• Connectivity
  • Research2Guidance publishes its eHealth connectivity report

    Working within ecosystems is increasingly important for eHealth. Research2Guidance third report of its mHealth Economics 2017/2018 program deals with connectivity. It sees mobile apps as the core of eHealth connectivity hubs. These extend connectivity to wearables, tracking sensors, medical devices, tools, access to third party aggregated health data and EHRs.

    The report is an introduction to mHealth connectivity in mobile health. It discusses the connectivity landscape too. Contents are: 

    Tool usageConnecting to health data via APIsConnecting to sensors and wearablesConnecting to API aggregatorsConnecting to electronic health recordsOutlook on the future of connected devices. 

    These provide answers questions of:

    What eHealth connectivity options exist?To what extent are eHealth publishers connecting to sensors and wearables?Which tools are mHealth app developers using?Are mHealth app developers offering Application Programming Interfaces (API) for their apps?To what extent do they use aggregated health data through APIs?Which roles do EHRs play in eHealth?How will connectivity to sensors change in the near future?

    It’ll provide a wide range of stakeholders with insights needed for mHealth strategies, plans and initiatives. As Africa’s health systems keep building on their mHealth investments, the report is helpful in moving them on.

  • Africa’s broadband needs to be faster

    Speed’s a bit of obsession in cyber world. Mahatma Ghandi said “There is more to life than increasing its speed.” It might not appeal to a young African trying to download a video. Health workers trying to reach remote communities with valuable health information may not be happy with plodding broadband either.

    A survey of global broadband speeds by Cable.co.uk show’s Africa’s lagging behind the rest of the world. Average download speed for 189 countries was 7.37mps. The average for 39 African countries was 1.91mps, about 26% of the global speed. At 8.83mps, Kenya’s the only African country above the global average. It’s below the global average plus one standard deviation. Seychelles, second in Africa’s rankings operates at 5.84, putting Kenya well ahead.

    Another eleven countries are above the 39-country average. They’re Morocco, South Africa, Tunisia, Madagascar, Nigeria, Zimbabwe, Zambia, Liberia, Uganda, Rwanda and Cape Verde. There speeds range from 4.38mps down to 2.00 mps. Four countries. Kenya, Seychelles,  Morocco and South Africa have broadband speeds above Africa’s average plus one standard deviation.

    Cable.co.uk analysed data collected by research group M-Lab, a partnership between four organisations New America's Open Technology Institute, Google Open Source Research and Princeton University's PlanetLab. Africa’s overall position in the global ranking is in the chart.

    Catching up’s a huge task. For Africa’s eHealth, two goals might be enough. First, creep up to the global average, which’ll probably increase. Next, creep up to Kenya’s speed. It’ll help achieve another of Ghandi’s philosphies that “It is health that is real wealth.” 

  • Broadband infrastructure’s crucial for SDGs

    The Broadband Commission for Sustainable Development, set up by the ITU and UNESCO, is urging policymakers, the private sector and other partners to make deployment of broadband infrastructure a top priority. The goal’s to help accelerate Sustainable Development Goals (SDG). 

    In a statement to the High-level Political Forum on Sustainable Development (HLPF) in New York from 10 to 19 July 2017, the Commission highlighted the many ways that broadband can improve global sustainable development, and improve millions of lives says an article in BIZTECH Africa. It includes addressing basic needs such as healthcare, food production and helping lift people out of poverty.

    "We must work together," said the Commission in its statement, "to harness the opportunities and benefits of ICTs, new and emerging technologies such as big data and artificial intelligence, as well as broadband-based technologies, while safeguarding against their downsides and risks. This will be critical to achieve the SDGs and realize the future we want. Let us seize the historical opportunity of the SDGs to build a model of sustainable development anchored by universal access to affordable broadband technologies and digital literacy in order to fulfil a future where no one is left behind."

    A report from ITU says only 15.4% of Africa’s households are connected to the Internet. There’s much to be done.

  • Can high-speed broadband improve health?

    Acfee sees a huge role for eHealth as helping to achieve healthier Africans. It seems the American Medical Informatics Association (AMIA) has taken it further. In a long letter to the Federal Communications Commission (FCC), AMIA says high-speed Internet access to low-income populations could enable them to benefit from mHealth interventions. Examples include disadvantaged populations accessing mHealth and participating in research studies without paying data charges. 

    It also proposes that FCC policies should leverage broadband-enabled solutions for specific patient populations, such as substance abusers and patients with chronic diseases. Wider and cheaper Internet access is seen as increasing mHealth use by underserved communities, improving their access to health information and care and improving clinical outcomes.

    The concept builds on the FCC’s assertion that of broadband-enabled services and technologies are improving availability and accessibility and transforming healthcare. AMIA also says broadband access is, or soon will be, a social determinant of health, defined as” structural determinants and conditions in which people are born, grow, live, work and age.” Examples are socio-economic status, education, physical environment, employment, life-style choices, clean water supplies and social support.

    This paradigm shift enhances mHealth’s role in health and healthcare. For Africa’s health systems, it may mean a shift to a wide, integrated and bigger mHealth strategies with more explicit, realisable benefits.

  • 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.

    To help to make progress on a bigger scale, a report from the UN Broadband Commission sets out three pre-requisites:

    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.

  • 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/

  • 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.

  • 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.

  • 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.

  • 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.