UN Broadband Commissions says eHealth success has three core parts
Successful and sustainable eHealth’s a challenge for all health systems. For Africa’s, it’s bigger than most, largely due to many types of resources constraints. Acfee’s African eHealth Forum report in 2015, Advancing eHealth in Africa, identified some 60 longstanding eHealth challenges. These are a brake on progress for many African countries.
Committed eHealth financing is one the challenges. eHealth’s a risky endeavour, usually manifested in increasing costs and deferred or diminished benefits. Commitments to eHealth finance and reliance on aid support need setting alongside commitment to and skills in effective risk mitigation.
1. Sustained senior government leadership and committed financing
2. Effective eHealth governance mechanisms that engages stakeholders and their clearly defined roles to ensure efficient decision-making
3. A national ICT framework that facilitates alignments of health and ICT sectors, promotes connectivity and Interoperability (IOp), establishes common standards and enables appropriate policies and regulations.
For eHealth leadership, Acfee sets out two more pre-requisites. They’re clinical and executive leadership. With healthcare’s labour-intensive requirement, political eHealth leadership from governments isn’t sufficient to reach right across the health workforce. All three types of eHealth leaders are needs at health systems’ national, regional, district and local levels.
A literature review for the report identified 21 countries with unique eHealth attributes. Seven are African, Gabon, Ghana, Kenya, Malawi, Nigeria, Rwanda and South Africa. Their profiles offer snapshots of some of themes and opportunities all African countries face in varying degrees.
While broadband expansion is an essential component for success, Africa’s mHealth initiatives offer opportunities to build some eHealth services across expanding mobile networks. An eHNA post refers to an estimated 15% to 20% of Africa’s population living in the last mile. Reaching them with eHealth’s a considerable task.
- 407 views
- May 03, 2017
- Tom Jones
Will NMFI stifle some cyber-crime?
As cyber-crime rises, technology’s fighting back. Near Field Magnetic Induction (NMFI) creates a short-range, low-power magnetic field of about 5.5 metres diameter, a body-area network, around devices. Connections are invisible to anything outside the bubble, so devices inside can transfer voice and data, and not be detected. mHealth Intelligence has said the CIA and FBI have already used it.
Michael Abrams, formerly a paediatric eye surgeon, now CEO FreeLinc Technologies in Boston, says “In two to five years, NMFI will become ubiquitous … The future of medicine lies in connected health, and this is a form of mission-critical communications that healthcare needs.” FreeLinc has several patents on the technology.
FreeLinc’s not alone. In 2012, Nithya Thilak and Prof Robin Braun of Sydney’s University of Technology studied NFMI communication in body-area networks for wearable sensors and devices.
Bluetooth has a low-energy, long-range communications protocol, making its susceptible to hacking from about a mile away. NMFI creates a much smaller electromagnetic zone around devices implanted with the chip. Nearby devices with NFMI attract each other like magnets and can pass information, data and voice, but that attraction disappears outside the bubble because magnetic fields decay a thousand times faster than Bluetooth’s energy. Another advantage is that NFMI uses a fraction of Bluetooth’s energy needed to move the same amount of information.
Abrams says Bluetooth’s gloss’s fading. Maybe, but its name’s better than NMFI. It’s from a 10th century Viking king, Harald Blåtand. He was accomplished at uniting and persuading people through polite negotiations. One result was a united Denmark and Norway. Blåtand in English is Bluetooth. As NMFI can be seen as the next generation from Bluetooth, maybe FreeLinc should name it after one of Blåtand sons, though somehow, Forkbeard doesn’t have quite the same ring to it.
Image from http://www.freelinc.com/
- 495 views
- June 14, 2016
- Tom Jones
How can Africa expand its broadband for health?
Yesterday, eHNA reported on Africa’s broadband challenges. It seems that Africa’s not alone. The UK, despite being ahead of Africa, has its own challenges. What are the lessons for Africa?
The UK’s Institute of Directors (IoD) published Ultrafast Britain, it’s remedy to the UK’s digital divide with Europe. It has some of the worst broadband speeds in the developed world, least reliable broadband in rural and urban areas and patchy mobile coverage. Investing to fix it needs to achieve two goals:
- Immediate improvement, including peak capacity of 3.6 times the average hourly rate
- Future proofing to meet growing demand partly fuelled by better supply, increased video use and the Internet of Things (IoT).
