Architecture of a Village Small Cell Network for

Mobile Health
Bessie Malila
Division Biomedical Engineering
Department of Human Biology
University of Cape Town
Cape Town, South Africa
bessie.malila@uct.ac.za
Tinashe Mutsvangwa
Division Biomedical Engineering
Department of Human Biology
University of Cape Town
Cape Town, South Africa
tinashe.mutsvangwa@uct.ac.za
Tania Douglas
Division Biomedical Engineering
Department of Human Biology
University of Cape Town
Cape Town, South Africa
tania.douglas@uct.ac.za

Abstract—This paper proposes the architecture of a village
small cell network for rural and remote areas for enabling the
delivery of healthcare services using mHealth applications and
systems. The proposed architecture is based on emerging 5G
technologies and is expected to address the need for cost- effective,
high capacity and reliable mobile connectivity in rural areas.
This will make it possible to provide more innovative video and
Internet-based mHealth applications and services, in addition
to the current SMS and voice-based services. Future work will
include addressing issues of security, privacy and data integrity
of patient health information.
Index Terms—mHealth, 5G, small cell networks, rural net-
works, massive MIMO
I. I NTRODUCTION
Mobile health or mHealth has great potential for aiding
diagnosis, monitoring, ensuring adherence to treatment and
creating disease awareness in areas with limited access to
healthcare services. mHealth technologies present opportuni-
ties to provide quality, equitable healthcare services in de-
veloping countries which currently have the highest burden
of diseases such as tuberculosis (TB) and HIV/AIDS, limited
healthcare professionals and poor health infrstructures. How-
ever, the effectiveness of mHealth applications and systems in
rural and remote areas is currently being hampered by lack of
limited mobile network coverage, and the problem is global
[1].
Emerging 5th generation of mobile wireless network tech-
nologies, commonly known as 5G, are expected to address
some of the limitations of existing mobile networks in terms
of network capacity, cost-effectiveness, coverage and energy
efficiency [2]. This paper proposes a mobile network ar-
chitecture, the village small cell network, which is based
on 5G technologies. In addition to enbling the delivery of
basic mobile services such as voice and text messaging, the
network architecture is designed to enable the delivery of
richer communication services such as video and Internet,
which are currently not easily accessible in remote and rural
areas due to limited or unreliable mobile network coverage.
Most importantly, this will make it possible to deploy mHealth
This research is supported by the South African Research Chairs Initiative
of the Department of Science and Technology and the National Research
Foundation (Grant no 98788).
services and applications such as remote surgery and web-
based Apps, which require reliable high capacity Internet
connectivity, compared to the basic sms-based mHealth ap-
plications currently being deployed.
The novelty of the proposed solution is in the use of
small cell network technologies, currently being deployed in
urban areas only, to provide reliable, low-cost, high capacity
mobile access to populations in rural and remote areas, where
traditional methods of providing mobile services are not eco-
nomically viable. Furthermore, we propose the use of massive
multiple input multiple output (MIMO) and beamforming
technologies at license-exempt frequencies to backhaul the
rural small cell network traffic to core networks in urban
areas. This will enable, among other mHealth applications and
services, the remote diagnosis, treatment and monitoring of
high burden disease such as tuberculosis and HIV/AIDS.
The rest of the paper is organized as follows: Section II
provides a brief overview of mHealth and small cell networks.
Section III describes existing architectures for rural small
cell networks. Section IV presents the proposed village small
cell network architecture, key enabling technologies, how the
solution addresses the issues of network connectivity and
service reliability in eHealth and mHealth systems. Section
V concludes the paper and identifies future work and open
research issues.
II. MHEALTH AND SMALL CELL NETWORKS
mHealth is characterised by the convergence of medicine,
public health and mobile technologies. This section gives a
brief overview of mHealth and the emerging mobile small cell
mobile networks.
A. mHealth
One field of study that is currently being pursued to
strengthen national health systems is digital health, which
incorporates electronic health (eHealth) and mobile health
(mHealth). The World Health Organisation (WHO) defines
mHealth as medical and public health practice supported by
mobile devices such as mobile phones, patient monitoring
devices, personal digital assistants (PDAs) and other wireless
devices [3]. mHealth has the potential to increase the quality
of healthcare, reduce the cost of its delivery and extend the
reach of healthcare services to millions of people [4].
