Establishing a production-ready AWS cloud foundation for Digital Healthcare

About the client

Grameen Telecom Trust (GTT) embarked on the development of a mobile application as a key initiative under its Digital Healthcare Solutions program. The application was intended to deliver healthcare-related services through mobile devices, requiring a dependable technical foundation capable of supporting consistent performance, secure data handling, and future growth. Beyond core application hosting, the project also required official app distribution channels, real-time communication capabilities, and access to professional digital assets.

Express Systems Limited (ESL) was engaged to design, implement, and manage the complete AWS Cloud environment, together with the associated enabling services. This case study provides a detailed account of the requirements, the solution delivered, and the operational model established to support the application.

The challenge

The application needed more than basic hosting. It required an architecture that could handle variable user demand, maintain high availability, and integrate specialized services for audio and video interaction. At the same time, GTT sought to minimize the internal operational burden associated with AWS Cloud management, developer account administration, and third-party service coordination. ESL addressed these objectives through a single, coordinated engagement covering AWS services, enabling services, and continuous operations.

Primary objectives

• Establish a scalable and resilient AWS environment suitable for production use
• Enable official distribution through the Android and Apple app stores
• Provide real-time audio and video calling functionality
• Secure access to high-quality digital graphics assets
• Deliver ongoing managed support so that GTT teams could concentrate on application development and service delivery

Key challenges

• AWS services that could scale automatically while remaining cost-aware during periods of lower demand
• A highly available database capable of supporting both transactional and read-intensive workloads
• Secure and efficient networking to protect internal resources while allowing controlled external connectivity
• Administrative complexity associated with creating and maintaining official developer accounts on major app stores
• Integration of a specialized real-time communication service
• Ongoing operational responsibility for monitoring, maintenance, and optimization

Solution

ESL designed and implemented a production-oriented AWS environment tailored to the application’s requirements. The architecture incorporated compute, database, networking, and storage components configured for reliability and operational manageability. Each component was selected and configured to function as part of a cohesive production environment rather than as isolated resources.

Core AWS services

• Web Server Layer: Linux-based instances with 2 virtual CPUs and 4 GB of memory per server, supported by 25 GB of SSD storage, in auto-scaling groups (minimum one instance, maximum four per group).
• Load Balancing: Four application and web server load balancers distributing traffic across tiers, sized around average production metrics of approximately 500 new connections per second and 2,000 requests per second.
• Database Layer: Amazon Aurora (MySQL-compatible) in a multi-AZ configuration for automatic failover and high availability, with separate read and write nodes. Initial provisioning of 2 virtual CPUs, 16 GiB memory, and 100 GB of storage, with compute scalable to 2 or 4 vCPUs and network performance up to 10 Gigabit.
• NAT Gateway: Outbound traffic from private resources, sized for approximately 1 TB of monthly data processing.
• VPC endpoints: Private connectivity for selected services, planned around 500 GB of monthly data transfer.
• Internet Gateway and data transfer: External access, with pathways flexible enough for actual usage including inter-regional movement.
• Object Storage: Amazon S3 Standard storage class, with an initial capacity consideration of 500 GB and the ability to expand according to application needs.

Enabling services

• Android developer account for application publishing and updates.
• Apple App Store developer account with full publishing capability, including ongoing annual subscription renewal.
• Agora.io account for the real-time communication service used for in-app audio and video calling.
• Shutterstock subscription for professional images, vectors, and illustrations, plus support for other digital goods, development tools, and licenses as requirements evolved.

Managed services model

• Initial setup and detailed configuration of all AWS resources
• Continuous monitoring of AWS resource health and performance
• Routine maintenance and timely application of necessary updates
• Performance optimization in response to observed usage patterns
• 24/7 operational support aligned with the agreed service expectations
• Administrative oversight of third-party accounts and subscriptions

Billing is based on actual usage, with detailed usage reports provided regularly. AWS-generated bills are issued in USD; GTT settles the equivalent amount in BDT. A service charge of 6.9% of the total AWS bill applies. The USD-to-BDT conversion rate is fixed for three-month periods and may be reviewed thereafter. As the application’s scale or complexity increases, both the AWS services and the support arrangements can be adjusted without disrupting service continuity.

Results & value

Upon completion of the primary implementation activities, Grameen Telecom Trust possessed a fully configured, production-ready AWS environment supported by the necessary developer accounts, real-time communication capabilities, and digital asset resources. ESL continued to provide managed operational support, ensuring the AWS environment remained stable, optimized, and aligned with evolving requirements.

The application was thereby equipped with a technical foundation designed for reliability and growth, allowing the organization to advance its digital healthcare objectives with greater confidence and reduced operational distraction.

• Operational Reliability: Multi-AZ database deployment, auto-scaling compute resources, and properly dimensioned load balancing established a foundation capable of maintaining availability under variable load conditions.
• Reduced Internal Overhead: By consolidating AWS Cloud management, developer account administration, real-time service setup, and digital asset provisioning under one partner, GTT avoided the need to develop or expand internal capabilities in these specialized areas.
• Simplified Coordination: A single accountable organization reduced the complexity typically associated with managing multiple vendors for interconnected components of a digital solution.
• Built-in Scalability: Auto-scaling groups, flexible database scaling options, and expandable storage provided a clear pathway for growth without requiring fundamental architectural changes.
• Focus on Core Objectives: GTT teams were able to direct their attention toward application features, user experience, and the broader goals of the Digital Healthcare Solutions initiative, rather than day-to-day AWS Cloud operations.

The collaboration between Express Systems Limited and Grameen Telecom Trust demonstrates the practical value of an integrated approach to AWS services and enabling services. By addressing AWS architecture design, third-party account management, specialized service integration, and ongoing operations within a single engagement, ESL delivered more than a set of technical resources. It established a coherent operating foundation that supports both current needs and future development.

For organizations pursuing digital initiatives in healthcare and related domains, this model illustrates how professional AWS Cloud management combined with comprehensive service enablement can accelerate delivery while protecting internal focus and capacity. The work completed for this Digital Healthcare Solutions application stands as a concrete example of that principle applied in practice.

Prepared by Express Systems Limited · Version 1.0 · September 2026