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2
The Global Fund’s Proposals and Grants Management Process
2.1 An Overview: The Global Fund provides non-repayable funds to AIDS, TB and Malaria prevention programs that are developed locally. So far, the Global Fund has had 5 funding rounds and has recently announced its sixth call for proposals. The Global Fund’s grants process is divided into 14 possible steps (as outlined below) and as adapted from the Global Fund. The Global Fund also provides a set of guidelines and eligibility criteria for appeals. (http://www.theglobalfund.org/en/apply/proposals/appeals/). When analyzed from a financial and health perspective, the Global Fund’s Proposal and Grants Management system is rigorous. The purpose of this proposal is however, not to judge the review process. The main preoccupation is to improve the reach and inclusiveness of the submission and management process, i.e. the desired principles of inclusiveness and equity.
1 2 Global Fund Secretariat in Geneva announces a call for proposals. Country Coordinating Mechanisms (CCM) prepare a proposal based on local needs and financing gaps. As part of the proposal, the CCM nominates one or a few Principal Recipients (PR). In many cases, development partners assist in the preparation of proposals. Secretariat reviews proposals to ensure they meet eligibility criteria; forwards all eligible proposals to the Technical Review Panel (TRP) for consideration. TRP reviews all eligible proposals for technical merit and makes one of four recommendations to the Global Fund Board: (1) fund; (2) fund if certain conditions are met; (3) encourage resubmission; and (4) do not fund. Board approves grants based on technical merit and availability of funds. An Internal Appeal Mechanism allows applicants whose proposals were rejected in two consecutive rounds to appeal the second decision. Secretariat contracts with one Local Fund Agent (LFA) per country. LFA certifies the financial management and administrative capacity of the nominated PR(s). Based on LFA assessment, the PR may require technical assistance to strengthen capacities. Development partners may provide or participate in such capacity building activities. The strengthening of identified capacity gaps may be included as conditions precedent to disbursement of funds in the grant agreement between the Global Fund and the PR. 8 Secretariat and PR negotiate grant agreement, which identifies specific, measurable results, to be tracked using a set of key indicators. Grant agreement signed. Based on request from Secretariat, the World Bank makes initial disbursement to PR. PR makes disbursements to sub-recipients for implementation, as called for in the proposal. Program and services begin. As the coordinating body at the country level, the CCM oversees and monitors progress during implementation. PR submits periodic disbursement requests with updates on programmatic and financial progress. LFA verifies information submitted and recommends disbursements based on demonstrated progress. Lack of progress triggers request by Secretariat for corrective action. PR submits fiscal year progress report and annual audit of program financial statements to Secretariat through the LFA. Regular disbursement requests and program updates continue, with future disbursements tied to ongoing progress. The CCM requests funding beyond the initially approved two-year period. The Global Fund approves continued funding based on progress and availability of funds.
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Source: The Global Fund (www.theglobalfund.org)
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It is our observation that, between the announcement of the call for proposals and the preparation of proposals by Country Coordinating Mechanisms –CCM (points 1 and 2 above), the whole process becomes undermined because many communities that are effective implementers but are financially needy, to begin with, are not even aware of the existence of the Global Fund and its functions. Secondly, Country Coordinating Mechanisms, in most cases central-government controlled national health system coordinating authorities and developmental partners, have not effectively reached the communities in need, while others are perennially left out for logistical, economic, historical and other reasons. Examples of these are the Dhalits of India, the Dorobo in Kenya, the Khoikhoi and San communities in Southern Africa. This means that, by the time proposal reviews begin (point 3), a number of proposals and components have been automatically left out. Some developing country coordinating bodies are so needy in terms of speed of Internet bandwidth, use and availability of technology and other technology-related facilities, that a number of their components do not even reach the Global Fund within the deadlines. In the more rigorous proposal review process that follows (point 4; review for technical merit), some countries may be asked to resubmit proposals. Technological gaps also undermine the internal appeal mechanism, Local Funding Agent’s assessment, the Principal Recipient’s submission of periodic disbursement requests, reports and audits, program updates and the CCM’s request for extension of funding. FIG.1 SUMMARY OF THE GLOBAL FUND PROPOSAL PROCESS
Source: The Global Fund (www.theglobalfund.org) 2.2 The Global Fund’s Proposal Process: (Format and System) Format The Global Fund currently uses a proposal form based on Acrobat Portable Document Format (PDF). The Global fund moved from using the Proposals and Grants Management System that is based on software developed by Synergy, a leading USBased software development company. Synergy was awarded the contract to produce this software in August 2003. Synergy’s Grants Performance Management solution provides comprehensive data management (grant proposals, agreements, disbursements), collaboration (comments, reviews, requests), automated notifications and alerts, automated workflow (evaluate, approve or reject an application, transfer funds, etc.), and analytics (ad-hoc reports, graphs, maps, M&E analysis).