These should be Africa’s goals too, but expanded to reflect a growth in cloud computing, which will be more common and routine in the future, and may have a much bigger role in Africa’s eHealth. The IoD report sees business growth expanding in several sectors, such as rail and sir travel. In Africa, eHealth’s expanding too.
An important theme was emphasised in the report’s launch: broadband solutions have no silver bullet and one size doesn’t fit all. The mix proposed for the UK’s:
- Fibre to and for homes, Fibre to the Home (FTTH)
- Fibre to and for businesses, Fibre to the Business (FTTB)
- WiFi and satellite for mobility.
This doesn’t fit Africa very well. Remote and rural homes can be many miles away from urban centres. It does offer a way to create an appropriate mix. If WiFI and satellite’s seen as needed for mobility, it can support rural and remote homes and businesses to give an African mix of:
- FTTH for urban homes
- FTTH, WiFi and satellite for rural and remote homes, depending on their remoteness
- FTTB for urban businesses
- FTTB, WiFi and satellite for rural and remote businesses, depending on their remoteness
- WiFi and satellite for mobility.
Once it’s installed, fibre’s 20% to 30% cheaper to upgrade and maintain than copper. It offers the most affordable solution. That doesn’t mean that it’s easily affordable. Aerial fibre uses telegraph lines, where they’re in place, offers a lower cost than digging trenches for fibre.
Financing this can rely extensively, but not entirely on the private sector. The IoD says that for rural areas, the Return on Investment (ROI) to suppliers isn’t attractive when FTTH opportunities remain in urban areas. For Africa’s event more rural and remote communities, government spending’s a requirement, but limited by affordability constraints. A long-term investment plan’s needed.
For super-fast broadband, the UK’s in a bid of a competition bind. Four big suppliers, BT, Sky, Talk Talk and Virgin dominate about 95% of supply. Smaller firms take a shrinking 5%. This’s a supply model African countries should try to avoid. One way to do this is to engage smaller, local and national firms in supplying Internet and broadband services to rural and remote communities.
How long will this take? The UK sees 2030 as the horizon. African countries are usually bigger, with more dispersed populations and bigger affordability constraints. An investment horizon well beyond 2030 seems inevitable. Two drivers for faster change are:
- Financial support from aid agencies
- Matching investment against IoT and IoT for health priorities.
New opportunities from IoT for health need new eHealth strategies. This’s the starting point for Africa’s health systems to take new opportunities alongside accelerating business investment in broadband. It’s a challenge that needs sustainable, affordable investment year on year.
- 508 views
- March 08, 2016
- Tom Jones
How can Africa's broadband catch up?
Broadband capacity depends extensively on commercial and business needs. This creates an eHealth dependency on the general economy to meet eHealth’s increasing broadband needs. Both Africa’s eHealth and broadband capacity lag behind the global curve, so how can Africa catch up?
A global broadband map from Akamai, a global leader in Content Delivery Network (CDN) services, shows Africa’s position about a year ago for average connection speeds.
In its latest report, Akamai says the broadband trends still upwards. This quarter’s report includes data gathered from across the Akamai Intelligent Platform in 2015’s third quarter. It includes data for Internet connection speeds, broadband adoption metrics, the state of IPv4 exhaustion and IPv6 adoption, Internet disruptions, and observations from Akamai partner Ericsson about voice traffic growth on mobile networks. It found that something may be stirring in some African countries, both up and down:
- Globally, average connection speed increased by 14% over the year to 5.1 Mbps
- South Korea’s top at 20.5 Mbps
- Increases were in 126 countries
- Congo’s growth rate was spectacular at 147%, the only country to see average connection speeds more than double, but it’s still low
- Declines were in 19 countries, including a 0.6% in Namibia to 1.8 Mbps and a 64% in Sudan to 1.3 Mbps
- Libya was one of two countries with an average connection speed below 1Mbps
- Gabon and Cameroon, had significant Internet disruptions.
Peak connections speeds are rising too:
- Globally, peak connection speed increased by 30% over the year to 32.2 Mbps
- Singapore’s top at 135.4 Mbps, up 63% on the year
- Increases in average peak connections were in 135 countries
- Mauritius and Congo achieved average peak connection speeds double over the year
- Ghana experienced a large fall of 51%, to 8.8 Mbps
- Tanzania had the lowest average peak connection speed after a 23% quarterly drop to 7.2 Mbps
- Zambia was bottom last quarter and saw a 22% gain in the third quarter to 9.0 Mbps.
