BRIDGING THE INFORMATION DIVIDE - HEALTH AND THE INTERNET SPECIAL Identifying ways that ICT can produce better health care Fighting trachoma: organising an ICT-based health campaign HIV/AIDS: using an e-mail list group at the sharp end Joined-up thinking for Africa's health centres Connecting malaria research centres by internet and satellite News round-up & Snippets On the money Useful websites and discussion lists Digital toolbox/ In search of the business model Jobs, people, events... Free small ads

If our correspondent is "off the mark" or you have factual amendments, mail them to us and we will include them in subsequent News Updates. If you'd like to contribute, write and let us know. If you need information about a particular place or issue, just send your questions in. We are always happy to follow up on readers concerns.

COMING SOON: THE INTERNET IN CAMEROON AND AFRICA'S E-COMMERCE REALITIES

ISSUE NO 35

BRIDGING THE INFORMATION DIVIDE - HEALTH AND THE INTERNET SPECIAL

Health care is the second largest industry in Africa but it is the most complex, cumbersome and paper-based. The opening article to this health and internet special by Lishan Adam argues that that ICT (in particular the internet) can make scarce healthcare resources work more effectively. The articles that follow explore how this might be achieved in detail.
Benedict Tisa looks at using ICT to combat trachoma. Omololu Falobi explains how Nigeria - Aids uses an e-mail list to combat HIV/AIDS. Chris Zielinski explains how Health Information for Africa plans to link up health information resource centres. Chris Bell explains how satellite and the internet were used to link up malaria research centres, several of which were in rural areas.

Identifying ways that ICT can produce better health care

CONTENTS

Health care is the second largest industry in Africa but it is the most complex, cumbersome and paper-based. There is only limited co-ordination amongst the different providers. Although major strides have been made over the last century in preventing disease and extending life, the situation in the health sector in Africa remains bleak. Life expectancy in most countries has declined below that of 1960s. Ravaging epidemics, spread of infectious disease, high level of infant and maternal mortality have now been exacerbated by a combined force of HIV/AIDS, Tuberculoses and Malaria (HTM). The incidence of AIDS is likely to diminish life expectancy by 20 years. All efforts to improve Africa's gains in economic development have been undermined by these threats to the health sector. Lishan Adams explains.

These threats have put tremendous pressure on African Governments. Some countries have declared HIV/AIDS as a national crisis. Others have continued to focus on increasing the availability of healthcare, training more doctors, construction of clinics and hospitals. Unfortunately a vicious cycle has set in. Declining economic activity means fewer resources. Therefore there are fewer resources to combat illnesses in the productive workforce and this undercuts the very economic "motor" needed to produce more resources.

Nevertheless, grounded observation and research indicates that most of Africa's health crisis is caused not by lack of resources alone but rather by information poverty and inadequate communication strategies to change attitudes to healthy life style, to control disease and change the quality of lives of communities and families.

"Information poverty is one of the most serious obstacles facing health, sector," according to Dr Ruhkana Rugunda, Minister of Foreign Affairs of Uganda - a medical doctor himself. Only a scant portion of the world's rapidly expanding medical knowledge trickles down to Africa. While most libraries in Europe subscribe to 2000-3000 medical journals, their equivalents in Africa often hold less than 30 old and sometimes discontinued medical journals. Efforts to bring connectivity and access to medical community in the region seems to remain poorly resourced. Whatever connections exist in the region they are mostly for medical faculty members- not for students. Many deaths in Africa could have been avoided and several problems faced by health professionals could have been overcome simply by having adequate information at hand when needed.

ICT could play a substantial role in shaping the information crises in the health sector in Africa. Opportunities are endless - ranging from improving management and administration of health institutions, fostering teaching and research, supporting decision making on curative and preventive health, improving distribution of medical supplies and bridging gaps between access to health services in rural and urban areas. Significant benefits could also be achieved in primary health care.

Over 90% African population that lives in rural areas could greatly benefit from information on better choice of food, safe water and basic nutrition, child care, family planning, immunization, prevention and control of endemic disease. Information and communication (traditional and modern combined) could play significant roles in collection of population-based health data and its transmission for decision making and research. Primary health care information could be gathered and packaged into programme content for community radios and telecentres to strengthen healthy life styles and to promote positive health behaviours.

The chronic shortage of specialists in rural areas in Africa could be narrowed by application of telehealth/telemedicine. Pilot telemedicine projects such as the one linking doctors in Beira to radiologist in Maputo have already shown that telehealth can give rural areas a more informed and better level of health service. It provides diagnostic data and expert opinions from specialists to rural health attendants. Telemedicine has also been proved vital for consultation, continued medical education and reducing costs and inconvenience to patients and health services.

