training to do so.demonstrate this collaborative,integrated success. Technology enables people to take ownership of their health - butWe need to build accountability into technology is not the only solutionany system that can be audited at to the challenges we face in ourthe push of a button. health service.Clinics and hospitals are swamped We need to foster innovation andand overloaded. There is a lot of support local development, lookingwork going on to bring new systems outside the health sector to bring ininto play but the results of this are solutions that work elsewhere. 23

Agreed follow-up actions Following deliberations by the panel and interventions from the audience, the following follow-up actions were proposed based on the eHealth round table and taking into account the recommendations made at eStrategies Africa 2014. eStrategies will monitor these developments and publish a report in early 2016 to determine progress being made. 1 The current National eHealth Strategy, published in 2012, should be reviewed eStrategies proposes that an academic/research body should perform a review of the current eHealth Strategy for South Africa that will focus on performance/implementation to date as well as provide a GAP analysis. Performance will be measured against the 10 eHealth priorities stated in the National eHealth Strategy. From the review: • An implementation plan should be developed with clear deliverables and timelines and a well-defined funding programme. • An overview of eHealth best practice should be compiled based on sustainability, quality, scalability and the need for solutions to be duplicatable. • A multi-stakeholder forum be set up to improve communication regarding the implementation of the eHealth Strategy South Africa between the public and private healthcare system, and including the electronic medical record vendor community. 2 Any new technology must ensure that it can comply with the National Health Normative Standards Framework for interoperability in eHealth (HNSF) Compliance with the HNSF will ensure that a service provider will be able to obtain information through and from the shared national infrastructure, and will allow seamless integration with all HMSF compliant systems. eStrategies propose that: • The coding standards required for semantic interoperability required by the HNSF be decided and published soonest to allow for complete interoperability compliance. • The technical interoperability specifications of the HNSF be reviewed to address new technological developments since the inception of the Framework. • That in addition to the HNSF, a set of norms and standards be compiled to govern and manage medical and other mobile devices connected or providing input to electronic medical record systems. 3 An innovation competition to be set up in South Africa To create an enabling environment for local innovation in South Africa, a two-day innovation competition is proposed. This should be run every six months to promote home-grown innovation. Entrants will be encouraged to look outside the health ecosystem to bring in innovations from other sectors that will help deliver better health care to citizens.24 eStrategies

Further Actions As well as these key actions. eStrategies Africa agrees to thefollowing publications to be publishedin the eStrategies Africa magazine in print and online in early 2016. These actions are: 1 eStrategies commits to publishing the opinion of private sector stakeholders involved in eStrategies Africa in relation to the work they are doing to advance the eHealth agenda in South Africa. 2 Further interviews with key participants will bepublished in early 2016 as a way to monitor progress on actions from this event 3eStrategies will publicise the benefits of compliance with recommendation No. 2.

Cape Town 2015 Connectivity Round Table Edited highlights of the eStrategies forum which looked at the issue at the heart of all successful eStrategies and underpinning all solutions discussed in the previous three round tables - connectivity. Ensuring fast broadband is available to all communities in all areas of the country is central to being able to deliver better healthcare, education and all government services2 eStrategies

The Panel Chaired by Mr Pakamile Pongwana CEO, ICASA Rapporteur - Dr Ntsibane Ntlatlapa, Networks and Media Competency Area Manager, CSIR Meraka InstituteMsEllieHagopian MrTimEllis MsMakhotsoMoiloa MrWarrenHeroRegulatory Chair, Group Executive: Business Executive Manager Operations, CTO,WAPA Development, Altron TMT USAASA MicrosoftMrShiletsiMakhofane MrGrahamdeVries MrArnoHart ProfessorHlengiweMkhize Deputy Minister, MinistryHead: Government and Corporate Services Executive, Telecoms Network Developer, of TelecommunicationsIndustry Relations , MTN TENET and Postal ServicesEricsson Sub Saharan Africa 29

