Report Landscapes the Agritech Ecosystem for Smallholder Farmers in Latin America and the Caribbean

In 2009, I had the opportunity to lead a project that created a Short Message Service, a system that enables mobile phone users to send and receive text messages, for farmers in Peru. Those farmers who possessed a feature phone, which is a mobile phone that incorporates features such as the ability to access the Internet and store and play music but lacks the advanced functionality of a smartphone, received text messages containing valuable information such as localized weather information, up-to-date market prices for the crops being cultivated, and best practices for maximizing yields. It was through this experience where I learned the importance of the agriculture sector to the Peruvian economy as well as the Latin American economy as a whole. Over a decade later, the GSM Association (GSMA), a UK-based organization representing the interests of mobile operators worldwide, published a report that focuses on landscaping the agritech ecosystem for smallholder farmers in Latin America and the Caribbean.

Published as an output of a project funded by IDB Lab, the innovation laboratory of the Inter-American Development Bank (IDB) Group, for the benefit of smallholder farmers in Latin America and the Caribbean, the report points out that "Agriculture is an important source of employment in Latin America and the Caribbean, particularly in rural areas where 54.6 percent of the labor force is engaged in agricultural production." Furthermore, "The region is an important source of food globally, generating 13.6 percent of total agricultural exports. Thanks to a wealth of natural resources and a vast and varied topography capable of producing a range of crops, Latin America is becoming known as the breadbasket of the world."

What is more, "The study is part of this endeavor to better understand technological solutions and opportunities in agriculture that will allow IDB Lab to support strategies and investments with social and economic impact and expand the agritech ecosystem in the region. The report features innovations aimed at smallholder farming, particularly in countries of Central America and the Andean region, thus bridging the information gap left by much of the literature to date."

"Although much of Latin America shares the same language and cultural heritage," the report says "the structure and scale of the agriculture sector vary significantly from country to country. Southern Cone countries are characterized by capital-intensive, highly-mechanized farming of export crops, while Central American and Andean countries rely much more on smallholder farming for crop production."

In addition, "Several barriers have prevented the region's agriculture sector from achieving its full potential, including some of the world's lowest productivity levels, low financial inclusion and a lack of resilience to external shocks, such as those caused by climate change and the global COVID-19 pandemic. Recognizing the positive impact that digital agriculture tools can have on productivity, incomes and resilience to climate change, agriculture-sector stakeholders throughout Latin America are implementing a range of tools aimed at easing pain points and benefiting those in the agricultural value chain, both on the supply and the demand side."

Examining 131 digital agriculture tools deployed throughout Latin America that are addressing the challenges of smallholder farmers, the GSMA AgriTech team looked at five use cases: digital advisory, agri digital financial services (DFS), digital procurement, agri e-commerce and smart farming. Key trends emerging from this review include:

• "Latin America's digital agriculture tools have failed to reach the scale of those in Asia and Africa. Most digital agriculture services available in Latin America today are led by governments or NGOs and have between 1,000 and 5,000 users, making them difficult to sustain long term.
• "Smallholder farmers in Latin America are increasingly looking for holistic solutions that address a range of farmer challenges, from knowledge gaps and low productivity to financial exclusion, climate change and poor access to markets.
• "New technologies, such as IoT sensors, drones, satellites, AI and big data, are increasingly underpinning digital agriculture tools in the region. IoT sensors, drones and satellites are automating data collection, making the process more efficient and accurate for ecosystem players. Meanwhile, AI and big data analytics are enabling richer, more personalized and actionable data for smallholder farmers to increase production and decrease costs.
• "Blockchain is being used for agri DFS and digital procurement. Heifer International, EthicHub, COOPSOL and other organizations are taking advantage of the transparency, security, speed and low-cost offered by blockchain to facilitate loans between lenders and smallholder farmers, provide traceability to crop buyers and support land registration.
• "Colombia has emerged as an agritech innovation hub for smallholder farmers in Latin America. This has been due to a confluence of factors, including a strong (by regional standards) DFS ecosystem, an enabling regulatory environment, a robust startup and investment culture, rising incomes and a relatively strong middle class. In Central American countries and Bolivia, where the opportunity for digital agriculture innovation is as strong due to the prevalence of smallholder farming, the sector has suffered from a less enabling and comparatively weaker environment."