The most significant benefit of ICTs could be derived from improving the management and administration of health services in Africa. A quick walk into a typical African hospital or health care center demonstrates enormous inefficiency, waste of resources, time and life. Poor quality of services, long queues and cumbersome treatment procedures that are costly both for patients and institutions are common. An overwhelmingly manual system in health institutions is prone to enormous inaccuracy, hinders the flow of information and impedes health care delivery and administration. Clinical Information Systems that cover patient records, bed-side data, lab records, drug use, demographic movement of patients, etc. could bring a substantial cost and life savings.

Africa has also remained far behind in sharing its medical research. Although considerable knowledge has been gained through access to diseases as a result to high patient to doctor ratio, this has not been available to local health professionals, other countries in Africa and worldwide. Lack of access to growing medical information by health workers and medical students means that Africa has difficulty in keeping up with the magnitude of medical literature, guidelines for practices and experience and evidences and remained silent in sharing what it knows. ICTs have increasing role in bridging this two ways communications gap.

Limited work has been done so far in shaping the use of information and communication technologies in the fight against HIV/AIDS elsewhere. However, it is clear that ICTs could play a key role in collection of demographic information to map the pandemic, in strengthening delivery of public education messages and to network professionals, care provides, decision makers and patients. There is already a growing community of people that uses computer networks to provide support and to help one another against the HIV/AIDS pandemic. (PUT IN REF TO ARTICLE BELOW)

Using ICT as a central tool in the dissemination of health information and knowledge requires a concerted effort at all levels. Weak infrastructure, limited resources, resistance etc., will continue to work against using ICT in reducing the health information and knowledge gap. Most of these challenges cannot be dealt with by the health sector alone. Countries need to have strategic responses at a governmental level for the use and implementation of ICT. Countries need to co-ordinate regionally to develop and exchange of local content and knowledge and to pool resources. It is important to raise awareness of the implications of ICT in the health sector in Africa. It also vital to introduce medical informatics to medical research institutions through out Africa so as to build a "corps" of skilled champions that can use new technologies, disseminate knowledge and act as evangelists for reduction of information poverty through expanded use of ICTs for better health in Africa.

Lishan Adam works for UNECA.

Fighting trachoma: organising an ICT-based health campaign

CONTENTS

Helen Keller International has begun a five-year project to expand community education and school health interventions in eight countries to help reduce trachoma, which is the second leading cause of blindness in the world. The Bill and Melinda Gates Foundation has funded the project, writes Bernard Tisa.

Trachoma is best described as a community disease, which can often be controlled with simple methods implemented within the community. Most of the active disease is concentrated in sub-Saharan Africa. 6 million people are blind or at high risk of blindness from trachoma, and roughly 4 million of them are women. Another 150 million, mostly children, need treatment for active disease. 540 million people, or 10% of the world‚s population, are at risk of developing the disease. The World Health Organization has endorsed a four-part strategy to eliminate trachoma as a blinding disease:

S: A simple surgical correction for trichiasis
A: Antibiotic treatment for active infection
F: Regular face washing helps prevent the spread of the infection
E: Specific environmental improvements that reduce contributing factors

In addition to technical support such as the training and equipping of trichiasis surgeons, HKI seeks to nurture and support community action through introducing or expanding school health activities, and improving health education through in-service training and information dissemination. The strategy is based on two interrelated interventions:

1) An innovative school-based community trachoma and eye health program which can be linked to the curricula of individual countries; and

2) the expanded application of information technologies to build local and regional health networks to improve the quality of education and trachoma information. Although trachoma and environmental sanitation is the core focus, other health topics based on community need are also addressed.

In February 2000, the first international workshop on Trachoma School Health and Information Technology was held Zagora, Morocco. 35 participants including HKI staff and partners represented nine countries from Africa and Asia. School health activities are currently being piloted in Mali, Morocco, Nepal, Niger, and Tanzania, with others to follow. The school health strategy involves four levels of activities:

• lesson plans linked to school curricula,
• community outreach, child-to-child and other non-formal education approaches to reach out of school children
• screening and service delivery for treatment of active disease.

All lessons and materials are developed directly by teachers with input from project staff and other community representatives.

In June 2000, the second international workshop focused on information technology for health and education. This workshop was held in Bamako, Mali and included forty participants from five francophone countries: Burkina Faso, Mali, Morocco, Niger, and Togo. Participants represented HKI offices, Ministries of Health, Education, nongovernmental partners such as PFIE, a Malian environmental organization, and C.R.A.N. a regional nutrition center in Lomé, Togo. The workshop was held with the help and cooperation of the InfoCom Project (USAID/Mali), URTEL (National Community Radio Association), the Spider Internet Café/Bamako and the WorldSpace Foundation. Workshop objectives included:

• Demonstrate use of the Internet, World Wide Web, listservers and plan how to use these application within project activities;
• Establish an email account and practice its use;
• Develop a basic understanding of desktop publishing, including the use of digital cameras, and production of at least one prototype material;
• Demonstrate the WorldSpace mobile unit, demonstrate the digital radio, and discuss its potential use within school health and community health education strategies.

