Telemedicine and village pay phones (2)
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Dear Colleagues,
as consultant to WHO I struggle for years to obtain funds for radiocommunica-
tions in the public health services in places in Africa where there is not even electricity. I finally achieved the probable funding of one position of WHO radio communication manager for Africa from the Swiss government. The final decision will be made by end of March or in April. This is already something but by far not enough. Much more funds would be required in order to really get the structures in place, not to talk about the cost of equipment. If HEALTHNET could help, it would be great. Please find below a copy of my summarized activity report with recommendations I presented to WHO HQ in October 1998. So far there has been no response. I would be pleased to furnish any further information on the matter.
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Summarized activities report of the Radio-communication consultant
in the Democratic Republic of Congo (DRC, ex Za�re)
Goal of the activities:
The consultant was hired on October 1st 1996 on a short time consultant
contract basis and charged with the concept and implementation of a radio-
communication network for the program of epidemiological surveillance in
the DRC.
A. BASIS and HISTORY
The 1996 outbreak of the ebola epidemic in Kikwit showed several insuffi-
ciencies in the management of epidemic outbreaks in central Africa. Besides
the medical and educational aspects it became clear that lack of communica-
tion caused an unacceptable delay for the information to reach the ministry
of public health and the WHO. As a reaction, the Italian Government finan-
ced a program for the improvement of epidemics surveillance in the DRC.
WHO was charged to implement the program that included the improvement of
telecommunication means in the hands of the public health services.
In the process of implementing the program, WHO is confronted with an in-
sufficient or non existent telecommunication infrastructure. In consequen-
ce, WHO has hired a radio-communication expert to setup a network of HF ra-
dio-communication for text and data transmission in the DRC. The HF Pactor
data transmission technique in combination with voice transmission possibi-
lity was chosen for its technical reliability and simplicity, and for long
term operating cost savings considerations. The same type of HF Pactor net-
works are already in operation with UNDP, UNHCR, WFP, ICRC, IFRC, MSF, IOM
and other organizations.
B. ACHIEVEMENTS
The period from October 1996 to June 1997 served for the conception and pre-
paration of the project, ordering and reception of the material, and the or-
ganization of their installations.
The various war events in the region have disturbed and delayed the realiza-
tion program. On 12th of June 1997 the consultant has been evacuated toge-
ther with the whole WHO AFRO regional office from Brazzaville and part of
the material was lost due to war looting.
On 1st august 1997 the consultant has resumed the work of the project in
Kinshasa. After reception of the replacement material for what has been
lost, the following Pactor stations for text and data transmission over HF
radio have been installed and commissioned:
WHO Representation Kinshasa
WHO field office Kikwit
WHO mobile HF voice radio station
WHO field office Lubumbashi
Ministry of public health in Kinshasa.
During the November 1996 refugees reflux from Goma to Rwanda, the consultant
joined the WHO emergency team for epidemic prevention in Rwanda. He managed
to receive immediately from the Swiss governmental Disaster Relief Agency a
grateful donation of tree HF Pactor radio stations. This allowed to install
the following world wide first WHO Pactor radio stations:
WHO Representation Kigali
WHO field office Goma
WHO AFRO regional office Brazzaville
In mutual agreement with the UNDP Geneva Pactor radio station, WHO and UNDP
form a common Pactor network. This allows the use of synergy's and in parti-
cular allows the access to the UNDP operated Internet E-mail gateway (inter-
face) for all Pactor stations in the field. Every WHO and UNDP pactor field
station owns an Internet address and can thus be addressed by any Internet
user.
By the end of October 1997 the funds of the project were used up, the con-
tract of the consultant was therefor not renewed. He returned home to Swit-
zerland with the promise to obtain a new contract for the finalization of
the program. To date this contract has not been renewed.