The use of mHealth to address the health challenges
faced by developing countries is currently being spurred
by the high growth rate of mobile networks and the ever-
increasing numbers of mobile subscriptions, especially in
Africa. mHealth systems have successfully been implemented
for disease surveillance, monitoring, diagnosis, adherence to
treatment and for distributing health education [5]. Emerging
applications include the use of clinical decision support tools
in the diagnosis of pulmonary TB through exchange of X-ray
images between healthcare professionals in rural areas and
those in health facilities [6], [7]; and the use of smartphone
cameras to capture induration images in the tuberculin skin
test response (TST) method, for detection latent TB infection
[8]. Other mHealth projects aimed at converting paper-based
clinical instructions to electronic form, making them accessible
online, have also been implemented [5].
B. Small Cell Networks
While the growth rate of mobile networks and subscriptions
in Africa is one of the highest in the world, network coverage
network in rural areas is very poor. Network operators lack
the interest to deploy networks in rural and remote areas due
to significantly high costs of deployment and lower average
revenues per user, compared to urban areas [10]; This is
the case for rural areas around the world. As a result, most
projects in these areas are neither scalable nor sustainable
beyond trial phases. Unavailability of high capacity wired
telecommunications infrastructure and absence of electricity
supply systems further limit the reach of mobile networks in
rural areas [8], [9]. The problem is worse in Africa due to lack
of funds for infrastructure development.
The problem of coverage holes, i.e. areas with no mobile
network coverage, also exists in urban areas. However, this is
currently being addressed by using small cell base stations to
complement existing macro base stations in locations where
it is practically impossible or not cost-effective to provide
network coverage using macro base stations. Small cell base
stations are defined as densely-deployed low-power, low-
cost, short-range mobile base stations operated by network
operators [11], and are one of the key technology enablers of
5G systems [10].
Besides improving network coverage, small cells will be de-
ployed to increase overall network capacity in traffic hotspots
like airports, universities and sports facilities. Small cells are
currently being proposed to provide cost-effective network
coverage to rural and farming communities in Europe and the
USA [12].
In Africa, small cell networks can be used to achieve
the same in rural villages to enable ubiquitous delivery of
healthcare services using mHealth applications. This way,
mHealth services can be extended to areas where it might
not have been practically possible to do so using traditional
mobile base stations.
Fig. 1. Architecture for rural small cell networks proposed by the Small
Cell Forum, consisting of access networks (local small cell network (SCN)),
Microwave or digital subscriber line (DSL) backhaul, small cell core network
(SCON), mobile core network (MCN) services network (Adapted from [13]).
Another feature of 5G technologies is the use of new
license-exempt frequency bands, which will allow the use
of fixed point-to-point wireless systems to backhaul small
cell networks. The cost of deploying small cell networks in
rural areas will further be reduced due to their self-organizing
network (SON) capabilities, which enable them to be installed
by semi-skilled workers and autonomously setup connections
with core networks [10]. Furthermore, small cell base stations
can be powered by solar or wind power generators due to their
lower power consumption. This will eliminate the need to rely
on the national electricity grid.
III. ARCHITECTURES FOR RURAL SMALL CELL
NETWORKS
The architecture proposed in this paper is based on the Small
Cell Forums architecture for rural small cell networks [13],
which is shown in Figure 1. The access network segment
consists of a set of small cell base stations, the local small
cell networks (LCN), which connect to the core networks the
small cell core network (SCON) via the S1 mobile network
interface. The microwave or digital subscriber line (DSL) links
provide backhaul connectivity services between small cell base
stations and the core network. Gateways (GWs), provide the
interfaces for interconnecting the different network segments.
The core networks connect to the services networks of the
network operator, the IP multimedia subsystems (IMS) and
the external networks such as the Internet, enabling access to
these services by mobile devices.
While the Small Cell Forum defines the rural village small
cell network architecture, it does not provide the best tech-
nology suites to realize solutions. The architecture, however,
provides a framework for the development of innovative solu-
tions to address specific social problems, such as the provision
of access to health services in rural areas, as proposed in this
paper.
An network architecture for providing mobile network ac-
cess to rural areas in Europe has been proposed in [12].