Equipment and materials have already been installed in Helen Keller International offices and local partner organizations in Mali, Niger, and Morocco; equipment will be installed in the remaining countries within the next few months. National and/or local workshops within each country are scheduled during the next 3 months. As an example, equipment installed in Fada N‚Gourma, Burkina Faso, a trachoma-endemic area, will reinforce the ability of local education and health offices to deliver quality education and public health services within schools and community.

A new partnership with the WorldSpace Foundation affords the opportunity to download information via satellite using inexpensive digital radios, enabling better information dissemination and distribution of education materials to remote areas. For example, training manuals such as HKI‚s Basis Eye Care for Community Health Workers can be downloaded and adapted for local use.

Within the next month, the HKI Trachoma Web site and listserve will be accessible to other interested agencies, providing additional information and exchange about HKI and other international efforts to control trachoma.

For further information, contact Kirsten Laursen, Project Team Leader Benedict Tisa, Senior Technical Advisor at: TrachomaLearn@mail.com. Trachoma School Health and Information Technology is a Project of the HKI Trachoma Program.

HIV/AIDS: using an e-mail list group at the sharp end

CONTENTS

One group in Nigeria is tackling the health information gap at the sharp end. Omololu Falobi shares his experience of using the internet to combat HIV/AIDS in a resource-poor environment. This is one of several examples aired on the ADF that addresses HIV/AIDS issues across Africa.

"I run an internet-based discussion forum and news group on HIV/AIDS in Nigeria called 'Nigeria-AIDS' (Web site: www.egroups.com/group/nigeria-aids). From an initial list of eight people in 1998 (when it was only a monthly bulletin on email) the e-forum currently has about 470 members who write in to exchange ideas and circulate urgent information on their work or the AIDS situation in Nigeria. Subscribers often forward messages on the forum to their own internal networks and listservs, leading to an estimated daily readership/hits of up to 1000".

"Subscribers and visitors to the Nigeria-AIDS forum include individuals from a wide range of backgrounds, including: HIV/ AIDS NGOs and CBOs, donor agencies, people living with HIV/AIDS, the scientific community, media organisations, international organisations and UN agencies, the public service, educational establishments and human rights organisations, national and international NGO networks as well as health documentation and resource centres. Of the present number of subscribers to the forum, about half are based in Nigeria".

"Using the 'Nigeria-AIDS' forum, members discuss current issues and information about HIV/AIDS in Nigeria. They also receive the monthly Nigeria AIDS Bulletin, news and views on HIV/AIDS from Nigerians across the world, information about grants, resources, international job vacancies, upcoming conferences as well as research reports and other news relevant to Nigeria. Members can also post information about themselves or their organisations, or make inquiries on any health issue".

"No one pays to access information on the 'Nigeria-AIDS' forum. Membership is free and open to anyone interested in HIV/AIDS or other health issues in Nigeria. Anyone can join by sending a blank email message to <nigeria-aids-subscribe@egroups.com> or leave at will by sending an 'unsubscribe' message. Messages on the forum are also archived on the web site: <www.egroups.com/messages/nigeria-aids> "

"The 'Nigeria-AIDS' forum is a project which I helped start in January 2000 in response to an identified need to get discussions about the HIV/AIDS situation in Nigeria out in the open and ensure stakeholders' participation in the HIV/AIDS policy formulation and implementation process in the country".

"In more ways than one, the Nigeria-AIDS e-forum has helped guide the policy response and stakeholders' input into the HIV/AIDS policy formulation and implementation process. It has also helped forge greater networking among AIDS workers and exposed them to skills-building opportunities and best practices".

"One of the weaknesses of the 'Nigeria-AIDS' forum is that it is intrinsically restrictive. It is not easily accessible to millions of Nigerians who cannot afford to pay for an e-mail account or internet time at cybercafes. But we know that the real need for HIV/AIDS is among the poorest of the poor, in slum settlements in our urban areas, in rural towns and villages where there are no cybercafes. We are currently exploring strategies to overcome this weakness".

"The experience of the 'Nigeria-AIDS' forum has led to the creation of two other e-mail networks on other aspects about HIV/AIDS: 'Durban2000Community' , a news forum on the 13th International AIDS Conference which held in Durban, South Africa in July 2000 and 'Treatment-Access-Ng' (www.egroups.com/group/treatment-access-ng), an electronic list which discusses issues of access to HIV/AIDS treatment and care in the African context".