Crucially, "The GSMA AgriTech team's research highlighted two opportunities in digital agriculture that could address farmers' low productivity and access to financial services in the short to medium term. These include:

• "Smart farming tools: Over the last two years, smart farming pilots for smallholders in Latin America have shown promising results, with production increases as high as 50 to 80 percent, and cost reductions of 20 to 40 percent. Despite these benefits, few smart farming solutions have moved from the pilot phase to commercial viability. Implementation costs are the main barrier, including the cost of equipment (sensors, gateways, drones) and the cost of on-going connectivity (sensors powered by cellular data).
• "Using farmer data from digital agriculture tools to extend financing to smallholders: Smallholder farmers in Latin America face significant gaps in short- and long-term financing, both for agricultural and non-agricultural financial needs. Access to credit from formal financial institutions requires an economic identity that most smallholder farmers do not have, but mobile-based digital agriculture tools can generate digital financial footprints populated with farm and farmer data. This data can be used to perform credit risk assessments thus offering a pathway to financial inclusion for farmers. This offers huge potential to bridge the data gap in smallholder financing and open a pathway to financial inclusion. Digital tools that enable farmers to access markets, such as digital procurement solutions and e-commerce services, are especially useful in generating rich data sets, such as transactional data from the sale of crops."

The report also presents the following seven enablers driving the adoption of digital agriculture solutions by smallholder farmers in Latin America and the Caribbean:

1. Coverage for mobile internet services is nearly ubiquitous in Latin America, but there are gaps between urban and rural areas;
2. Smartphone penetration in Latin America is the highest of all developing regions;
3. Mobile money services are available in Latin America and the Caribbean, but have not been widely adopted outside Paraguay, Haiti and Honduras, limiting the potential of agritech tools;
4. A growing middle class is changing consumption patterns;
5. Investment in agritech is increasing;
6. Latin America is a leading producer of crops that are well suited to digitization; and
7. An enabling regulatory environment is key to the success of many digital interventions.

Lastly, "The GSMA AgriTech team has developed a set of 11 recommendations to support funding, product development and marketing for several key stakeholders in the digital agriculture ecosystem, including agritech companies, donors and investors."

1. Support viable, private sector-led digital advisory services;
2. Ensure that users are at the center of service design;
3. Focus on developing a strong value proposition that offers an end-to-end solution and a clear revenue model;
4. Build reliable partnerships;
5. Carefully assess smart farming opportunities before launch;
6. Do not approach the region with a one-size-fits all approach;
7. Focus on value chains where digital interventions can have the greatest impact;
8. Create an enabling regulatory environment, focusing on markets with the greatest need;
9. Help address the financing gap;
10. Support smallholder farmers to mitigate the impact of climate change; and
11. Leverage existing mobile assets and explore partnerships to develop digital solutions for smallholders.

As noted in a blog post published just over a couple of months ago on GSMA's report about Latin America's mobile economy, the region's digital landscape is evolving rapidly. The report said that in "Latin America, mobile technology continues to play a key role in bringing unconnected populations online and providing a platform to create, distribute and consume life-enhancing digital services." This provides hope that the 11 aforementioned recommendations will be implemented to build and strengthen the region's digital agriculture ecosystem.

What are your recommendations for how to improve the agritech ecosystem for small farmers in Latin America and the Caribbean?

 

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

TradeTech Has the Potential to Facilitate and Promote Further International Trade by Lowering Barriers for Companies to Enter New Markets

According to a report published by the World Economic Forum (WEF), a Swiss-based international organization promoting public-private cooperation, "TradeTech is the set of technologies and innovations that enable global trade to be more efficient, inclusive and equitable. The interplay of technology and trade has a long history, spanning from advances in transportation to the advent of the container to the emergence of coordinated production networks."

Mapping TradeTech: Trade in the Fourth Industrial Revolution "considers modern TradeTech in two layers: (1) a first layer in which trade data and processes are transformed from analogue to digital; and (2) a second layer in which trade process optimization and synchronization occurs between different parties, and where emerging technologies play a key role." The report adds that  "TradeTech solutions work in bundles. While the second layer depends on data generated in the first one, it is also hard to separate artificial intelligence (AI) from robotics or the internet of things (IoT) from 5G."

Aiming "to shed light on the landscape of emerging trade technologies and consider the opportunities and challenges for each, with case studies used for illustration," the report notes:

Business perceptions show that many technologies have a significant impact on trade. The World Economic Forum launched a global survey to understand how firms are currently using technologies in international value chains and to assess which technologies will have the biggest impact on global trade. The results are being used to determine a landscape of technologies that have the biggest effect on trade in the short and medium term. According to this survey on TradeTech, conducted from June to September 2020, "fundamental" technologies such as digital documentation, digital platforms, digital payment and cloud computing are perceived as most relevant in the shorter term, along with IoT, digital

services and 5G. Technologies expected to affect trade in the longer term are robotics, virtual reality, 3D printing and AI.