The purpose of this round tableThe purpose of the final session of eStrategies Africa2015 was to consider the challenges that lie ahead inconnecting all of South Africa to fast broadband and,therefore, to the services and opportunities discussedin the previous three sessions. The debate focusedon some key questions: What are the barriers, bothtechnical, commercial and others? The panel lookedto identify the problems and figure out concrete nextsteps. There are, of course, many challenges, so thedebate tackled those surrounding high cost and how tolower costs and how to increase access across the wholecountry.With this focus, deliberations centred on why there isnot more investment into under-serviced areas and therole of public and private sectors and how they canbetter work together.Of course, getting the technology is also key inconnecting the country so the panel considered thechallenge of picking the right technologies and notover-investing in buying kit which is too expensive forthe actual need. How and why does this happen?A significant amount of time was spent on all aspectsof utilising the spectrum to the country’s bestadvantage. What spectrum policies will support theoptimal use of spectrum for broadband (as opposed torevenues for the government from spectrum licencefees, or spectrum for mobile operators)?Like in other round tables, the panel considered the level - but to enable equity of access, there shouldforthcoming ICT Policy review and what should be be significant peculiarities between rural and urbanits priorities. There is a need more clarity for the contexts as well as further granular priorities in theregulators to enable them to move from this policy context of development and community informatics.to implementation, so the panel considered what These are crucial to ensure consumption - withouttechnology exists to enable the regulator to manage the which the sustainability of the ICT Ecosystem could bespectrum more efficiently? compromised.Can this technology be deployed for better access to Other key issues tabled for discussion in an effortthe spectrum - use of TV white spaces and open access to reach some for of commitment to ongoing actionto fibre were discussed and the panel looked to get were the need to identify the readiness of our systems,commitment on these issues. departments and communities for the eWorld, the need for a roadmap towards a Digital Government based onFurther to this analysis of the spectrum issue, the panel these areas, identifying a long-term Integrated strategyaddressed the need for several spectrum ‘clean-ups’ to address Digital Literacy and acceptance and thethat have to happen for South Africa to ensure its more country’s security strategy for data, privacy, systems,optimal utilization. If we do not apply this hygiene and cyber attacks.discipline we would simply be adding to the chaos as wethink about dynamic spectrum utilization in isolation.There is still no coherent cloud policy for SouthAfrica - even in the context of two major piecesof legislation that are currently under review. Thedigital divide is always addressed at an aggregate4 eStrategies

The spectrum is a scarceresource and allocatingit is important to enablegovernment to be able todo what it needs to do.ProfessorHlengiweMkhizeRapporteur’s StatementThe following highlights of the round table debate were recorded after deliberationsby the panel and interventions from the expert audience membersThe actual build of any network is very BBI has network plans for connection ICT enables the change we need andstraight forward - it is everything else in all municipalities. USAASA is working the more we have of it, the more wethat makes it complex. with them to incentivise the sector to consume. provide services to those networks.USAASA’s mandate is to ensure under- South Africa should re-use appropriateserviced areas are connected. These There is a perception that the standards that already exist. Developingareas are viable and the business case Government is not moving on this issue our own is time consuming and slowshas been proved. There is money to be - that is not the case, so it needs to down development.made in those areas. communicate what it is doing better. The compliance cost of security is high,There are 195 municipalities that require It is not about planning any more, but but we must ensure our systems areattention in varying degrees - USAASA funding implementation and allowing secure. Transparency delivers services inhas worked with MTN, IBIS and Ming the private sector to come in using the real time.in six of these areas and all three are anchor tenancy model.making money. Our vision is incredible, but our execution Working together changes lives. The is terrible. We have covered 80% ofAreas become commercially viable if problems we face are so great that no the ground, so let’s do the rest, fail, tryproviders change their operating models one organisation can solve them - so we again, give people a chance to get it rightto aggregate demand. must work together. and get it done. 5

Microsoft has trained 8,000 people in The delay is having a serious impact on We must make the successful deliveryICT and taken them from this education economic prosperity. South Korea was of connection to public bodiesto employment. The gender balance in a similar position, but achieved huge affordable within their existing spendof this scheme was 50/50 and 98% of advances using ICT. South Africa can do and it must be scalable at the samethem are still employed. the same. price. The key to growing a network is to ownWe need to define our intent - what we Should we be bolder and simply tell it. Every government department shouldneed to do, how to achieve it and how the broadcasters to jump to digital be connected to this same network andto measure it when it is done. now and free up the spectrum? If we the bandwidth should be shared at cost. cannot go directly to satellite, then weTV White Space is like a road. If we should develop a framework now for Collaboration partnerships shouldprovide people with a road, they will its allocation. We must not wait for this be formed between small and largeuse it. any longer. companies. There advantages to having a national brand that people know andThe spectrum is a scarce resource and We need to free up lower-end spectrum trust working with local companies whoallocating it is important to enable and both infrastructure and devices understand local requirements.government to be able to do what it need to be delivered at low cost.needs to do. But the available spectrum Operators are being constrained in what There should be incentives for largeris not sufficient so needs careful they can do due to the lack of available companies to have more wholesalemanagement as demand exceeds supply. spectrum. The government must act products designed with the customer now to free it up. in mind and not for the benefit of theSpectrum allocation is a bottleneck in re-seller.achieving the NDP so we need to speed All mobile operators are rolling outup the shift from analogue broadcasting driven by consumer demand, and Open access cannot be defined byto digital as this will free up high quality the investment being made is huge - regulation.spectrum. R100bn. We need to connect schools as we doThe Government is behind on delivering Trials have been conducted in Cape universities and then spend the moneyon its digital agenda, but it cannot Town where it has been demonstrated saved on something else.succeed on its own so needs a that you can deliver broadband usingbroad-ranged, multiple-stakeholder TV white space without impacting on We need to review what we are doing ininvolvement. broadcasting. terms of SA Connect. We are collecting