Radio-communication material received in Kinshasa:
11 Radios Barrett 550L
1 Radio Codan 9480
10 Pactor modems Swiss-PTC-2 (1 modem looted during war in
Brazzaville)
11 SWR meters Daiwa
11 Battery chargers Carion 12/15
1 Battery charger Codan 9113
11 Folded dipole antennas Barker&Williamson
1 Folded dipole antenna Codan 140
11 Toshiba 440CDT Laptop computer (1 computer stolen, 1 defective)
11 HP Deskjet 340 printers
10 Mobile HF voice radio equipment Barrett 550R with automatic
antenna
div. connection cables and installation material
Material installed by the local technician M. Odilon Mfwemfwe:
Residence of WHO representative Kinshasa
WHO field office Kisangani
WHO field office Kananga
WHO field office Bukavu
WHO field office Goma
WHO field office Mbandaka (Pactor not operational)
WHO field HF mobile voice station
Material left for installation:
2 Radios Barrett 550L
1 antennas Barker&Williamson
1 HP Deskjet 340 printer
9 Mobile HF voice radio equipment Barrett 550R with automatic
antenna
Field offices still awaiting HF Pactor communication equipment:
Town of Kindu
Town of Matadi
Town of Mbuji-Mayi
Town of Bandundu
C. OUTCOME
The installed and operational HF Pactor communication equipment has proven
itself. Besides the transmission of written messages and field reports, the
reception of the daily IRIN news bulletin for the Great Lake Region from the
Nairobi UNOCHA office is very much appreciated. As a result, the wish to be-
nefit from the same type of communication infrastructure has emerged from
all African countries. It is suggested for the Ministries of Public Health,
the WHO representations as well as on the intermediate and provincial level
such as field offices of the various organizations that are active in the
field of public health. Certain countries would extend the network according
to their specific need down to provincial level (sanitary district).
As a result, all African country WHO representatives have requested the same
radio-communication infrastructure in their country for the epidemiological
surveillance. This was strongly pronounced at the 1998 spring meeting of the
representatives in Harare.
Also, the 1998 conference of the central African Health Ministers in Libre-
ville has written the determination to equip all countries public health ser-
vices with this type of radio-communication infrastructure for the epidemio-
logic surveillance, in its final protocol of July 10th.
In the meantime, the operational equipment has become irrevocable for the
epidemiological surveillance and is appreciated by the users. However in order
to maintain continued and reliable service of the equipment, periodic mainte-
nance and follow up by qualified personnel is required.
D. PROBLEMATIC
WHO is in the process of implementing important radio communication networks
in Africa. On the other hand it already operates extensive VHF networks
(Motorolas) for operational and security reasons on local level.
The installed material represents an important asset and financial value.
The actual project in the DRC is only the beginning. Similar radio infra-
structures are requested from all African countries and await their realiza-
tion. However, in order to make optimal use of it and to prevent wastes by
non appropriate operation and lack of maintenance, periodic maintenance and
following up by qualified personnel is required.
In order to coordinate all these logistic activities, WHO needs appropriate
organizational, technical, financial and administrative structures. For the
responsibility to coordinate, conduct, implement and supervise all radio-com-
munication related activities, a management position should be created wit-
hin the WHO region AFRO.
None of such is actually available.
For a few years only, WHO has become active in emergency situations such as
the 1996 Rwanda action. However, to my knowledge, WHO does not have an orga-
nized emergency action plan, nor structure or material. In emergencies, re-
quired material is not readily available in time. This is critical for medi-
cal (vaccination, emergency treatment, sanitary) as well as for communica-
tion equipment. If WHO plans to continue this activity, appropriate structu-
res with specially trained personnel that can depart within hours, should be
put in place. In particular, telecommunication equipment cannot be procured
in useful time to go in the field, it must be ready on stock for emergency
application. To achieve this goal, collaboration with private organizations
or partnership with relief agencies such as the Swiss Disaster Relief is
thinkable.
WHO has recently announced to intensify the combat of Malaria and other de-
ceases such as Onchocerciasis in Africa. To achieve success with these pro-
grams, coordinated logistic and radio-communication support will be neces-
sary.