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System Processes
The system streamlined the Global Fund's collection and evaluation of grant proposals from organizations around the world and facilitated the Global Fund’s efforts to monitor the effectiveness of projects and programs. The Proposal Process could be used over the World Wide Web to enter critical data, such as grant proposals, agreements, disbursements, and communicate with each other through the system comments, reviews, and requests. Furthermore, users could subscribe or automatically receive various types of notifications and alerts according to their assigned roles. They responded to comments, requests for additional data, or for disbursements. Users may also carry out their implementation processes, evaluate and produce analytical results. When Synergy’s web-based system was used in a computer and communication network with ample capacity in terms of space, ability to perform and with fast internet connection speeds (Adequate bandwidths), it can become useful in all countries. However, the system can be cumbersome when used in low bandwidth environments or in environments with low technology penetration. The Proposal Process, due to its functionalities, is relatively heavy software. Global Fund headquarters staff has encountered many delays when working with the Proposals and Grants Management System at a bandwidth of 100 mbps. Some submitting countries have access to considerably less advanced technology (than TGF), allowing throughput of only 100kbps in some cases. This makes it very difficult to enter data into the proposal form. Due to this fact it is possible that some countries omit potentially useful details from their proposals, as evidenced in the tiny number of proposals (1%) that were recommended for funding with no or minor changes (illustrated below).
FIG. 2: THE GLOBAL FUND’S FOURTH ROUND RESULTS
TGF Round IV Results
Recommended for funding with no or minor changes 1% Recommended for funding provided clarifications are met within a limited timeframe 31% Not recommended for funding in its current form but encouraged to resubmit 44%
Ineligible for TRP 19%
Not recommended for funding 5%
(Source: The Global Fund)
While improved technology by itself would not guarantee that all submissions would be recommended for funding, increasing the scope of assistance to proposing bodies would increase the number of components that pass the screening phase. These could then be recommended to the Board by the Technical Review Panel (TRP). Satellite communications would facilitate a more efficient use of the Proposal Process Information System as many countries are still using wire / dial-up solutions to access the Internet.
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G & F Steward LLC 3 Analysis of Technological Capacities in Recipient Countries
The ability to communicate is the basis for cooperation. As indicated earlier, the lack of timely comprehensive communication is the reason why a number of components were not recommended. Proposal screeners encountered many delays with the Proposals and Grants Management Systems at a bandwidth (speed) of (100 mbps.). Over 80% of all countries that qualify for the Global Fund’s support have access to considerably less advanced technology than that required by the Fund. The adverse effects of this technological lag also compound to affect their ability to reach people in remote areas, or to forewarn residents about impending breakout of diseases such as Malaria. In these cases, the process of entering data into and sending proposals is a cumbersome undertaking for them. Noting these discrepancies, the Global Fund recommended the use of alternative forms for proposal submission. However, problems regarding standardization, relevance and time have also been encountered. Over one hundred (100) countries are classified, according to the International Telecommunications Union (The United Nations Global Telecommunications Coordinating body), as countries in need of further technological development, and by the World Bank as Low and Lower Middle Income Economies. A number of countries also qualify as transitional economies. These countries incidentally form the core recipients of the Global Fund’s assistance. (See Annexed List of Countries, page 14) Low bandwidth has the following disadvantages for computers, users, and proxy servers: - Slow connection speeds - Low hit ratios (for some proxies) - High Central Processing Unit (CPU) system disk usage - High CPU use. Costs This means that more time is spent in front of the computer and more money is used on machine repairs, updates and communication. Technology tends to cost much higher in developing countries than in developed countries. An internet connection costs highest per minute in developing countries. Some of the highest cost countries are to be found in East, Southern and West Africa e.g. Niger, Burundi and Tanzania where the cost of