"My experience with these e-forums has led me to realise the huge impact achievable with email networking. Even in resource-poor settings like Nigeria where internet costs are still very high, email is still a much more cheaper, immediate and effective medium for networking than say, the monthly newsletter or monthly meetings. It is an activity that a small organisation or a single individual with a PC and a vision can float and reach out to audiences near and wide".

Omololu Falobi is based in Lagos, Nigeria ( omololuf@micro.com.ng )

Joined-up thinking for Africa's health centres

CONTENTS

There are many health information resource centres throughout Africa but nobody knows how many. What do these centres do? What are their policies and aspirations? Where do they get their information and what do they do with it? What technology do they use &SHY; the options include voice, pencil, pen, typewriter to photocopier, computer, CD-ROM, scanner, printer, telephone and modem &SHY; and what training have they received in this technology? Are they engaged in translating and republishing information they collect, or do they just pass it on unchanged? To what extent do they originate their own information? Do they share it with other centres? Chris Zielinski of Health Information for Africa (HID) explains how they are seeking to get answers to these questions.

All of these questions have been impossible to answer on any large scale to date, mainly because the typical health information resource centre (HIRC) operates pretty much alone and in isolation of other centres. One of the two principal objectives of the Health Information for Development (HID) project is thus to provide comprehensive information about as many HIRCs as possible. The project was launched in January 2000, after considerable discussion conducted through the Health Information Forum (a British NGO think-tank supported by INASP and the British Medical Association), and online lists such as AFRO-NETS and AHILA Net. Health Information for Africa's Director Chris Zielinski is a former Director of Health and Biomedical Information at WHO/EMRO.

Working with numerous partners throughout the world, HID will produce a Global Directory of Health Information Resource Centres, which we intend to publish in January 2001 for wide circulation in paper, CD-ROM and electronic form. The Directory will contain information about several thousand centres, and is being created as a philanthropic, non-profit, public-service activity with the assistance of the Bill and Melinda Gates Children's Vaccine Program at PATH (Program for Appropriate Technology in Health).

At present, questionnaires are being distributed to the HIRCs themselves, as well as to "intermediary organizations" such as WHO. The questionnaires have been elaborated with input from a 35-person Project Advisory Board. Policy issues are considered by the Board, as well as by a Policy Advisory Council which includes foundations (Gates/PATH, Open Society/Soros), international and regional organizations (AMREF, ECA, Third World Academy of Sciences, WHO, UNDP, UNFPA) and others (British Council, British Telecom). Please fill in our questionnaire at www.iwsp.org or request the e-mail version from dvt@compuserve.com (available in several languages, including English, French and Swahili).

Preliminary results are interesting. We have so far had about 600 replies. Each of these documents the surprising range and extent of the activities of the centres contacted.

Before summarizing these very early findings, I should declare that about two-thirds of these respondents sent their questionnaires in through the web site and by e-mail. This is clearly far from being representative of the actual situation among health information resource centres, and we will certainly find the skewing of results redressed with the increasing arrival of hand-completed ink-on-paper questionnaires.

• The centres were of various sizes &SHY; from 2 to 320 staff. Equal numbers considered themselves to be largely self-supporting or funded by their Government or Ministry, and just under 40% were funded by a foreign donor. Two thirds of them considered information handling and provision to be their "primary activity", and the remainder considered it to be a "secondary activity".
• When it came to technology in this very particular sample, over 80% of the centres had at least one computer. Centres that didn¹t have computers predictably considered they could achieve their objectives better if they had one or more (88% of them), while fully 96% of the centres that had some form of computer technology considered that they needed more or better computers, training or databases.
• In considering who used the information gathered or produced by these centres, all the expected categories came up &SHY; primary/community health workers, hospital staff, doctors, nurses, researchers/teachers/students, ministry personnel and institutions. The Centre¹s own staff and the general public were also served by most centres. An interesting finding was that over 80% of centres shared their information with other centres and NGOs in the country, and over 30% shared the information with other centres and NGOs abroad. This is quite compelling evidence for an inherent drive to networking.
• Where does the information come from? Majority categories included self-produced materials and sources within the country, but 76% also used information originating outside the country. Over half received information through the Internet and 44% received it via CD-ROM or diskette.
• In this sample 59% of the centres used local non-formal/indigenous knowledge, while 79% used local formal knowledge (local journals etc.)
• When it comes to what centres do with the information they receive, we find them covering the whole gamut from simply reproducing and distributing what they receive unchanged, to adapting and otherwise modifying (54%) and translating (40%) materials. Three-quarters of centres provided information to users on demand by non-electronic means (usually to people coming to the centres to consult the information), while just under half provided information electronically.
• The questions on training were unequivocal &SHY; even though appreciable percentages of staff had already received training in information handling skills (38%) and technology (47%) over 80% wanted further training in each category.