data from multiple sources but it doesnot accurately reflect the currentsituation.Broadband roll-out will create jobsand that is a top priority, alongsideimproving our GDP. Delays in the roll-out is impacting on those priorities.The regulator needs to meet with allstakeholders in the TV white spacesector and thrash out a solution. Ifwe agree that this will transformconnectivity, then we should do moreand push more together.Sharing infrastructure is the way tobring down costs. MTN and Vodacom doit successfully.Broadband connect policy is four yearsold and the data on which it was basedis three years older. We are makingdecisions on information that is sevenyears old. So, are we really slipping downthe ICT rankings as publicised? This isharming investment potential and so wemust have up-to-date data on the realsituation.Data needed on wi-fi usage and whatdevices people are using to help usdefine the networks required.Start-ups who leverage ICT have agreater chance of surviving. We mustensure they do.The policy time-frame is three years,while the technology time-frame is sixmonths. More agile policy frameworksare required. They will provide adequateguidance and progress will be faster.Government needs to move fasteron building their own networks. Theycannot just rely on the private sector.Meanwhile, streamline funding avenuesso that the networks can be built faster.The tender process needs review - withan ombudsman to rule on if they arebeing conducted fairly.To ensure scalability, APIs should beconsidered for all installations. 7

Agreed follow-up eStrategies actions Following deliberations by the panel and interventions from the audience, the following follow-up actions were agreed as a result of the Connectivity round table. eStrategies will monitor these developments and publish a report in early 2016 to measure progress being made. 1 Operation PHAKISA ICT Delegates agreed that the President’s office would be approached with a proposal for an extension to PHAKISA to the ICT sector. The motivation for this action is to create a sense of urgency in delivering on the implementation of the excellent policies already in place, removing the barriers that exist to that implementation and as a tool to get things done. All further proposed actions to have emerged from eStrategies Africa 2015 will form part of the agenda for ICT PHAKISA. 2 Spectrum availability is a barrier to connectivity It was agreed that there is a need for closer discussion and agreement between the Department and ICASA to remove the confusion that exists over the rolls and responsibilities in relation to spectrum allocation. This dialogue will emerge within ICT PHAKISA and the notion of continuous sharing of information will be developed. 3 The leveraging of the commons will be advocated It was agreed that from now the roll out of all joint and shared infrastructure would be conducted in a coordinated fashion with the aim of lowering input costs. 4 USAASA commits to sharing successful finance models for funding connectivity roll-out USAASA highlighted its approach to funding broadband connectivity in rural and other under-serviced areas of the country and demonstrated the commercial viability of its approach. These models will now be made public. 5 An annual report on the ICT sector will be published Much of the collected data about South Africa’s ICT sector is out of date and policy is often devised based on this information. It was agreed that an annual report will be compiled about the state of the country’s ICT sector. An academic/research organization will lead this exercise and multiple stakeholders will also participate. Ericsson has already committed to participate. A key outcome of this proposal will be to develop a deeper understanding of progress being made and it was agreed that more accurate information, publically available, will attract further investment and speed up this progress.8

Our vision is incredible, but our execution is terrible. Let’s work together to put that right and use technology to change lives Warren Hero, Microsoft Further Actions As well as these key actions. eStrategies Africa agrees to the following activities to be published in the eStrategies Africa magazine in print and online in early 2016. 1 eStrategies commits to publishing interviews with key private sector stakeholders about their activities taking place in South Africa and elsewhere to provide a deeper understanding of what is possible and valuable case studies. 2Further interviews with key participants will be published in early 2016 as a way to monitor progress on actions from this event 3 eStrategies will provide an executive summary of the ICT Annual Report for widespread dissemination. 4eStrategies will provide an executive summary of USAASA’s funding models and a case study of how it is financing connectivity roll-out. 35

eStrategiesBe part of 2016 in collaboration with www.estrategies.co.za36