dialup internet access is about US$ 400 per capita annually and Mozambique, Uganda and Malawi, where internet costs are as high as US$ 250 per capita. The concentration of highest cost internet access countries with low bandwidth can also be found in Eastern, West, Central and Southern Africa, with the exception of Seychelles, Mauritius, Botswana, Gabon, South Africa and Cameroon. In most countries in Europe and in the U.S.A., the prices of high speed internet connections have fallen dramatically since the 1990s. Where ADSL technology is available, the cost for a 512 kbps Line is US$ 12 to US$ 40 per month. Dial-up lines cost nearly as much for 12-25 hours of usage per month. In Africa, where people earn much less, the cost of a dial-up connection is similar to or more expensive than in Europe, but is only half as fast or even slower. A shared fixed line – Virtual Private Network – costs US$ 300 to 500 for very low speeds. Again, a user in Africa must work more than 100 more hours than a user in Europe in order to pay for a monthly connection on the internet. In developing country rural areas, where communities have most need to access national health funding, internet connections are on average virtually impossible to find.
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The high cost of using Internet and e-mail in developing countries not only undermines economic growth, but also deters the inclusion of many components that would otherwise warrant the Global Fund’s financing. Developing countries, especially African nations need a rapid increase in the use of ICT, but most national telecom operators hinder the wide use of internet through their pricing and investment policies. Also, most national literacy programs do not include the use of electronic technology at any level of education. There is need for deregulation, more competition and investments in the ICT sector. These changes would take years. The International Telecommunication Union (ITU), The World Bank and the United Nations Conference on Trade and Development (UNCTAD) are some of the organizations on the forefront of advocating for policy change in developing countries. The pragmatic strategies that have been adopted by the Global Fund and the urgency needed to respond to AIDS, TB and Malaria do not allow it the time to await policy change. Efforts by the private sector have largely failed due to both supply related (inadequate infrastructure e.g. tele-density, satellite systems, and hardware; weak regulations, slow liberalization; weak consumer perspectives) and demand related constraints (low electronic literacy levels, and lack of awareness). Nevertheless, the fact that developing countries have adapted the mobile phone technology at a faster rate than those in industrialized countries is an indicator of the need and readiness of the communities in developing countries to adopt technologies that are user friendly and cost-effective once their availability is ascertained. 3.1 Bandwidth performance: Communication Networks Vs. Computer Systems This section answers the following questions: What causes slowness in speed? Or, which of these, between communication networks, servers and computers, affects speed and capacity? The answer is Low Bandwidth. Effect of Low Bandwidth Client-Connections Low-bandwidth does not just affect the end user. Low bandwidth may also have several disadvantages for information technology software and hardware. Analyzing the impact of low bandwidth connections on proxy performance reveals two interesting technological facts. 1. When proxies (servers, etc), handle requests sent by several clients, using slow connections, such as dial-up modems, it reveals conclusions that can be drawn about the source of low speeds, that is, whether they arise from communication networks or from the CPU. While performance is slightly varied per manufacturer, it has been found, with no errors observed, that the low bandwidth has serious effects on both server and computer performance. It takes a longer time between a request to read the memory, and when it is actually visible, when using a low-bandwidth. 2. Given the differences in first phase and second phase latency (where low bandwidth has shorter difference between first and second phase latency leading to shorter service time for the lower bandwidth) it is clear that the time spent in the communication between client and proxy is the dominant factor in the overall bandwidth performance and it is much more important than the delay introduced by misses in the cache (which can be more pronounced in larger bandwidths). Observing the results collected by iostat and vmstat, it is clear that the bottleneck is the transmission in the network. Even with shorter service time, disk throughput is lower for the experiments with low bandwidth. The utilization of both disk and CPU is much lower for the 28Kbps bandwidth experiment and, as consequence; the overall proxy throughput is lower.
