The Making of a Healthy Backbone: Malawi and e-health

Information and communication technology has become a first order necessity, just behind access to water, electricity, and sanitation. Therefore it is no surprise that governments across Africa are undertaking ambitious infrastructure projects known as backbones, the industry terminology for the layout of long-haul optical fiber at the national level. These backbones are built with the future in mind, designed to consider current and future demand for bandwidth, and planned for anticipated economic growth.

Yet the question may be: why invest in ICT in Africa when other critical services need to prioritized, such as healthcare? On average Africa has only 52.6 physicians per 100,000 inhabitants compared to 300 physicians for OECD countries1, and nearly 40% of the continental population is urbanized2. There is a service gap between densely populated centers, where infrastructures tend to be concentrated, and the needs of the greater rural population. ICT can, however, bridge some of the geographic inequity in the distribution of basic services. For instance, one country has had success with an experimental program at the intersection of ICT and health: Malawi.

Malawi is a country with very limited resources in the realm of healthcare, with high rates of tuberculosis, malaria, and HIV/AIDS affecting its population. And yet over the past decade Malawi has led the way in the implementation of e-health services, through the Electronic Medical Record System (EMRS), a comprehensive health database of individual patients’ records accessible to hospital clerks and clinicians across the country. The successes of the program are multiple: health workers devote less time on administration and spend more time on patients, hospitals administrators can forecast demand in supplies with real time patient data, and policy makers can readily use the database to monitor changes in public health and to appeal to international donors.

Malawi’s e-health initiative predates its backbone, having relied mostly on wireless satellite connectivity, which can be slower and less reliable than fiber. However, the development of a fiber backbone along power lines and roads has been a game-changer. The construction of the national backbone began in 2008, and since then, the telecom sector’s contribution to GDP has increased from 3.5% to 4.5% and the number of internet subscribers has more than tripled3.

Fiber backbones have enabled the growth of telemedicine, or remote healthcare services. It cannot replace the need for hospital beds and medical staff; nor is fiber a prerequisite for the implementation of e-health programs. However, an anticipated benefit of a newly implemented backbone is the expansion of reliable and affordable channels of communication, which can drive further investments into more ambitious and lasting e-health programs. The Malawian government is offering incentives for mobile operators to service rural areas, and supporting this with continued expansion of the national backbone. These developments continue to drive e-health initiatives and the quality of healthcare available in the country, while providing an interesting model for countries facing structural challenges similar to Malawi’s.

Population Density and the Backbone4

In an attempt to identify areas potentially isolated from access to broadband internet, the map below presents the proximity of hospitals to fiber in Malawi within 1km, 5km, and beyond.

Hospitals and Proximity to the Backbone

Description: In green are hospital within 1 km of fiber, in yellow those within 5 km, and in red those beyond 5 km (the furthest hospital being nearly 70 km away from fiber)5

There is a visible concentration of hospitals southeast of Blantyre beyond 5km of the backbone, in an area that is non-negligible in population. However not all hospitals have taken part in the EMRS program (for a comprehensive list, visit the Baobab Health Trust website), and those far from fiber may be relying on wireless networks. Furthermore it may be equally erroneous to assume that all hospitals near fiber have necessarily been connected.

For these reasons, regulators and responsible agencies need to maintain updated records of fiber routes and public infrastructures connected to fiber in order to identify both inadequacies in services and opportunities for investments. InfraNav™, through its comprehensive and accessible database on the state of fiber in Africa, provides the information and tools to assist ICT professionals and infrastructure planners. A healthy backbone is one which provides for core services, from health to education, efficiently and reliably.

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