E. NEW ACTIVITIES
On July 1998 the consultant has undertaken a trip to Kinshasa on his own
risk and costs. The goal of this mission was:
1 Recover his belongings left in Brazzaville after the evacuation and move
the non utilized WHO radio equipment from Brazzaville to Kinshasa.
2. Help and assist WHO to elaborate a paper for the request for funding of
the position of a WHO radio-communication coordinator and responsible
for Africa from the Swiss Agency for Development and Cooperation.
On 10. July the WR and the consultant had audience with the Swiss ambassa-
dor in Kinshasa. They informally presented the project for the request for
funding by the Swiss cooperation of a WHO radio-communications coordinator
and responsible in Africa. The project was well received and the ambassador
encouraged WHO to formally establish the demand.
In the following, the consultant has elaborated in collaboration with Dr.
Tshioko the document for the request for financing. The document was then
sent to the WHO regional office in Harare for finalizing and signature.
The paper and its covering letter was signed by the WHO regional director
Dr. Ebrahim Samba by the end of July and handed over to the Swiss ambassa-
dor beginning September. It is now in the hands of the Swiss Agency for
Development and Cooperation.
On July 15th the consultant has crossed over to Brazzaville. He recovered
his own, from looting left over belongings as well as the WHO radio station
equipment from Brazzaville.
The WHO radio material recovered and transferred to Kinshasa consists of:
1 Radio Barrett 550L (defective)
1 Pactor modem Swiss-PTC-2
1 SWR meter VCi PM-30
div connection cables.
Further more, the consultant has assisted the WHO Kinshasa office and wor-
ked on all acute problems related with radio-communication. In particular,
the new outbreak of war in the DRC on August 2nd made reprogramming of all
VHF portable radios (Motorolas) necessary for personnel security reasons.
Without the presence of the consultant this would not have been possible.
The consultant has not received any pay nor compensation for his expenditu-
res and costs during these activities for the WHO.
F. RECOMMENDATIONS AND PROPOSALS
1. Organizational:
WHO AFRO should create the appropriate organizational, technical, admini-
strative and financial structures for the management and coordination of
all radio-communication related activities.
In consequence, the position of a WHO radio-communication coordinator and
responsible manager for Africa should be created with the following terms
of references:
* Implementing the technical, organizational and administrative structu-
res for radio-communications within the WHO regional direction AFRO.
* Finalizing the radio-communication network for epidemiological surveil-
lance in the DRC and in the central African region.
* Coordination of all radio-communication activities of WHO (AFRO).
* Organization of training, operation, maintenance and following up of
the equipment.
* Training of the users and local technicians.
* Training of cadres for decentralized responsibilities.
* Contacts and recherch of synergy's with other UN agencies and NGOs.
* Contacts and demarches with the national authorities for obtaining licen-
ces and frequency attributions.
* Coordination with the security officers of other agencies and implemen-
ting VHF and UHF radio networks for operational use and persons securi-
ty.
* Evaluation and conception of new radio-communication needs in Africa.
* Planning of future radio-communication networks for the public health
services in the African region.
* Standardization of the equipment and recherch for its improvement toge-
ther with the manufacturers.
2. Financial:
2.1 WHO should create the budgetary financial background for the manage-
ment of all radio-communication related activities.
2.2 WHO should search for the funding (fund raising) for the implementa-
tion of radio-communication infrastructures for epidemiological surveil-
lance and general public health services in all African countries.
ANNEXED DOCUMENTS:
* The Pactor communication system of WHO. 9.10.1998
* Projet de cr�ation d'un poste de coordonnateur radio-communication.
28.7.1998
* Memo 16.5.1997: Equipement de radio-communication d'urgence.
* Rapport et propositions pour la sous-r�gion Afrique de l'Ouest. 26.6.1997
Geneva, 10.10.1998, Beat Streckeisen
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Beat Streckeisen BSEE,
Radio Telecommunication Consultant
Rue de la poste,
CH-1141 Severy, Switzerland
Tel: +41-21-800-3502
mailto:streckeisenb@who.ch
mailto:beat.dan@smile.ch
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