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An experiment by the University of Wisconsin Madison defined bandwidths of 28.8Kbps for each process. They measured the performance of four proxy servers from different manufacturers including Apache, CERN, Squid and Proxy N used by 30 clients spread out over three DEC Celebris XL590 90 MHz Pentium machines with 32 MB of main memory each and standard 10 Mbps Ethernet card.
FIG 3: THE EFFECT OF LOW BANDWIDTH CONNECTION ON CERN AND APACHE PROXIES PERFORMANCE. 3|c|Cern Metric First phase latency (s) Second phase latency (s) Hit Ratio Byte Hit Ratio reads/s writes/s svc_t (ms) Disk busy (%) CPU idle (%) cpu user (%) cpu system (%) 3|c|Apache Metric First phase latency (s) Second phase latency (s) Hit Ratio Byte Hit Ratio reads/s writes/s svc_t (ms) Disk busy (%) CPU idle (%) cpu user (%) cpu system (%) 28Kbps bandwidth 10.78 (4%) 9.75 (7%) 12.89 (4%) 8.84 (25%) 6.58 (3%) 11.31 (57%) 55.46 (43%) 26.93 (35%) 94.05 (1%) 0.64 (26%) 5.27 (17%) 10 Mbps bandwidth 5.51 (42%) 3.00 (20%) 26.06 (40%) 18.07 (51%) 9.48 (52%) 33.64 (76%) 115.64 (12%) 65.62 (47%) 78.50 (6%) 2.98 (32%) 18.58 (21%) 28Kbps bandwidth 12.61 (4%) 11.19 (21%) 19.12 (24%) 15.59 (38%) 0.27 (21%) 13.64 (10%) 63.49 (9%) 19.50 (13%) 87.12 (3%) 2.68 (32%) 10.16 (18%) 10 Mbps bandwidth 4.98 (21%) 2.92 (7%) 22.98 (7%) 18.26 (9%) 1.18 (85%) 35.48 (85%) 78.36 (72%) 53.99 (87%) 30.79 (18%) 15.50 (13%) 53.69 (7%)
Conclusion: It can be concluded from the above and several other experiments that what affects bandwidth performance is the time spent in the communication between client and proxy and not delays introduced by misses in the cache. A cache, by its general definition is storage of digital data which could be situated within computers, web-browsers or web servers. It is therefore clear that the bottleneck is the transmission in the network.
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Overview of Proposed Technology
Most developed countries use low bandwidth, 56k – 256k. Capacities are as illustrated in the table above. Regardless of effort, performance would be limited as indicated. Noteworthy is the fact that higher bandwidth can be purchased directly for more effective transmission capacities. Findings from the analysis of bandwidth performance in recipient countries lead to several conclusions and implications for the Global Fund. The Global Fund needs to adopt the use of more inclusive technology and concentrate on network connections. The options that are available to the Global Fund for Satellite/ Wireless communication are many, and they include: 1. Purchasing and installing satellite systems and negotiating with governments to allow for their use by Country Health Systems. This option could also entail renting existing Satellite-PC communication gateways in parts of Africa, Asia, the Caribbean, the Pacific and Latin America. These satellite gateways provide connectivity to specific country telecommunications networks, which can then be used to reinforce communications with health systems. 2. Using very Small aperture terminals and paying for or renting existing global broadband services. This option could also entail purchasing and managing bandwidth. 3. Most of the affected countries are difficult to reach. The satellite system could facilitate the use of GPS; getting information such as medical alerts and weather warnings to geographical segments through cell phones. 4.1 Implementation Options: The costs of the following options are given in the budget appendix. Option 1: Purchasing and installing satellite communications systems and negotiating with governments to allow for their use by Country Health Systems This option entails building the Global Fund’s own global communications infrastructure. Several suppliers of existing satellite systems provide a single service that can be used by a client or internet service provider for global distribution. This type of communication would need several hardware including large antennas, adaptors, cables, connectors, splitters, satellite modems, powerful amplifiers, terrestrial wireless and satellite gateways. It would also need qualified personnel. The client would then have to decide whether to install point-to-point or point-to-multipoint connections. The latter would be a better option to use because the Global Fund serves many countries. It also allows for flexible bandwidth allocation and the use of Very Small Aperture Terminals (VSAT). When analyzed, this package/ option is only slightly more expensive than option 2. It is suited to a satellite Communications specialist with vast experience. Many operators already provide satellite communication services. Among them are Hughes Network Systems, a world leader with 25 years experience, Gilat, and Sky Visionwith 16 years experience.
