1 Abstract—This paper reports on three years of research and fieldwork with a rural wireless Internet Protocol communication project. We built a long-range WiFi network and custom communication software to support a rural telehealth project in the remote Eastern Cape. We report on our work using cellular networks, devices and applications as reference technologies because our users and beneficiaries are very comfortable with them. Of most concern are the technological and contextual issues affecting take up of the systems we designed. The paper intends to provide a summary analysis of our experience so that others in the field can learn from our successes and mistakes with respect to rural Information and Communication Technology for Development (ICT4D) in a South African context. SATNAC Classification: Innovation and Regulatory – Telecommunications Developments and Inventions Keywords: communication, ICT4D, Internet Protocol, rural wireless networks, SMS, telehealth, text, video, voice I. INTRODUCTION This paper reports on an Information and Communication Technology for Development (ICT4D) [1] project that has been running for over three years in a remote rural part of South Africa [2-4]. This project is concerned with the power, networks, devices and their application interfaces to support ICT4D, as in [5]. We orient the discussion around multi-modal (i.e. text, voice and video) messaging, using cellular technology as a reference point, because our beneficiaries are very comfortable with their cell phones. The paper is organised as follows. First, we provide background on the project and its beneficiaries. Next we briefly cover some of the technical details. Then we place more emphasis on the contextual issues surrounding the project, especially with respect to infrastructure, regulatory issues and socio-economic and political realities. We Manuscript submitted April 16, 2007. W. D. Tucker is with University of the Western Cape, Computer Science Department: Private Bag X17, Bellville 7535 South Africa. Phone: +27 21 959 3010, Fax: +27 21 959 1274, Email: btucker@uwc.ac.za. E. H. Blake and G. Marsden are with University of Cape Town, Computer Science Department, South Africa. M. Pearson is with University of Waikato, Computer Science Department, New Zealand. R. Westerveld is with Delft University of Technology, Faculty of Technology, Policy and Management, Netherlands. explain our approach and methods for evaluation and impact assessment. Finally, we draw a brief conclusion with respect to cellular and wireless technology in an ICT4D context and plot future work. II. BACKGROUND Canzibe hospital and Lwandile clinic are located in the Libode district of the Eastern Cape, South Africa. The beneficiaries are a) the patients who receive more informed and productive healthcare closer to their homes, b) the rural health practitioner with improved ICT skills, c) district and provincial Department of Health (DoH) management interested in the effectiveness of telehealth communication and d) postgraduate students at the University of the Western Cape (UWC) and University of Cape Town (UCT) doing research theses on various aspects of the project. Canzibe is typical of a rural Eastern Cape hospital that serves about a dozen rural satellite clinics. Cellular coverage in the area tends to be very good though some patches are still not served. For example, during the course of our research, coverage was added to Lwandile clinic. There is no culture or practise of hospital and clinic staff communicating with each other regarding rural patients. These patients prefer treatment at the clinic because treatment is free at the clinic (a small fee is required at the hospital) and closer to their home than the hospital. South Africa has some of the most expensive telecommunications and Internet in the world [1]. So we built a pilot rural long-range WiFi network along with custom communication applications running on laptops. We now use WiFi-enabled cell phones because laptops (and our application prototypes) were proving too cumbersome. Many rural habitants are well versed with cellular handsets. We use smart phones that enable text, voice and video over WiFi much more cheaply than data over General Packet Radio Service (GPRS) available throughout many of the rural areas. We encourage users and our local support team to use applications like MXit and Fring to text. These Instant Messaging (IM) applications transfer text messages orders of magnitude more cheaply than Short Message Service (SMS). A. Beneficiary selection Transcape, a non-government organization (NGO), introduced us to the medical staff at Canzibe hospital. We had prior experience with another telehealth project [6]. We chose to link up the Lwandile clinic in 2005 because it was Reflection on three years of rural wireless Internet Protocol communication research and fieldwork W. D. Tucker, E. H. Blake, G. Marsden, M. Pearson and R. Westerveld