# A Decision Framework for Choosing Telecommunication Technologies in Limited-Resource Settings
## 4 Evaluating Existing Networks
### Rwandan Health Pilot Project  
Carnegie Melon University (CMU) Africa in Rwanda runs a graduate program in Information and Communications Technology (ICT) and attracts high-quality faculty by capitalizing on research opportunities that are multitudinous in the rapidly expanding Rwandan economy. The health service in Rwanda is plagued by a low patient-to-doctor ratio and a lack of well-trained medical personnel [37]. Electronic communication offers streamlining of service provision that could be advantageous to the Rwanda National Health Service, as well as lucrative to international healthcare providers. The Rwandan health pilot project under discussion here was executed by CMU Africa and funded by a multinational healthcare company (Richo) to learn about the pros and cons of electronic record keeping in a developing world environment.  
This pilot project was performed in cooperation with the Rwandan Ministry of Health (MoH) and Kibagabaga hospital. In response to health burdens, Rwanda initiated a reform of the national community health system, which was initially implemented in 1995 [38], including Community Health Workers (CHWs), who are major participants in the Rwandan health system that provides preventative and curative healthcare services. Therefore, the project involved CHWs from Gasabo district, one of the most populated districts in Rwanda with approximately half a million people ([[http://statistics.gov.rw/publications/2012-population-and-housing-census-provisional-results](http://statistics.gov.rw/publications/2012-population-and-housing-census-provisional-results)]([http://statistics.gov.rw/publications/2012-population-and-housing-census-provisional-results](http://statistics.gov.rw/publications/2012-population-and-housing-census-provisional-results))). The study tested a hypothesis that CHWs could use smart phones for health data collection; a mobile application was installed on a smart phone, and given to 24 Rwandan CHWs to monitor children's growth and development. The research question was whether CHWs with no more than secondary school education could operate an electronic record keeping system that would actually save doctors and health workers time and effort in the long run.  
An initial decision made by the researchers was to implement the electronic record keeping system using the existing cellular network. There is an extensive cell service throughout the capital (Kigali) and its suburbs. Although the power system is unreliable, the cell system (as in most parts of the world) is required to run independently of the power grid. In addition, the Rwandan top cellular provider, MTN, has network area coverage of 99%, with a footprint that is covered by 4G, 3.75G, and EDGE networks, as well as an extensive fiber network. With the support of the MoH of Rwanda, who has an excellent collaboration with MTN, it was possible to obtain greatly reduced prices for 3G networking time. Time delay tolerance was built in to the smart phone data collection program so that servers that were disabled due to temporary power outages did not pose a problem for system operation. CHWs were able to learn how to use a specially devised mobile application for data collection, and using the cell network, upload the results to a centralized server were data was served for subsequent analysis.  
The system was implemented as a pilot in 2014-2015. The pilot was successful in demonstrating that using modern electronic tools for health data collection allows better tracking of health indicators [39]. Because of the extent of the cell network, the system could be expanded to nearly nationwide with little change. Finding funding for continued operation in a cash-strapped economy has been a problem, despite the Rwandan impressive economic growth of 8% per year [40].  
For this project, a choice was made to collaborate with the existing carrier, and that choice was in accordance to the argument made about key partners, related to the business canvas discussed in Section 3.