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FIG 4. AFRICA, ASIA AND EASTERN EUROPE: TYPICAL AREAS COVERED BY A SINGLE SATELLITE SYSTEM
Source: Skyvision.
Option 2: Renting existing global broadband services, or purchasing and managing bandwidth. The satellite communications industry has reproduced a technology that is capable of providing cost-effective network communications in places that are otherwise difficult to reach with conventional communications networks such as fixed lines and other cable-reliant networks. This technology is called ‘Very Small Aperture Terminal’ (VSAT) and it is capable of providing commercially viable connectivity, even in the most hard-to-reach sites. The technology can be used to provide cheap Internet, telephone, fax, audio and visual digital data. VSAT refers to receive/transmit terminals installed at dispersed sites connecting to a central hub via satellite using small (0.6 to 3.8 meter) diameter antenna dishes. VSAT technology represents a cost effective solution for users seeking an independent communications network connecting a large number of geographically dispersed sites. Until now, these systems operate in the Ku-band and C-band frequencies. Ka-band VSAT is now being implemented and promises higher capacity transport and even smaller terminals. Ku band (pronounced "kay-yoo" K-under band) is a portion of the electromagnetic spectrum in the microwave range of frequencies ranging from 12 to 18 GHz. Ku band is primarily used for satellite communications, particularly for satellite backhauls from remote locations back to a television network studios for editing and broadcasting. The band is split into multiple segments that vary by geographical region determined by the International Telecommunications Union (ITU). Ku-band is used extensively in Asia, Africa and Latin America but requires a larger antenna. C band ("compromise" band) is a portion of the electromagnetic spectrum in the microwave range of frequencies ranging from 4 to 6 GHz. C band is primarily used for satellite communications, normally downlink 3.7 – 4.2 GHz, uplink 5.9 – 6.4 GHz, usually via twentyfour 36MHz-wide transponders on board a satellite. C-band based networks are used primarily in Europe and North America and utilize the smaller sizes of VSAT antennas. Ka band (K-above band) is a portion of the K band of the microwave band of the electromagnetic spectrum. Ka band roughly ranges from 18 to 40 Ghz. The term ‘Ka band’ is frequently used to refer to the recommended operating frequencies of WR-28 rectangular waveguide, which is 26.5 to 40.0 GHz.
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The advantages of the Ka band option are that it does not cost as much as the preceding option, does not need a specialist operator and that it offers several opportunities to the Global Fund relative to its operations. These include the option of managing its own purchased bandwidth. Bandwidth should be managed because, just like any other scarce resource, it comes at a cost. Also, users compete for access. Advantages of managing bandwidth are many but the two main ones are explained below: a) Usually, over sale rates (number of users ranging from 5:1 up to 12:1) i.e. to serve 10 users of 1Mbs, only 1 Mbs may suffice. b) It is highly unlikely that all users in all countries will ever use the maximum bandwidth at the same time. Data Transfer Data Transfer is the amount of data transmitted over an Internet connection in a given time. It is used up by traffic to your Web site and also sending and receiving e-mail. For example if someone views a 1MB Web page on your site 1MB of data transfer is used. If 10 people view it then 10MB of transfer will be consumed. If you send an email with a 2MB attachment it will use 2MB of data transfer. The amount of transfer that you require while choosing a host depends on two factors: The size and popularity of your site. If your Web site provides large audio/video files, computer programs, and audio / video downloads then you should consider a package with a large amount of data transfer. For example, if you have a video file that is 1.5 MB in size and 100 visitors download the file during one day. This means that 1.5 GB (1.5MB * 100 visitors) of transfer will have been used. If you multiply that by 30 days for the month it comes to 45 GB. Flash Web sites and Virtual Reality (VR) sites require the most transfer of all.