With the clear expression of the needs for such capacity building expressed in the Directory, we trust to secure the funding to make the long-cherished dream of a sustainable network of health information resource centres throughout the world a reality.

Apart from providing a description of each centre, the Directory will include a clear indication of the real needs of all the centres. We intend to use this information as the basis for a project proposal for a very large-scale programme of capacity building called the Information Waystations and Staging Posts project.

The Information Waystations and Staging Posts project aims to strengthen 1,000 selected HIRCs into fully equipped electronic "information waystations" that will provide locally appropriate content on health issues.

As such, this is the largest programme of support ever proposed for health information resource centres. Nevertheless, the project is intended to reinforce existing health services, education systems and networks, not replace them. This five-year project will cost US$45 m. Funding is currently being sought.

As a start, we are preparing to embark on a series of pilot projects throughout the world. In the African continent, we have been discussing with a wide range of partners from the North and South and donors the prospects of projects in sub-Saharan Africa &SHY; East Africa, West Africa , Southern Africa and the Indian Ocean Islands &SHY; as well as North Africa and the Middle East. A proposal has already been submitted for support from the World Bank's infoDev program, and further proposals are being developed for submission to the European Commission and other major donors. Most of these proposals have been under preparation and discussion for as long as a year, so the groundwork has been quite painstaking.

In due course, I look forward giving you news of some success in securing funding for these initiatives, which have been based on over 3,000 e-mails, as well as numerous meetings, and other discussions by telephone and face to face that have been exchanged around the project. And we welcome correspondence from all News Update/Balancing Act readers. Above all, please complete one of our questionnaires!

Chris Zielinski, Director, HID Health Information for Africa, P.O. Box 40, Petersfield, Hants GU32 2YH, UK
e-mail: dvt@compuserve.com web: www.iwsp.org

Connecting malaria research centres by internet and satellite

CONTENTS

Medical scientists throughout the world are working together in the field of malaria research to develop vaccines that can overcome this widespread and frequently fatal disease. However may of the research sites are by their very nature sited in remote areas where the mosquitoes are found. In Africa the Multi-lateral Initiative on Malaria (MIM) has embarked on a programme, lead by the US National Library of Medicine (NLM), to co-ordinate and address the many issues this research work is facing. Amongst these are the absence of reliable Internet communications at many sites which has been solved by a satellite communications in ways that Chris Bell of Redwing Satellite Solutions outlines.

Malaria is a killer disease that afflicts many millions of people throughout Africa and other parts of the world. Unfortunately there are a number of strains which require different preventative solutions and treatment of infected patients. In Africa malaria is a major problem and research is being undertaken in many countries and at multiple sites to understand this disease better and develop a vaccine or other treatments which will reduce the suffering it causes. For the researchers working in remote areas of Africa many of the sites themselves have problems, apart from the mosquitoes, which include unreliable power supplies for refrigerators in which to keep specimens cold through the lack of computer facilities to poor local telecommunications infrastructure which seriously limit the exchange of scientific information. So what do places like Kilifi, Navrongo, Kisian, Accra and Nairobi have in common? Well they all are part of the African Malaria VSAT Project( MIM) and make use of satellite communications. This in turn enables them to exchange scientific data and clinical trial results with other centres which it is hoped will accelerate the development of suitable treatments and vaccines

Since the beginning of this initiative many changes have taken place at these sites and more are on the way. These range from the installation of new back-up generators to ensure an uninterrupted supply electricity all year round to state of the art local area network computer systems with wireless local loop and fibre connectivity linking separate buildings. Where sites can get good local access to the Internet through an ISP that is being done, however some sites are too remote or the local connectivity is either inadequate or unreliable so a satellite link has been installed.

Now for the first time many of the sites have on-line Internet connectivity that is probably better than most people are able to access in their offices, schools or homes. The impact of these technologies is impressive for now even the most remote sites have high quality Internet access through which they can send reports of clinical trials and look at other scientist s research in real time.

Those sites that use satellite communications have installed a 2.4 meter antenna with a small C-band transceiver and modem which connects to a router. This in turn connects to the sites server which the network manager is also able to manage and reconfigure over the satellite. All sites using satellite communications receive the same 512kbps carrier and the router throws away any packets that do not have an IP address associated with the specific site. By putting all IP traffic for the various sites into the same carrier much more efficient use can be made of the total available satellite capacity.