The architecture, shown in Figure 2 consists of small cell
base stations, referred to as community wireless systems
(CWS). The small cell base stations interconnected in mesh
topology, enabling local communications between villages in
nearby communities. However, the architecture assumes wired
 The backhaul radio device is based on MIMO technology
with beamforming capabilities. This gives the backhaul link
the required robustness when the radio signals suffer attenua-
tion due to blockage by vegetation or other land features. The
solar or wind power sources can also be used for charging
mobile devices, thus improve the quality of the end-to-end
mHealth services.
The small cell access networks can provide a myriad of
mHealth services such as patient monitoring, disease surveil-
lance, clinical decision assistance, health education for com-
munity health workers, remote diagnosis and remote surgery,
in the case when a small cell base station is installed at a
Fig. 2. Architecture for rural small cell networks with in-band backhaul remote healthcare center.
consisting of converged wireless system (CWS) of small cell base stations
(SCBS) and local aggregation center for the SCBSs [12]. B. Backhaul Links
Traditionally, microwave backhaul links have a reach of
backhaul, which may not be available in rural areas, especially 100km. However, because of signal attenuation, the available
in Africa. The proposed use of in-band backhauling could throughput on a link can be as low as 2Mbps. In this paper
potential limit the backahul capacity, hence the performance of we propse to replace panel antennas with massive MIMO
mHealth applications that require high capacity connections. antennas at the aggregation site. Each miniaturized antenna can
have its energy directed towards a small cell backhaul radio,
IV. PROPOSED ARCHITECTURE making it possible for a backahaul link to reach data rates of
This section describes the proposed village small cell net- 100Mbps per backhaul link, compared to the 2Mbps achieved
work architecture, capable of delivering mHealth applications on traditional micorwave links over the same distance.
which can be based on voice, video and internet services to C. Massive MIMO base station
rural villages. The architecture consists of clusters of small
The massive MIMO base station is expected to be installed
cell base stations with up to 2000m coverage radius.
in a nearby town, where mobile operators can still obtain
Connecting small cell base stations to core networks is a
revenues by providing traditional access network services to a
challenge, even in urban areas, due to their deployment strat-
larger population, thus making the investment more attractive.
egy, which focuses on areas with no wired connectivity and
The massive MIMO base station is also assumed to have
installation of bases stations up to six meters above ground.
access to high speed fibre optic cable, which is usually
Using traditional micorwave backhaul lins is a problem due
available in most towns close to rural areas. The fibre optic
to capacity limitations[14]. Furthermore, wired backhaul con-
link connects all the traffic, including that from the village
nections are expensive and time-consuming to deploy [14].
In this paper, we propose the use of massive multiple
input multiple output (MIMO) technologies with beamforming
capabilities, instead of the traditional panel antennas, for the
microwave links [15]. This improves the transmit power to
each small cell base station, and therefore improves link
throughput. Like all wireless solutions, the solution will be
cost-effective compared to wired solutions. Figure 3 shows
the proposed network architecture. The following subsections
briefly describe each of the network segments.
A. Access Network
Each village small cell access network consists of a small
cell base station, a small cell backhaul radio and a solar
panel. The base stations provide network access to mobile
devices, owned by subscribers or healthcare workers. The
base stations are installed up to six meters above ground,
resulting in reduced distance between the base station and
mobile devices, hence higher link throughput. Small cell base
stations can be configured to share network resources equally
among connected devices. This allows dynamic allocation of
Fig. 3. Proposed architecture of village small cell networks consisting small
these resources to the devices, resulting in high data rates when cell networks, backhaul links, a massive MIMO base station and health
few devices are connected to a small cell base station. services networks.
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V. C ONCLUSION [13] Small Cell Forum, Rural and remote small cell network ar-
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This paper has proposed an architecture of a village small IEEE journal of selected topics in signal processing, Vol. 8, issue 5, pp.
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to villages in rural areas with limited or no mobile network
coverage. The proposed architecture is based on 5G technolo-
gies, whose performance specifications will enable delivery
of high quality, cost-effective and energy efficient mHealth
applications and services to the worlds unconnected billions,
hence enable countries to meet the United Nations goal 3, of
ensuring quality, equitable healthcare to all at all ages by 2035.
Some of the challenges limiting the adoption of mHealth
applications by governments include lack of capacity to prove
sustainability and scalability of mHealth solutions and en-
suring the security, integrity and privacy of patient data on
mHealth systems. Future work will include demonstrating the
utility of the proposed architecture and addressing the issues
of data security, integrity and privacy on the network.

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