FIG. 5: LARGE, MEDIUM AND SMALL SATELLITE DISHES/ ANTENNA FOR KU-BAND AND C-BAND RECEPTION AND TRANSMISSION
The Large Antenna is mainly for worldwide communications between the Global Fund Headquarters and Major Points in Asia, Latin America and Continents. One large antenna may be sufficient to serve the Global Fund’s collaborators worldwide. The medium sized one is common all over Africa, Asia and Latin America where the main transmission type is KU-band. The smaller sized one is common in Europe and North America where C-Band transmissions are prevalent. Picture Sources: All Areas Antennas Australia and Satcom
A VSAT network consists of a large high performance hub earth station (with an antenna of up to 9 m in diameter) and a large number of smaller, lower performance terminals. The small terminals can be ‘Receive Only’, ‘Transmit Only’ or ‘Transmit/Receive.’ However, this ‘receive’ and ‘transmit’ definition has not been adopted by everyone. In some VSAT networks all terminals have the same size and performance. Interactive VSAT networks are especially useful for computer communications, reservation systems, database enquiries, billing systems, large file transfers, electronic mail, video conferencing, point of sale transactions, credit checks and credit card verification and stock control and management. Country Coordinating Mechanisms and Principal Recipients using the Global Fund’s Proposals software would greatly benefit from VSAT networks. Encouraging the use of cost-effective technologies such as VSAT has benefits beyond the Proposal Process. Studies have shown that the use of technology can drastically change health systems (see section 4.4.)
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4.2 Possible Technological and Policy Gaps:
One potential hindrance with all the options described above is that unless the country has already regulated the use of Very Small Aperture Terminals, the Global Fund would need to negotiate directly with the local telecoms operator for a license to use VSAT networks. While over 120 countries are already licensing these services to individual corporations and organizations, the licensing process may take anywhere from a few hours to a few months and even years. Again, public use of VSAT has only been ratified in a few countries. In Africa, notable countries are Egypt and South Africa. Kenya, Togo and a number of other countries are to follow. However, there is nothing hindering the Global Fund from applying for these licenses for humanitarian reasons. Again, in most cases the Global Fund is one of the largest sources of health donations to countries; hence countries would feel obliged to facilitate the improvement of their communications systems with the Global Fund. Many local health systems, if left on their own, have neither the resources nor the competence to successfully apply for such licenses and implement such telecommunications systems cost-effectively. Further advantages of the Global Fund being involved include the assurance of standardized systems, and the possible savings that would accrue due to economies of scale (discounts arising from many orders being given at once.)
4.3 Installation and Configuration:
FIG. 6: COMPLETE INSTALLATION
Configuration There are many VSAT configurations, but the most common is the Time Division Multiple/Access (TDM/TDMA) star network. These have a high bit rate outbound carrier (TDM) from the hub to the remote earth stations, and one or more low or medium bit rate Time Division Multiple Access (TDMA) inbound carriers. This makes interactive VSAT technology appropriate for any organization with
centralized management and data processing.
This configuration minimizes overall lifetime costs for the complete network, including satellite transmission costs. The use of a single high performance hub allows the use of low cost remote VSAT terminals and optimizes use of satellite capacity. However, the combined cost of the VSAT terminals still exceeds the cost of the hub when there is a large number of remote sites (countries) (typically a VSAT terminal is 0.1 to 0.2% of the price of the hub).