Each site is assigned a Committed Information Rate (CIR) which guarantees it a minimum amount of capacity whenever there is traffic for the site. In addition the site has a 'burst' CIR which allows it to use capacity that is assigned to other sites but is not in use. In this way very little, if any, capacity remains unused during the day which in turn results in a more cost effective solution. For sending traffic each site has a permanent connection to the Internet with a fixed data rate of 32, 64 or 128kbps depending upon the size of the site and its level of traffic. All the data rates and CIR's at the remote sites can be changed by the network manager sending commands over the satellite At the hub station just north of London the satellite network is directly connected to the Internet backbone at the same rate as is used over the satellite to achieve the maximum possible throughput

The asymmetric nature of the network and the fact that all the data rates can be individually sized for the specific sites means that the network can operate with a minimum amount of bandwidth. Traffic statistics are being collected from all sites. This will be used to determine if and when additional capacity may be required and to see if there are ways in which more efficient use of the network can be achieved on a 24 hour basis through caching and sending files in those periods of the day when utilisation is lower.

A training programme is now being developed which will enable the local support staff to have more effective control of their own sites. Two new sites in Tanzania will join the satellite network in September with sites in other African countries expected to be added soon. Many of the sites are also involved in Aids research and this work is soon expected to make use of these same facilities.

The immediate success of the satellite network is due to the detailed site survey and detailed preparatory work undertaken at the sites prior to commencement of each installation. In addition all the equipment was pre-assembled, configured and tested over the satellite prior to delivery. The benefits of this approach are immediately apparent as the installations are often accomplished and fully operational within a day which immensely increases the confidence of all involved. One thing that does stand out is the very high reliability being experienced and the reliance that researchers attach to it.

Business versus social needs

While it is an admirable objective to provide everyone with access to good quality telecommunications services the reality is that those with the need and the ability to pay for the services must be served first. Subsequently and from these beginnings a network can be expanded to reach the majority of the population in a more cost-effective way.

A major problem for incumbent telecom operators is the need to juggle resourses between competing infrastructure requirements, maintenance and new services. This situation is often more problematic when the source of funding comes from a governments treasury department which in turn is looking at other priorities. When private investment is sought there is a clear correlation between investment, risk and reward which the financial backers will seek to protect. In particular where specialised or specific requirements occur it is often easier to obtain funding related to a project when costs can be amortised over the period of the project. For incumbent operators financing such projects can cause major problems particularly if it becomes necessary to suddenly divert resources into unplanned activities that distract from an agreed plan.

Telecommunication Infrastructure

In developed countries the cost of creating new network infrastructure has been borne not just by the original incumbent monopoly operator but by the new entrants in the market who have been able to raise venture capital and financing on the basis of good business plans. This has resulted in a number of interesting facts. The first is that in spite of the new entrants, the original operator has continued to see revenues and profits rise as they share in a bigger and expanding market. Secondly the new entrants have largely focused their attention on specific market segments and requirements which the original operators were not adequately able to address because of spending restrictions imposed by their owners (often governments). The result of this is that users with special requirements, and the ability to pay, have been able to secure services essential to the success of their business much more quickly. This has left the original operator better able to concentrate its limited resources in the areas of basic network extensions and public telephony services. At the same time the new entrants have created competition, which provide a yardstick against which the incumbent can be measured. This in turn has resulted in some quite spectacular improvements in the quality of the basic services and even more spectacular reductions in costs. The bottom line is that everyone has benefited from deregulation.

In the lesser and newly developed areas there have been some remarkable improvements in the quality and availability of telecommunication services. However these are mainly found in the larger cities or where deregulation has already taken place. It is a sad fact however that in most rural areas the general availability and quality of the full range of telecommunication services is still inadequate for today¹s business and social needs. The obstacles to resolve these issues in rural areas are the low density of population, the great distances involved and the often hostile terrain over which transmission capacity needs to be installed and subsequently maintained

Transmission Infrastructure

Developing markets often have a unique advantage in establishing modern services as there is often little or no legacy network infrastructure that is compatible with the new user requirements. A well-known example of this was the former East Germany where after unification it was found that there was little that could usefully be integrated into the then West German system. The result was a rapid deployment of a VSAT network which established local points of presence throughout the country that were used to provide domestic and international gateway services in the local area. At the same time a plan was developed to install a new national fibre backbone network and local networks. The result is a very capable and effective network.

In Africa the need to establish fibre trunks is understood and relatively easy to implement and maintain. The difficulties start to occur when it comes to providing the infamous 'last mile' connection to serve isolated communities. These two problems generally require distinctly separate and different solutions.

