Meraka Telehealth:Project Chapter

FMFI Telehealth Project in Tsilitwa, Eastern Cape Province, South Africa

Researchers:	Chris Morris (cmorris[@]csir.co.za)
	Ajay Makan (amakan[@]csir.co.za)

Background to the problem

The high unemployment rate in the Eastern Cape contributes to poverty. For example, 87% of the population in OR Tambo and Alfred Nzo district municipalities earn less than R800 per month. Poverty and the rurality of the Eastern Cape create a high dependency on public health services.

67% of communities live in rural areas in the Eastern Cape where harsh weather conditions, poor road and telecommunications infrastructure, and the lack of public transport have a direct impact on the delivering of healthcare services.

This situation is due to poor infrastructure and isolation of rural clinics. The workload is also increasing due to HIV/AIDS epidemic and thus the need for specialized advice or consultation or second opinion.

Lack of transport, bad roads makes referring of patients sometimes impossible thus treatment of patient in the community is the only option.

Lack of telecommunication, particularly in rural areas, makes proper referring of patients difficult and costs patients time and money to travel. Lack of access to training and Continual Medical Education (CME) severly limits healthworker development in rural areas and keeps healthcare workers away from the rural health centres.

A major challenge in the Eastern Cape is the drain of healthcare professionals from the rural communities to the more developed urban centres. Professional isolation from their peers contributes to the difficulty in attracting and retaining qualified staff in rural areas. Traditionally health professionals and managers have to travel long distances for meetings and knowledge transfer. This also results in high cost and loss of productivity.

Specialised care is very scarce in the Eastern Cape. There are only 2 dermatologists, 2 radiologists, 2 oncologists and no oral health specialists in the public service.

Due to the lack of telecommunications infrastructure in rural areas, wifi is seen as a potential solution to meet the needs of rural connectivity. However, the use of wifi in the 2.4GHz ISM band (which is license free internationally) is forbidden where it cuts across public boundaries and where the power emission of the antenna exceeds 100mWatts. So the challenge of this project is to pilot the use of wifi in order to demonstrate to government how low-cost technologies such as wifi can be used to meet the communication needs of deep rural communities.

The Tsilitwa Project

The tele-health application developed in Tsilitwa in 2001 formed part of the Department of Science and Technology’s Innovation Fund project entitled “Information and Communication Technologies (ICTs) in support of communities in deep rural areas”.

The community leader from Tsilitwa approached the CSIR in 1999 to draft a funding proposal after having visited a similar CSIR project at Lubisi. The request was for Information Communication Technology (ICT) to support health, education, agriculture and small business.

The project involved the two communities of Tsilitwa and Sulenkama that were geographically separated by a hill preventing direct access between the villages and requiring people to travel the 15km by a very poor dirt road where the public transport was unreliable. These towns are approximately 100km north east of Umtata. The two villages are typical of the former Transkei area and to this day have no electricity to homes, no running water, dirt roads and no telecommunications. The villages are spread out and people build mud-block houses with thatch roofs or corrugated iron. Some houses are constructed from brick with tile roofs. The population is mostly unemployed totalling approximately 2000 in each village.

The community facilities in Tsilitwa include a pre-fabricated clinic and technical school that, through the efforts of the headmaster, is electrified. The clinic ran on solar power until 2002 when it was electrified. The village of Sulenkama some 15km away has more infrastructure boasting a 200 bed community hospital called Nessie Knight with electricity (generator back-up) and 3 DECT telephone lines. The telephones do not usually work and the hospital staff rely on their personal cell phones to call Mthatha for an ambulance.

Regulatory Environment (South Africa)

It is important that the project team have a clear understanding of the regulatory environment in order to be able to use the research results as inputs for future policy. Regulation regarding WiFi

• WiFi networks are allowed when:
  • The network is deployed on a single site
  • Signals may only traverse short distance; EIRP not to exceed 100 milliWatts
  • No interference to users of other ISM equipment or other frequency bands may be caused
  • The network must be confined to computer systems of the same user

• For community based networks a license is needed; either a PTN (Private Telecommunications Network) or VANS (Value-Added Network Service) license. The latter is needed when the network is connected to the Internet, and Internet services are provided
• Self provision has been an issue for long, but likely with the Electronic Communications Act (ECA), self provision will be allowed [need to check this]
• The regulatory framework surrounding WiFi deployment nevertheless remains complicated, and due to quick changes of staff at the regulator, applications for licenses could take long.

In order for community owned networks to be legally pursued, the regulator requires such projects to obtain both a PSTN as well as VANS license and the deployment of facilities dictates that the telecommunications facilities must be that belonging to Telkom or the SNO. However, the issue of self-provisioning remains a grey area open to interpretation. Under the ECA a class license would be needed by FMFI partners for both infrastructure and services, but the use of WiFi is still hamstrung by the control on power levels and crossing public boundaries. It is suggested that the FMFI partners continue to lobby government for a regulatory relaxation for the use of WiFi across public boundaries in rural areas for use in non-commercial sectors such as health and education.