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In a typical VSAT network, remote user sites have a number of personal computers, dumb terminals and printers connected to the VSAT terminal which connects them to a centralized host computer either at the organization’s head office or data processing centre. Data sent to the VSAT terminal from the Digital Terminal Equipment is buffered and transmitted to the hub in packets. Sharing hub networks To reduce the cost of hub networks and increase the cost-effectiveness of VSAT networks, the hub may be shared between several users e.g. the Global Fund, WHO, UNAIDS, other health donors, and Internet Service Providers, thereby spreading the cost. In this case the hub is usually owned by a service provider who retains overall control of the network and who manages the hub itself. Privacy is not lost since each user is allocated time slots or carriers, allowing them to operate their private network using the shared hub facility. Operation and management of sub networks is performed by the users themselves, completely and independently of the service provider. VSAT networks are flexible and can be customized to changing user needs over time, e.g. the need for more space. VSAT terminals are controlled by microprocessors and can generally be reprogrammed remotely using downloaded software from the hub. If additional interfaces or capacity are required this can usually be provided by adding or replacing cards in the VSAT terminal. Comparison of existing Transmission schemes from different suppliers: Three different transmission schemes are used for interactive hub VSAT networks. These include TDM/TDMA, Demand Assigned SCPC, and CDMA. Of these, TDM/TDMA is the dominant technique, while CDMA is used minimally. Demand assigned SCPC is currently not in use. VSAT systems can also support audio-visual transmissions such as one way television transmission from the host to remote stations. Two-way, 2 Mb/s transmissions can also be supported by some VSAT systems. It is however notable that more bandwidth can be purchased and used from different providers. Provides of note are Hughes Network Systems, the world’s leading broadband provider and subsidiary of the DirecTV Group and Gilat Spacenet.
Comparison of Interactive VSAT Network Characteristics (Note that surplus bandwidth may be purchased or rented)
Supplier Hardware Type Inbound Data Rate (kb/s) 64, 128, 256 9.6, 19.2, 38.4, 56, 64, 76.8, 128 Outbound Data Rate (kb/s) 128, 512 64, 128, 256, 512, 1024, 2048 Modulation
Hughes Gilat/Spacenet
ISBN/PES Skystar Advantage Arcanet Nextar V
TDM/TDMA TDM/TDMA
BPSK DPSK or MSK
Indra Espacio NEC
CDMA TDM/TDMA 64, 128, 256 64, 128, 256, 512, 768, 1536, 2048 64, 128, 256, 512, 1024, 1544 0.3, 0.6, 1.2, 2.4, 4.8 2.4 - 9.6, 14.4, 16.8 BPSK/QPSK
STM
X.Star
TDM/TDMA
96, 192, 384
BPSK
TSAT
TSAT 2000
TDM/TDMA
0.3, 0.6, 1.2, 2.4, 4.8 2.4 - 9.6, 14.4, 16.8
4FSK, 2-4PSK
TSAT
TSAT 2100
TDM/TDMA
QPSK
ViaSat
Sky Relay
TDM/TDMA
Source: The Saudi Net
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4.4 Other Health Sector Satellite Communication Applications
The adoption of Satellite Communication systems by the Global Fund stands to add immense value to other health services within countries. Countries which choose to take and scale-up the use of Satellite Technology can benefit from a number of increasing applications which may revolutionize their health systems. Europe and North America already have an unending list of ways in which the use of Satellite communication has revolutionized their health sectors. To date, over 22 million North Americans use the internet as a gateway to health information or online consultation with doctors. European countries have also used wireless communications in an increasing number of ways. Among low and mid income countries examples of effective wireless communication use abound. In China, for instance, Shanghai Telemedicinet initiated a Telemedicine Project network in September 2001. The Telemedicine Project network is an Internet Protocolbased two-way satellite multimedia network linking 200 hospitals throughout China. The first phase of the project connected 20 sites with a hub in Shanghai. The network carries video and data traffic that makes medical expertise from China’s major medical centers accessible to remote medical facilities throughout the country. Medical personnel are able to perform distant review of patient records, x-rays and charts and participate in televideo consultation and diagnosis via this new network. The Telemedicinet network makes possible a high degree of interaction among dispersed staff by way of remote-to-remote video communications. Many other cases of the use of VSAT technology to increase coverage, quality and performance have been documented in the rest of Asia, the Americas, and Europe. The United Nations Economic and Social Commission for Asia and the Pacific (UNEASCAP) and the Centre National d’Etudes Spatiales (CNES- the French Space Agency), in close cooperation with several healthcare professionals, have initiated several projects that document five different uses of telemedicine in developing countries i. Tele-consultation and tele-evaluation:
This has been applied in isolated areas, in emergency medicine, and at a more general level in all geographic areas deprived of a means of land-based communication, or in the case of vehicles. Countries that have benefited from teleconsultation and tele-evaluation include Cambodia, French Guyana, India and Colombia. Australian territories and the French National Maritime company have also benefited. ii. Tele-epidemiology:
Recognizing the harmful consequences of environmental factors on human and animal health, telemedicine has repeatedly been used to forewarn on the appearance or reappearance of such infectious diseases as the Rift Valley fever on both sides of the Senegal River, hemorrhagic dengue in French Guyana, and the deadly Malaria. Such systems are also operational in Mauritania, among other countries. iii. Tele-assistance :
A number of people suffering from Alzheimer’s disease, Diabetics and people with chronic illnesses or needing continuous medical attention have been fitted with constantly monitored electronic vests, fitted with vertical, shock and specific biosensors linked to calculation, sitting and communication units. This has saved longterm costs for both the affected and the medical service providers.
