Information and Communication Technologies (ICT) are considered a cross-cutting tool that contributes to meeting the global challenges set out in the Sustainable Development Goals (SDGs). However, in many countries, there is still a significant connectivity gap between cities and rural areas. Using a case study approach and the Digital-for-development paradigm proposed by Heeks, this paper explores an innovative strategy for addressing the rural connectivity gap and examines its impact on the SDGs. The model under analysis is the Rural Mobile Infrastructure Operator (RMIO). The specific case analyzed is the first company operating under an RMIO figure and offering services in underserved rural areas of Peru. The results show that the RMIO strategy primarily contributes to some specific targets of SDGs 3, 9, and 17. Key stakeholders can use the methodology and results of this study to develop strategies to address the connectivity divide and promote the achievement of the SDGs in rural contexts. .

Summary The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q’eqchí and/or Poqomchi’ languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas).

Recent years have witnessed a massive penetration of cellular systems in developing countries. However, isolated rural areas (sparsely inhabited by low-income population) have been disregarded because classical access and backhaul technologies do not ensure the return on investment. This article presents innovative techno-economical solutions to provide these areas with cellular voice and data services. We first analyze the general characteristics of isolated rural communities, and based on this information, low-cost solutions are designed for both access (using 3G access points) and backhaul networks (using non-carrier grade equipment as WiFi for long distances or WiMAX in non-licensed bands). Subsequently, a study of population-dependent income vs. costs is presented, and a new business model is proposed involving mobile network operators, rural operators, and infrastructure providers. In order to test these solutions, we have built two demonstration platforms in the Peruvian jungle that have allowed validation of the technical feasibility of the solution, verifying the business model assumptions and the scalability of the initiative.

Rural areas in developing countries are characterized by lack of resources, low population density and scarcity of communications infrastructure. These circumstances make it difficult to provide appropriate healthcare services. This paper explains research results achieved by EHAS (Enlace Hispano Americano de Salud - Hispano American Health Link) and how they have contributed to improve healthcare in isolated areas of developing countries through the use of Information and Communication Technologies (ICT). As the first step, EHAS always collaborates with public health systems to identify its communication and information needs. Based on the analysis of needs, EHAS does research on appropriate technologies to provide communication in each context and on information systems suited to needs of health personnel. In parallel, EHAS has worked to provide applications that, making use of the communications services installed, could improve the healthcare services in these remote areas. In this line, solutions to improve epidemiological surveillance or to provide telemedicine services (like a digital stethoscope or a tele-microscopy system) have been developed. EHAS has also performed several researches trying to ensure the sustainability of their solutions and has summarized them in a Management Framework for Sustainable e-Healthcare Provision. Finally, the effort to spread acquired knowledge has crystallized in a book that details all the technologies and procedures previously mentioned.

The HPV-Automated Visual Evaluation Consortium is validating a cervical screening strategy enabling accurate cervical screening in resource-limited settings. A rapid, low-cost human papillomavirus (HPV) assay permits sensitive HPV testing of self-collected vaginal specimens; HPV-negative women are reassured. Triage of positive participants combines HPV genotyping (4 groups in order of cancer risk) and visual inspection assisted by automated cervical visual evaluation that classifies cervical appearance as severe, indeterminate, or normal. Together, the combination predicts which women have precancer, permitting targeted management to those most needing treatment. We analyzed CIN3+ yield for each HPV-Automated Visual Evaluation risk level (HPV genotype crossed by automated cervical visual evaluation classification) from 9 clinical sites (Brazil, Cambodia, Dominican Republic, El Salvador, Eswatini, Honduras, Malawi, Nigeria, and Tanzania). Data from 1832 HPV-positive participants confirmed that HPV genotype and automated cervical visual evaluation classification strongly and independently predict risk of histologic CIN3+. The combination of these low-cost tests provided excellent risk stratification, warranting pre-implementation demonstration projects.