1. The Royal Government of Bhutan (the Government) has identified information and communications technology (ICT) based e-governance as a key area for improving efficiency and enabling wider reach of public service delivery. The focus of the Government is to enhance gross national happiness by building a knowledge society empowered by ICT. The Government is taking a dual approach to achieve this namely by (i) furthering efficiency building measures through ICT and (ii) developing ICT related sectors for exports and local consumption.
2. The Asian Development Bank (ADB) has undertaken discussions with the Government to explore opportunities for providing support to strengthen e-governance activities in the area of efficiency improvement by establishing an e-Services platform through a pilot initiative to deliver public services. The Government has recommended starting the pilot in the health sector by offering services such as telemedicine and basic medical laboratory testing facilities through e-Health centers. The proposed category B, small-scale capacity development technical assistance will finance the pilot establishment of an e-Services delivery platform in the area of e-Health in Bhutan in collaboration with private sector participants.
3. ADB, as part of its strategy to enhance sustainable development in its developing member countries, encourages private sector participation where possible in its developmental initiatives. Thus, for this initiative ADB is seeking to collaborate with and leverage resources through corporate social responsibility programs of private sector corporations, - Hewlett-Packard (HP) and Microsoft. ADB will liaise and facilitate with the two private entities in bringing together the needed hardware, software, implementation services, and subsequent knowledge transfer for maintenance of the pilot components to the Government agencies namely, the Ministry of Health (MoH) and the Ministry of Information and Communications (MoIC). The Government is expected to provide in-kind contributions, including civil infrastructure facilities, staff assistance, and utility services such as water and electricity.
|Project Rationale and Linkage to Country/Regional Strategy
4. As a sparsely populated country in a mountainous region, Bhutan is still in the developing stages with regard to infrastructure. Poor roads, combined with the rugged topographical nature of the land, have made transportation difficult. With approximately 80% of Bhutanese people living more than an hour's walk from the nearest road, high costs are incurred when bringing patients and medical equipment to and from the remote locations. An ambulance may take over 20 hours going from east Bhutan to Thimphu, the nation's capital. Bhutan's underdeveloped transportation network has serious implications not only on the timely provision of efficient health care, but also on equal access to health services by rural and urban populations.
5. Bhutan's constitution mandates the provisions of free health care for its population. The Government of Bhutan together with development partners has implemented innovative approaches such as telemedicine and e-Health since 2000 to remote populations. The Government of Bhutan aims to expand the application of e-Health. According to the annual health bulletin 2011 report of MoH, there exists visible demand for quality health services and health care costs are rising. Therefore, using available information for decision making and designing cost-effective interventions is increasingly becoming the need of the day. The Government has introduced the health help center concept to provide medical advice on any medical presentation and ensure the right medical care is provided. Since the health help center is a new set-up, challenges are faced in various areas such as human resources, telecom solutions and budget. The interventions from ADB with support from HP, in the form of an e-Health center, will partially fill the gap in health services delivery and are in line with the Government's strategic plan. For delivering e-Health services at remote locations, availability of high capacity internet broadband access is a necessary precondition.
6. Enabling internet connectivity and ensuring its wider usage is a challenge faced in many developing member countries. There are various factors influencing its provisioning and usage. The cost of deploying conventional connectivity solutions such as terrestrial connections, satellite based connections, and the limited revenue generating prospects of such investments, are some of the major deterrents to provisioning of sustainable digital access at remote and rural areas. In the ICT industry, this is referred to as the last mile connectivity problem. With the advent of newer technologies, such as mobile technology, optical fiber technologies and television (TV) white spaces, solutions are used to tackle the last mile connectivity issue progressively. As internet is the backbone infrastructure for sustainable delivery of e-Services, it is essential to find innovative solutions to bridge the digital gap especially at remote and rural areas.
7. The geography of Bhutan consists of Himalayan Mountains, river valleys, and sub-tropical forests. Topographical extremes are a defining feature of its geography. In such conditions providing telecommunications infrastructure throughout the country is a challenge. Providing terrestrial broadband connectivity in remote areas is thus not feasible. To a large extent, these areas can be served by wireless functionalities. However, conventional wireless methods suffer from attenuation issues in high mountainous habitations. TV white spaces technology is emerging as a new technology in extending solutions to the last mile connectivity problem. Bhutan's internet service provider (ISP) market is a dominated by two major operators namely Bhutan Telecom Limited and Tashi infoComm Limited. The leased lines for internet services for higher bandwidth requirements will have to be sourced from them. These lease lines offer data security, high access speed, resilience and stable connectivity. However, leased lines are expensive, take long lead times to install and need contract management function to monitor and enforce service level agreement.
8. The Government of Bhutan, in its effort to promote ICT, has started initiatives such as (i) demand creation for Information Technology (IT) and/or Information Technology Enabled Services industry; (ii) talent development; (iii) infrastructure building; and (iv) establishing conducive legal, policy, and regulatory frameworks. The proposed pilot approach will establish the requirements for the larger e-Services initiatives in line with the government's effort. It will provide needed insights to demand generation, infrastructure upgrade, capacity development, and policy requirements.
9. Therefore, it is anticipated that this pilot will help in identifying operational issues and approaches to scale up on a countrywide basis. Discussions with other development agencies will be undertaken to draw lessons, assess risks, and design risk mitigation measures. The concept will provide insights to strengthen the Government's service delivery requirement and establish a sustainable engagement mechanism to plan, maintain, and extend the pilot country wide.
10. The TA will (i) establish dedicated lease line and associated link infrastructure for the project; (ii) pilot implementation of TV white spaces technology in the remote location; and (iii) establish pilot e-Health center. The details on the project components are provided as supplementary appendix 1.