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FIG 7: A FEW ALTERNATE USES OF SATELLITE COMMUNICATIONS IN HEALTH:
From Left to Right: Teleconsultation Platform, Electronic Vest and Interactive Multimedia System for Health Education. Source: United Nations Economic and Social Commission for Asia and the Pacific.
iv.
Medical distance learning For beginners, continuing, informative education, and for the general public.
v.
Health education and home-based therapeutic follow-up for patients suffering from chronic illnesses.
When not being used for communication with the Global Fund, satellite systems in beneficiary countries could be put to use in the above ways and may also be used as a revenue generator by hospital systems. Conclusion: It is cost-effective to outfit all of the Public Health Systems, of the disease burdened countries, with satellite communication capability enabling them to bypass their limited communications infrastructures. For instance, within a year of implementing a technological roll-out, in over 50 countries, health services could reach over 100 million more people. The cost of less than 1 million US dollars per country (US .50 cents per person) would be nominal, if not negligible, compared not only to the amount of funding lost to the ineligible and non-recommended bodies, but more importantly to the value of the lives that would consequently be affected if not lost entirely. Even a modest 5% increase in TRP recommendations could result in saving hundreds of thousands if not millions of lives. With the cooperation of the international community, the potential of this pandemic to threaten the realization of the Millennium Development Goals can be averted.
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G & F Steward LLC ANNEX A: LIST OF LOW INCOME AND LOWER MIDDLE INCOME COUNTRIES
Low-income economies (61) Afghanistan Angola Bangladesh Benin Bhutan Burkina Faso Burundi Cambodia Cameroon Central African Republic Chad Comoros Congo, Dem. Rep Congo, Rep. Cote d'Ivoire Equatorial Guinea Eritrea Ethiopia Gambia, The Ghana Guinea Guinea-Bissau Haiti India Kenya Korea, Dem Rep. Kyrgyz Republic Lao PDR Lesotho Liberia Madagascar Malawi Mali Mauritania Moldova Mongolia Mozambique Myanmar Nepal Nicaragua Niger Nigeria Pakistan Papua New Guinea Rwanda Sao Tome and Principe Senegal Sierra Leone Solomon Islands Somalia Sudan Tajikistan Tanzania Timor-Leste Togo Uganda Uzbekistan Vietnam Yemen, Rep. Zambia Zimbabwe
Lower-middle-income economies (56) Albania Algeria Armenia Azerbaijan Belarus Bolivia Bosnia and Herzegovina Brazil Bulgaria Cape Verde China Colombia Cuba Djibouti Dominican Republic Ecuador Egypt, Arab Rep. El Salvador Fiji Georgia Guatemala Guyana Honduras Indonesia Iran, Islamic Rep. Iraq Jamaica Jordan Kazakhstan Kiribati Macedonia, FYR Maldives Marshall Islands Micronesia, Fed. Sts. Morocco Namibia Paraguay Peru
Source: The World Bank
Philippines Romania Russian Federation Samoa Serbia and Montenegro South Africa Sri Lanka Suriname Swaziland Syrian Arab Republic Thailand Tonga Tunisia Turkey Turkmenistan Ukraine Vanuatu West Bank and Gaza
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