South Africa, ranked 92 globally, has the highest average and peak speeds of African countries. They’re 3.7Mbps and 18.9 Mbps. They’re up 2.3% and 10% over the year. It also has the highest adoption rate of 22% for >4Mbps, but only ranked 90 globally. Its rate’s 2.9% for >10Mps. Both are down, 5.2% and 15% respectively. All other African countries increased their 4Mbps adoption rates.
Internet Protocol version 4 (IPv4) addresses authorised by AFRINIC, the Regional Registry for Internet Number Resources serving the African Internet Community increased from about half a million to about five million. Globally, IPv6’s expanding. It’s an evolutionary standard running alongside IPv4 that increases the pool address. It offers technical improvements too.
With Africa’s expanding mHealth base, mobile connectivity’s vital. Ericsson found that global mobile data traffic grew by 14% between the second and third quarters of 2015. Voice seems stable, while the growth in data’s shooting up from about 200 petabytes a month in 2010 to about 4,700 in 2015’s third quarter. The growth in video’s fuelling the rise.
In this context, the Broadband Commission’s report, The State of Broadband 2015, shows Africa’s mobile broadband connections as 5% of the population. Asia Pacific’s top at 50%. In Africa, Fibre to the Home (FTTH) is a considerable challenge. The Return on Investment (ROI) to suppliers isn’t attractive when FTTH opportunities remain in urban areas. For rural and remote communities, government spending’s a requirement, but usually limited by affordability constraints.
The report highlights Internet of Things (IoT) as a broadband driver. More alarmingly for Africa, it describes a new digital divide. Some 30 years ago, a UN Commission published the Maitland Report to identify actions needed to deal the growing digital divide in telecommunications. Progress masks a new, growing digital divide in the next Internet phase driven by IoT. Africa’s estimated growth is from 1 new, connected device to 1.4 per person from 2014 to 2019. North America’s estimate’s 6.1 to 11.6. Western Europe’s 4.4 to 8.2. From a start already below the rest of the world, Africa’s forecast to bump along.
Africa’s eHealth’s affected adversely by these broadband and Internet trends. eHNA’s already reported on GE’s IoT for health goals. These opportunities will be constrained if Africa’s healthcare can’t have more broadband capacity. eHNA’ll post tomorrow on possibilities to turn the trend up.
- 551 views
- March 07, 2016
- Tom Jones
Gulf to Africa cable coming soon
Communication technology’s on it’s way to North East Africa. Middle East wholesale carrier and national operator of Oman, Omantel, has entered into a supply agreement with Xtera Communications to construct a submarine cable linking Oman with Somaliland, Puntland and Ethiopia. The new low-latency cable system, Gulf to Africa (G2A), will be developed in partnership with Ethio Telecom, Golis Telecom and Telesom Company, and will connect Salalah in Oman to Bosaso in Puntland and Berbera in Somaliland. There’ll be a terrestrial extension to Addis Ababa in Ethiopia too, says an article in ITWeb Africa.
The G2A cable will bring content closer to end-users in Africa, provide Somalia and Ethiopia with internet capacity, and access to cloud services and apps. Xtera will supply its turnkey 100G/100G+ submarine cable system solution for this project, including subsea optical repeaters, Nu-Wave OptimaTM Submarine Line Terminal Equipment (SLTE), cable and all marine services. Designed for 20 Tbit/s of capacity with the latest 100G technology, the G2A system, will optimise the connectivity costs in Africa and add needed capacity to an under-served and fast growing region.
The new connectivity brings opportunities for a wide range of sectors, including healthcare. It lays the foundation for further digital health initiatives that could help improve healthcare quality, communication and analytics.
- 501 views
- February 23, 2016
- Lesley Dobson
Nigeria-Cameroon submarine cable's live
MainOne, a leading telecoms and network services provider in West Africa, has announced that the high capacity Nigerian-Cameroon Submarine Cable System (NCSCS) connecting Lagos, Nigeria and Kribi, Cameroon has been completed and is now live. The new submarine cable system will address increasing demand for reliable broadband connectivity in Cameroon, and is a key component of the country’s strategic plan to provide internet access to its citizens through its National Broadband Network, says an article in BIZTECH Africa.
The submarine cable is the result of a tripartite partnership between MainOne, The Ministry of Post and Telecommunications and Huawei Marine Networks. The 1,100 kilometer submarine cable system will deliver capacity of up to 12.8Tbps to broadband users in Cameroon and has 40GB capacity. This extension is expected to boost Cameroon’s extremely low fixed broadband penetration, currently estimated to be around 5%.
