Bill Gates: the proliferation of mobile devices hasn’t yet revolutionized life in developing countries

Bill Gates The Optiists Timeline

This interesting article by Bill Gates, Microsoft founder and co-chair of the Bill and Melinda Gates Foundation, looking at some of the challenges facing mHealth gave me some thoughts:

…there is one area of technology and global development where reality has tempered my optimism: the idea that cellphones would revolutionize life in developing countries. A decade ago, many people believed that the proliferation of mobile devices in Africa would mean a short leap to digital empowerment. It didn’t

In light of the stats I’m not sure how you can arrive at this conclusion:

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Last year when I was in Dubai I spent some time in the evening talking to workers (many of whom were Kenyan) who were queuing up to send money home to their families and they certainly would agree with me. The data shows that 10 years ago there was little mobile network coverage in Kenya outside of the major cities in sharp contrast to today 99% of internet connections are made via mobile and within just 4 years of the Sept 2007 launch of M-Pesa more than 30% of Kenya’s GDP was transiting a mobile network payment service.

Digital empowerment is a long and ongoing process, and the mere existence of cellular technology does not immediately change how poor people meet their basic needs

Of course your cellphone isn’t going to feed/clothe you (in the same way it won’t ensure someone who is affluent will eat and exercise well) but it might help your parent make a living, free up time that they can then spend caring for and educating you, etc.

There is an abundance of sources of good info detailing how mobiles are helping alleviate poverty and improving the chances for the poorest and those who care for and govern them.

Consider the example of M-Pesa, Kenya’s mobile-banking service that allows people to send money via their cellphones. M-Pesa first needed to invest in many brick-and-mortar stores where subscribers could convert the cash they earn into digital money (and back into cash). This real-world infrastructure will be necessary until economies become completely cashless, which will take decades. Without omnipresent cash points, M-Pesa would be no more convenient than traditional ways of moving money around. At the same time, it was impossible to persuade retail stores to sign on as cash points unless there were enough M-Pesa subscribers to make it profitable for them

I’m confused as I always thought M-Pesa cash points were initially the retailers of Safaricom services (eg. prepaid credit, SIMs, Mobile Phones) so there was no need to build it out because it was already in place to sell mobile services and it also created efficiencies because cash paid in could be recirculated locally (to those accepting money transfers) rather than requiring it to be banked locally. Today it’s obviously the prevalence and low transaction costs that are driving retailers to start accepting MPesa payments.

This kind of boot-strapping is exactly what we had to do at Microsoft Corp. in the early years of the personal computer. No one wanted a machine unless there was software, and no one would create software unless there were machines. Microsoft convinced both hardware and software companies to bet on future volume by showing how our platform would change the rules

I’m not sure this is the case. In my opinion Mobile networks and mServices/mHealth are unlike the Personal Computer/Software dilemma in that they are already in use by 7 billion citizens (and accessible to many more). For many projects the adoption hurdle is just our creativity – something I point to in this post discussing a Gates Foundation sponsored paper that suggested (incorrectly) that mobiles are complicating efforts to prevent AIDS.

There have been many successful small-scale pilot programmes using cellphones. But examples of large-scale, self-sustaining programmes powered by digital technology, like M-Pesa, are harder to find, because the key pieces have not been put into place to enable the required work to advance beyond the limits of controlled experiments

I don’t think it’s so too hard to find successful uses of mHealth if you know what you’re looking for and Alexander Oswald has done a great job of sharing the mobile innovation leadership that he encountered on a trip to Africa that I encourage everyone to watch:

Digitally-enabled health care, or mHealth, is one area that has been slow to emerge, because it is difficult to build a great platform and then convince everybody in a health system that it is worth using. If some health workers use cellphones to send information to a central database, but others do not see the value, the digital system is incomplete—and thus just as flawed as the current paper system

Obviously mHealth is far from being “digitally-enabled health care” but even if I ignore that I still find it hard to make sense of this, to me it’s akin to saying that the Doctors and Hospitals that were early customers of Microsoft PCs were as flawed as those who couldn’t see the opportunity for PCs. In my opinion it was these pioneers who rolled up their sleeves that have shaped the changes we see today in healthcare practice.

Although people don’t always think these have been positive (eg. collossal white elephants like the NHS’s >$20B National Program for IT) to me the change is clear and no one would want to go back (eg. you now have more access to information in the palm of your hand than I had in a teaching hospital library when I started studying medicine in 1995).

I can see no reason for anyone to think the opportunity is in waiting for complete “digital systems” to arrive and this should be obvious when you appreciate that mHealth is today leading the redesign of the worlds most expensive healthcare systems.

…The most promising mHealth project that I have seen, called Motech, focuses on maternal and child health in Ghana. Community health workers with phones visit villages and submit digital forms with vital information about newly pregnant women. The system then sends health messages to the expectant mothers, such as weekly reminders about good pre-natal care. The system also sends data to the health ministry, giving policymakers an accurate and detailed picture of health conditions in the country…

I wonder why Bill Gates doesn’t see the relation between increases in mobile penetration and GDP (something that the Mohammad Ibrahim Foundation is doing great work highlighting) and the resulting impact GDP has on education and health in an economy that is so heavily dependent on agriculture?

Note: probably the most promising Healthcare project involving mobiles I’ve seen being conducted in emerging markets is not being done by a healthcare organisation or NGO but by counterfeiters who are distributing pirated copies of expensive medical text book content to healthcare workers via cheap micro SD Cards.

Those working on AIDS, tuberculosis, malaria, family planning, nutrition, and other global health issues can use the same platform, so that all parts of a country’s health system are sharing information and responding appropriately in real-time. This is the dream, but it works only if frontline workers are inputting data, health ministries are acting on it, and patients are using the information that they receive on their phones

Perhaps these NGO’s just need to think more creatively about the challenges they face? For example imagine AIDS workers thinking about how they can prevent HIV transmission in the first place eg. by using mobile as a means to communicate with sex workers, by working with the mobile industry as a media company to ensure that the adult content that these firms are distributing across their networks only show safe and consensual sexual relations, etc.

I think it’s important we appreciate the little things because very soon we’ll be looking back and appreciating that they were in fact the big things. What do you think?

About David Doherty
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