First let us look at the Œlast mile¹ problem where even developed countries have their share of problems and expense of installing and maintaining this part of the network. In developing countries where the population and teledensity are significantly lower this simply increases the scale of the problem. It is therefore necessary to look at cost effective solutions that can be easily installed and grow in line with an increasing customer demand. It therefore goes without saying that in spite of potentially lower manpower costs the idea of installing telegraph poles and stinging wires between them and buildings on a wide scale is neither cost or time efficient particularly when the teledensity is low. An alternative is a wireless local loop solution. There are a variety of systems operating in different frequency bands and with a range of service capabilities that can be tailored to meet specific users requirements. Some systems are for point to point applications while others provide a point to multipoint network in which multiple users can connect with specific bandwidth. The range of these systems depend upon the heights of the antennas, the transmit power, antenna efficiency and frequency band in which they operate. It is therefore essential to consult experts in the field who can advise and design a network specifically tailored to the required application.

Other advantages of these systems is the relative simplicity of the hardware which once installed can generally be forgotten due to the inherent reliability of their designs. Many of these systems are also able to work from low voltage DC power and current drain which further enhances their suitability in remote areas. Installation of the base station is straightforward and provided a clear line of sight exists between that and the user all that is required is the proper alignment of the remote sites small antenna.

At an operational level such systems offer tremendous flexibility as they can handle a wide variety of data rates typically between 64kbps to 2Mb and either a single or mixed data steam combining voice, Internet, videoconferencing and data traffic.

Providing telecommunication services into remote areas has until quite recently been a costly exercise. That has now changed as the cost and complexity of VSATs have dramatically reduced along with the ongoing operational cost and peripheral hardware that is likely to be connected. As a result the cost of operating a VSAT service over a typical three or five year period can compare very favourably with a terrestrial alternative that would take significantly longer to install and have substantially less 'availability'. Probably the most significant advantage of VSATs is that they alone have the unique ability of being able to rapidly provide virtually any location on earth with a full range of reliable high quality telecommunication services. In addition circuit capacity can be easily and quickly upgraded in line with traffic growth.

This makes satellite solutions ideal for those requiring telecommunication services in underdeveloped areas or where a large amount of bandwidth is needed in a local area. Unlike terrestrial circuits which are always balanced, satellite circuits can be operated in an asymmetric mode. This makes them particularly appropriate for ISPs and others who operate unbalanced traffic as it results in the user paying for only the capacity needed to operate the service. Many myths exist about satellite communication however the reality is that satellites have been used to provide commercial communication services world-wide since the early 1960's which is considerably longer that we have been using fibre! One particularly advantage of a satellite solution is the incredible reliability and availability that these systems have demonstrated over many years in even the most hostile environments. Such availability is seldom if ever matched on long distance terrestrial circuits where multiple carriers cables and switches have a negative impact on the overall circuit availability. In a satellite link the only intermediate point is the satellite which over the years have typically demonstrated availability of as close to 100% as you can get. Another major plus for a VSAT is that it solves the Œlast mile¹ problem which is so often is the Achilles heel of a terrestrial solution.

The range of applications that can be supported over a satellite circuit range from simple low bandwidth telephony circuit to multiple megabit circuits carrying vast quantities of data over the Internet backbone. In between fall more general users such as corporate businesses requiring a circuit to connect a remote facility to the corporate global network. In such an example the satellite circuit may be multiplexed to carry internal voice, data and video conferencing traffic in a single data stream. This enables the capacity to be used much more efficiently for different purposes at different times of the day. The fairly recent development and application of the IP protocol for, not just Internet and email traffic but also for Voice over IP and Videoconferencing is resulting in greater flexibility in the way bandwidth is allocated and more efficient use.

Electrical Issues

The key to deploying advanced technology in less well developed areas starts with a good understanding of the problems that are likely to be encountered. Even today the greatest problem we still have to contend with is the vagaries of the mains power found at many locations. To address this problem it is essential to install very robust surge protected UPS systems to overcome temporary disruptions in the mains supply. Where longer term outages are likely it is also necessary to install a standby generator. This may seem tedious but the pay back will be quickly seen. Other electrical issues that need to be taken care of are proper earthing arrangements and protecting vulnerable site from the effects of nearby lightening activity. Regrettably nothing can protect against a direct lightening strike! The latter point has bearing on the issue of equipment redundancy. Our preference is to avoid the cost and complexity of switching arrangements and instead keep spares on the shelf. Then if a site does suffer a lightening strike only the installed equipment is affected and service can be restored as soon as a technician is able to get to the site &SHY; a far better solution than having to replace the operational and spare equipment and the 1:1 redundancy switch.

