Disclaimer: Wayne Thembani Chinembiri, LL.M is a PhD candidate at the Technical University (TU) Munich. The views expressed in this article are his own and do not necessarily represent those of the University or of ARIPO.

Access to better and faster healthcare: The role of cellular standards

What are cellular standards, and what has been their role in promoting greater access to and improved quality in health care services?

Global cellular standards develop and widely disseminate cutting-edge technologies, making mobile communication devices and services compatible with one another. These (cellular) standards are a widely and openly agreed upon way of designing devices, platforms and services that facilitate communications devices to interoperate and be substitutable.  For example, global cellular standards govern the technology that is incorporated into smartwatches and mobile phones, allowing them to communicate with each other and share important patient data about heart rate or blood pressure measurements collected by the smartwatch.

Cellular standards are important because they allow for the development and proliferation of unlimited choices for consumers and help reduce prices for smart devices such as watches and other wearables and services while simultaneously allowing for product quality and performance improvements.

“According to GSMA Intelligence, by the end of 2020, 495 million people had subscribed to mobile services in Sub-Saharan Africa, of which 303 million were connected to mobile internet, a figure equivalent to 28% of the entire population”.  These figures are a testament to the rapid uptake and use of standardized technology in the mobile phone industry. Furthermore, innovations in the cellular standards space establish a sustainable foundation for affordable, accessible, and high-quality medical devices, and system innovations, pursuing novel solutions and giving room to smaller companies in Africa and around the world to participate in entrepreneurial ventures and address the most challenging health problems. 

The connectivity guaranteed by cellular standards enables smartphone apps, web-based platforms and wearable devices to become realistic methods of addressing disease management, and telemedicine makes remote healthcare more feasible. 

A practical example of the importance of cellular standards in promoting access to healthcare in Africa is telehealth and telemedicine. By definition, telehealth and telemedicine refer to the “use of medical information that is exchanged from one site to another through electronic communication to improve a patient’s health”.  

Telehealth and telemedicine services do not require advanced mobile internet connections such as 4G or 5G, often beyond reach in rural African areas. Rather, telemedicine uses already existing infrastructure, such as 2G (GSM), to send SMS or text messaging to deliver information to patients and customers 24 hours a day.  Telemedicine and telehealth can, therefore, use available technology to eliminate distance and time barriers and encourage positive lifestyle changes that prevent and control common diseases.  

Currently, vast experimentation with new use cases is still ongoing. In Malawi, several projects that use drones to transport blood and medical supplies from one clinic to another are being piloted.  Meanwhile, in South Africa,  hospitals are increasingly considering investments in robotic surgery equipment.  It is reported that robotic-assisted surgery takes place every 25 seconds worldwide, and therefore, it is time for more and more African governments to consider incorporating this type of technology into their medical emergency theatres. 

How can governments take greater advantage of opportunities presented by 5G and 6G, among other cellular standards?

Governments need to adopt a standardized approach towards the administration of healthcare services. Patient data should be centralized, and clinics and hospitals must become data centres. Arranging data into useful and exploitable datasets and databases allows other stakeholders, such as research institutions and private actors, to study and analyse the data to create learning opportunities for human and artificial intelligence systems.

Mobile connectivity and smart device/wearable technology are key factors that will expand universal health coverage by eliminating several barriers, such as costs, complicated access and lack of quality of care, while extending the range of services, particularly in regions where infrastructure and personnel are scarce or non-existent. 

In an Ericsson ConsumerLab study reflecting results from an online survey of 4,500 advanced smartphone or mobile communication users between the ages of 18–69, consumers reported feeling frustrated by inconveniences such as waiting times associated with physical or in-person medical appointments.  In addition, 39% of patients suffering from chronic illnesses prefer to have online consultations as opposed to face-to-face meetings. 

Developing future generations of cellular standards for a faster and more efficient eHealth system

5G mobile internet connections are reported to be 100 times faster than 4G connections.  Future standards such as 6G (already in development) will guarantee even faster speeds and lower latency than existing options. The possibilities of this kind of connectivity are truly endless. Even more complex robotic surgeries, such as heart transplants and brain tumour operations, can be conducted with ease and doctors halfway around the world can perform highly invasive procedures without breaking a sweat. Connectivity is truly the way of the future and it is important to ensure its continued existence.

The rapid uptake and use of cellular standards has contributed a lot to technological innovation and has led to a fall in the costs of device manufacture, making smartphones and related technology more affordable to all.  

Cellular standards are developed using an open and collaborative approach that brings together multiple stakeholders such as Standards Development Organizations (SDOs) and other members such as companies, research centres and universities. An example is the 3rd Generation Partnership Project (3GPP), which developed 2G up to 5G.  3GPP is a consortium that unites seven Standards Development Organizations (SDOs also referred to as ‘Organizational Partners’) and includes members such as companies, research centres and universities.  Massive investments are poured into research and development (R&D) by the various collaborators but the majority of these (70%) come from ten companies, including Ericsson.   

Since these companies invest millions of hours and billions of dollars into R&D, they typically protect their inventions with patents. Access to cellular standards is provided to implementers of this technology from the very first day because of contractual undertakings made by the contributors to develop standards.  These agreements seek to ensure that patented technology incorporated into a standard will be available to all on Fair, Reasonable and Non-Discriminatory terms (FRAND terms).

Thus, it is not only fair but also beneficial that those creating the standard be allowed to obtain adequate returns on their investment, e.g. via (FRAND) licensing agreements of these patents.  FRAND enables the inventors of standardized technology to be able to continue their work of developing future standards, leading to a virtuous cycle of innovation.  

Incorporating technology into the delivery of healthcare services is a strategic method of helping Africa meet its people's health-related goals. While not solving all of the African healthcare sector problems in one sweep, the concept of eHealth is promising. As shown above, it can release time from healthcare workers, promote access to healthcare information via mobile phone channels, promote disease prevention, increase patient safety, and improve the quality, effectiveness, and efficiency of procedures in African healthcare facilities. This is why 41 of 54 African countries have national digital health strategies and architectures. 

Estimates are that, for every 10% increase in life expectancy at birth, there is a corresponding rise in economic growth of 0.4% per year. For example, in some areas, high malaria prevalence is associated with reduced economic growth of at least 1% a year. 

Industry standards are required to solve the industry’s most complex technology problems through open methods and meritocratic processes that recognize the best solutions. Standards in respect of data collection via smart devices, IoT equipment and wearables for the healthcare industry of Africa should also be invested in.  This will allow Africa to harness and harvest the combined power of big data.

More innovations are expected to emerge as healthcare spending rises, with an estimated global average of $11,674 per person by 2022, for reasons including increased costs for healthcare providers, an ageing population, healthcare coverage, and new treatments and technologies.  In that context, eHealth, supported by cellular standards, can strengthen the African governments’ potential to deliver universal health coverage and fulfil Goal Number 3 of the Sustainable Development Goals. 

A properly calibrated intellectual property law system is needed to encourage large and often risky investments in mobile technology innovation and the eHealth sector.  As cellular standards are often protected by patents accessible on reasonable royalties, Africa must guarantee a functioning and adequately developed patent system. Weak patent protection in Africa may lead to suboptimal infrastructure and technological development investment. On the other hand, if patented technologies are appropriately protected, inventors can capture part of the socio-economic value of their discoveries, fostering reinvestment in R&D.