Built with branching units for strategic extension of its connectivity into Nigeria’s Escravos in Delta State, Qua Iboe in Akwa Ibom State, and Bonny Island in Rivers State, MainOne has concluded plans for a distribution hub in Port Harcourt. It’ll bridge the technology gap between the South-South and the rest of Nigeria.
Speaking on the milestone, David Nkoto Emane, General Manager, Cameroon Telecommunications Corporation (CAMTEL), said, “The NCSCS system enables us to provide users with faster bandwidth connectivity at a significantly lower cost. By providing direct connection to Nigeria, the cable system will also serve to enhance Cameroon’s position as the major bandwidth hub in the region and internationally to Europe and beyond.”
Sustainable high speed connectivity help lay the foundation for digital healthcare in Cameroon. mHealth and eHealth solutions which were previously impossible because of connectivity constraints can now be developed and implemented.
- 570 views
- January 15, 2016
- Lesley Dobson
Is more connectivity what African eHealth wants for Christmas?
A huge, long-standing challenge for Africa’s eHealth’s expanding connectivity to reach more people and enable more use. As mobile phone numbers and coverage expand, and mHealth opportunities with it, there’s many other typed of eHealth, such as hospital information systems that rely on other types of connectivity and networks. As these expand, connectivity and the networks have to expand too, and this is on top of the investment needed to improve existing networks to meet users’ needs.
Michael Lewis describes an extreme example of network investment in Flash Boys, the story of faster, allegedly immoral electronic trading on USA’s stock markets. Network projects that shave a few milliseconds, a thousandth of a second, off networks speeds to change and improve traders’ performances and add lots of US$ to their organisations’ profitability.
It can take between one and four tenths of a second to blink, so investing in a few extra milliseconds of network speeds is beyond Africa’s eHealth needs. Instead, a survey by Corning, Healthcare Facilities Struggle to Keep up with Rapid Growth of Network Demand, and published by Fierce Markets, offers a more realistic option.
Alongside expanding health workers’ network needs, patients and families want more reliable, connected services too, but hospitals’ networks are under strain and clogged up. Corning, a fibre-optic supplier, surveyed four main types of healthcare organisation: hospital systems, 38%, healthcare facilities, 31%, university hospitals, 17%, and teaching and multi-system hospitals rounded, 14%.
Network needs are driven by other eHealth investment that includes:
- 69% healthcare facilities provide clinicians with laptops
- 69% provides computer workstations on wheels
- 49% supply smartphones
- 36% provide cell phones
- 36% provide tablets
- 32% offer pagers
- 24% offer tablets not specifically designed for healthcare.
Each facility provides an average of 3.2 devices with network capabilities to each of their clinicians. These need network capacity:
- 69% use wireless apps for clinical communications
- 60% for medical device connectivity
- 43% for Wireless Medical Telemetry Services (WMTS)
- 42% for inventory management using Radio-Frequency Identification ( RFID)
- 29% for location and tracking using Real-Time Locating Systems (RTLS) or Bluetooth.
In this setting, more than half the respondents said inconsistent cellular coverage is a problem. About 53% said slow data transfer from wireless devices is too slow. Some 76% said Wi-Fi is either always or sometimes not sufficient for guest and clinical use. Some of these constraints adversely affect patient safety and slows down some clinical decision taking.
Solutions aren’t simple. Nearly 20% upgrade their networks every two to three years. About 34% upgrade every four years or more. About 39% don’t know. As eHealth expands and relies more and more on the cloud, network capacity will need expanding further, probably with more frequent upgrades. Network investment will need an increasingly bigger share of Africa’s eHealth resources to keep up.
- 460 views
- December 25, 2015
- Tom Jones
Will light-spots replace hot-spots?
Since 1997, Wi-Fi’s expanded access to the Internet at an enormous rate. Like all technology, it suffers from obsolescence, and after 18 years, is it’s time coming? Velmenni, an Estonian start-up, has used Li-FI successfully. The International Business Times (IBT) has reported on the achievement of using a Li-Fi-enabled lightbulb to transmit data at 1 gigabit per second (Gbps).That’s about 100 times faster than Wi-Fi’s radio signals.