The Site Survey & Installation

A successful installation begins with a good site survey and subsequent preparation for the installation. As an example we have recently installed a number of 2.4m VSAT systems in remote African locations and had them fully operational on the day we arrived. This is entirely due to the survey, site preparation work and the tremendous enthusiasm and help of the local people. Although some sites are located in very remote areas they have proven extremely reliable. A key to this is our KISS (Keep It Simple Sam) approach. We do this by using well proven, tried and tested technologies which when integrated together provide the user with a very powerful capability that is neither complicated to operate or maintain.

In rural areas a small VSAT with a 2.4m antenna is capable of connecting about twenty four telephone lines to the international network or an equivalent mix of voice and data traffic. In an Internet application the same VSAT could receive data from the Internet backbone at rates up to 2Mbps and transmit a continuous stream of emails and world wide web (www) requests at about 192kbps. In both cases more than enough capacity for small communities and local ISP's! For those with larger traffic requirements a similar set up using a 3.7m antenna could carry about 60 voice calls or transmit data at about 512kbps. After that the sky is literally the limit with capacity being sized to meet the demands of the particular operational requirement. In general it is also true to say the larger the antenna (higher capital costs) the lower the ongoing operational costs

In Africa most ISPs operate in the big cities and many would like to extend their access into the rural areas. Unfortunately in too many instances the availability or quality of the existing telecommunications infrastructure in inadequate to support such services. Again an alternative that can be employed is to provide such groups of people with direct access to the Global Internet backbone by installing a VSAT in the rural towns. This coupled with a low cost Wireless Local Loop (WLL) system means that distributed local access can be quickly and easily provided without the need to install cables.

Are such technological steps sheer fanciful ideas for developing telecommunication services in lesser developed areas? No. However they do provide a unique method to leapfrog the current limited and often ageing networks that do not reach those who require the services. In summary VSATs and WLL offer a unique and cost effective means to rapidly deliver a full range of telecommunication services to even the most isolated users.

Liberalisation

Liberalisation is often seen by those who have a monopoly as a simple attempt to dilute the existing operators earnings and market share. However in many cases those with the monopoly are frequently unable to install and deliver the services requested by the customer. Under such circumstances it is a fatuous argument that the incumbent operator will loose revenue if they are by-passed by an alternative means. After all how can you loose something you do not already have and cannot or will not de able to deliver in the foreseeable future?

Many of the enterprises requiring bandwidth need it for the success of their operations and without the provision of such services the enterprise will be either inhibited from starting a new operation or its success and efficiency will be compromised. Given that a government will have much to gain through taxation and jobs created by the enterprise it is illogical to create artificial barriers that in the end benefit nobody.

A number of countries have stared to liberalise their telecommunications markets but some have imposed such excessive duties on equipment together with licensing and other fees as to make the use of VSATs and WLL uneconomical for the average potential application. This is effectively giving with one hand and taking it back with the other so that the status quo is maintained. In other countries certain market sectors have been withheld from competitors so that the incumbent retains control over say all international links which again forces the emerging telcos to buy inferior services at excessive charges. Another area of real concern to those who are willing to invest in new licences is the need for the regulator to impose upon existing operators realistic local access charges for accessing other operators networks. This is an issue that confronts all emerging telcos and one which the UK government has only recently taken steps to address.

Conclusion

The more enlightened administrations and governments are seeing their national economies grow through inward investment and liberalisation of their telecommunications networks. The subsequent industrial development in turn plays a major role by accelerating the updating of infrastructure and the availability of better education, health and social services. Unfortunately not all countries are following such radical thinking and continue to try and control everything from the centre with the result that they do not attract investment and are being left further behind. The liberalisation of national telecommunications can be a major factor in the economic growth of a country. The money to fund improvements to a national infrastructure for new high bandwidth services such as the Internet can often be found but to make it happen requires an open approach which enables all the parties to benefit. In the meantime those more isolated rural areas, communities with special requirements can be quickly and effectively address by VSAT and WLL solutions. For this reason policy makers and regulators should take bold and imaginative steps to liberalise the wholesale use of VSATs and WLL services to that everyone may reap the benefits like those enjoyed by the MIM.

This article is based on a paper given by the author at ACT 2000.

Chris Bell, Redwing Satellite Solutions Ltd ( mail@redwingsat.com )

CORRECTIONS: Incomplete editing on Daniel Espitia's article in issue 34 made a nonsense of the second to last sentence. It should simply have been deleted. Apologies. There may be a further correction on the uncertainty over deregulation he identified. See the first story in News Round-Up and Snippets.

News Update is a free e-letter produced by Balancing Act that covers African internet content and infrastructure developments, It goes out to government, the private sector, education and NGOs. To subscribe, send a message saying "I want to subscribe" to info@balancingact-africa.com