Li-Fi uses Visible Light Communications (VLC) technology. It’s a subset of optical wireless communications technologies that delivers high-speed, bidirectional, networked mobile communications. It works in a similar to Wi-Fi, but much faster. In 2008, the Institute of Electrical and Electronics Engineers (IEEE) released IEEE P802.15 Working Group for Wireless Personal Area Networks (WPANs), a tutorial on VLC. Since then, Harald Haas, a physicist at Edinburgh University, set up pureLiFi. It now has a partnership with a French industrial-lighting company to roll out VLC technology in its bulbs in 2016. Li-Fi might be available a few years after these light-spots are available.
VLC, so Li-Fi, works with Light Emitting Diode (LED) bulbs. They’re semiconductors, so the optical output can be modulated at very high speeds and detected by photodetector devices that can convert signals back to electrical current. To create Li-FI, a microchip needs fitting to the LED bulbs.
IBT says Li-Fi won't work through walls. It doesn’t work outdoors either and it needs the lights on all the time to deliver connectivity. These limitations may mean that Li-FI and Wi-Fi may work alongside each other, so it may be too soon to think about turning the lights out in Wi-Fi.
- 474 views
- December 11, 2015
- Tom Jones
When will Wi-Fi overtake cellular networks?
Africa’s growing number of mHealth initiatives may be accompanied with a change in its communication infrastructure. Wi-Fi First says that Wi-Fi’s everywhere, and it's disrupting the mobile industry in a big way. Will it boost mHealth in Africa?
Wi-Fi First℠ is an infrastructure where mobile devices and services use Wi-Fi hotspots as their main network. Cellular networks are only used to fill the blackspot gaps. Free, a French ISP started the trend in 2012. GIGAOM likens it to a French revolution. It’s claimed that it has considerable benefit for consumers and offers new business models by putting Wi-Fi and at the forefront of mobile communications.
A recent survey found that 90% of people spend at least nineteen hours a day within Wi-Fi range. The Wireless Broadband Alliance says the number of Wi-Fi network access points is expected to reach 5.8 million by 2015, up from 1.3 million in 2011. Alongside this, Cable Wi-Fi is could soon have more availability than cellular infrastructure.
An article in The Economist says that the Wi-Fi First growth could catch out cellular providers, similar to the way that Skype did with telecoms companies. Last year, Conventional networks had 569 billion minutes of international calls. Skype had 248 billion, more than 30% of the minutes.
For Africa’s healthcare, the issues are first, will Wi-Fi First help to expand the continents mHealth growth? Next, when will it make a difference? Then, will it be a big difference. It could all depend on the number and distribution of the hotspots.
- 508 views
- June 30, 2015
- Tom Jones
Cote d'Ivoire has an Orange dialogue
Dialogue is crucial to successful stakeholder engagement. Elie Wiesel, a Romanian-born American novelist and 1986 Nobel Peace Prize winner, sees dialogue as “I continue to cling to words because it is up to us to transform them into instruments of comprehension.” Orange and Cote d’Ivoire’s health system are using Orange’s specific, structured dialogue mechanism to involve members of its healthcare ecosystem, including government, healthcare professionals, and patients.
The dialogue began in Abidjan and the Bouaké region in February this year. They addressed day-to-day healthcare challenges faced by Ivoirians, aiming to identifying appropriate, relevant ICT solutions. Four major issues emerged:
- Healthcare affordability
- Geographic accessibility
- Medical care quality
- Disseminating prevention and awareness information.
Affordability topped patients’ eHealth solutions and its links to geographic accessibility. Initiatives for remote medical monitoring, dedicated hotlines, and information and prevention campaigns by text and voice messaging were seen as good initiatives.
Doctors wanted the development and provision of distance learning and a professional directory. Institutional representative stakeholders’ priorities were computerisation of patient data and healthcare services networks. EHRs were accorded a high priority.
A challenge is now is for Cote d’Ivoire to integrate these stakeholder perspectives for a set of affordable eHealth initiatives over an investment timescale. After that, procurement, successful implementation then benefits realisation follow. The African Centre for eHealth Excellence (Acfee) shows that success for each of these depends extensively on continuous, effective stakeholder engagement.
This in turn depends on continuous, effective, constructive dialogue. Cote d’Ivoire seems to already have it in place. It hasn’t fallen into the trap that Edward do Bono found when he said “In 80% of Socrates' dialogues there was no constructive outcome. He saw his role as simply pointing out what was "wrong.” What’s needed is always better.
- 555 views
- June 19, 2015
- Tom Jones
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