On the topic of TradeTech for micro-, small and medium-sized enterprises (MSMEs), the report says: "As the Fourth Industrial Revolution sets in, MSMEs face both opportunities and challenges in this wave of technological transformation. New technologies in trade, such as cloud computing, blockchain, IoT, big data and AI, present MSMEs with opportunities to tap into the technological edge previously only available to large firms. The application of new TradeTech can help MSMEs save costs, improve efficiency, streamline operations and scale up. Software as a service (SaaS) and e-commerce platforms have made trade more inclusive as there are no upfront costs."

As for supporting TradeTech adoption by MSMEs, the WEF suggests governments could support MSMEs in a number of ways, including by:

• Promoting education and IT skills development, through the inclusion of IT in school and university curricula, and encouraging public-private partnerships through internship programs
• Facilitating big data and AI tools that help MSMEs reduce market research costs and improve online visibility
• Improving information and communications technology (ICT) and logistics infrastructure
• Providing cybersecurity training
• Setting up a TradeTech network, composed of key stakeholders, that has the potential to maximize the scope and outreach of any given solution while encouraging the development of local solutions (for instance, a single web page might compile and easily display all the resources, tools and services offered by the members of the TradeTech network); given the lack of skilled human resources affecting companies, external experts might bridge the gap by providing qualified advice
• Establishing a benchmark for TradeTech adoption by MSMEs, which could help incentivize government reform actions to promote TradeTech adoption.

"Internationally," the report explains that "an increasing number of trade agreements include chapters on e-commerce and digital trade. Recent agreements, such as the Digital Economy Partnership Agreement (DEPA), include provisions on MSMEs and digital inclusion specifically. Commitments go from information sharing to enhancing public-private dialogue and cooperation involving e-commerce platforms."

Given my experience working in developing countries, I appreciate the report's assertion that "TradeTech offers developing countries leapfrog opportunities. The potential to seize these opportunities may vary by technology. TradeTech that requires higher capital, such as robotics and IoT, may be more challenging to diffuse in low-income country settings than technologies that are mainly software defined (e.g. blockchain, AI and digital platforms)."

What is more, "The network nature of TradeTech’s benefits, in which the more users there are of the technologies, the more value each user can derive from them (positive network externalities), creates incentives for the diffusion of technology worldwide.

"The most straightforward opportunities might come from the first layer of TradeTech, that is the digitalization of trade and logistics-related documents. This is a mature innovation in developed countries, where the opportunities for additional market expansion are limited, although certain developing countries have also advanced significantly in this area, for instance regarding e-invoicing."

The WEF says "TradeTech has the potential to facilitate and promote further international trade by lowering barriers for companies to enter new markets. Major TradeTech gains originate in good coordination between the different actors in supply chains. TradeTech, especially in its second layer, allows holistic decisions that can result in efficiency and environmental advantages for the whole value chain. Yet unintended consequences in terms of job displacement, competition and techno-nationalism trends require attention."

Moreover, "TradeTech's impact will depend on how data and tech interoperability are addressed, regulations are harmonized, and inclusive access to close the digital divide, also present in the trade space, is ensured. To deliver on TradeTech's promise, action is needed to build the trust required for supply chain transparency, to promote cooperation in tech regulation, to drive a trade facilitation agenda around interoperability, and to provide training for upskilling and reskilling workers."

Many will agree with the report's assertion that "[t]he COVID-19 pandemic has significantly accelerated the adoption of digital technologies and opened a window of opportunity to drive tech innovation in trade. The moment should be seized to use TradeTech to make global trade more efficient, inclusive and equitable."

How do you see emerging trade technologies facilitating and promoting international trade?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

'Earthling Project' Aims to Send Collective Human Chorus Into Outer Space

Launched in 1977 by the National Aeronautics and Space Administration (NASA), America's space agency, to study the outer Solar System, Voyager 1 and 2 each carried a message in a phonograph record, a 12-inch gold-plated copper disk containing sounds and images selected to portray the diversity of life and culture on Earth. As explained by NASA's Jet Propulsion Laboratory (JPL), "The contents of the record were selected for NASA by a committee chaired by Carl Sagan of Cornell University, et. al. Dr. Sagan and his associates assembled 115 images and a variety of natural sounds, such as those made by surf, wind and thunder, birds, whales, and other animals. To this they added musical selections from different cultures and eras, and spoken greetings from Earth-people in fifty-five languages, and printed messages from President Carter and U.N. Secretary General Waldheim." (The Golden Record cover shown with its extraterrestrial instructions. Credit: NASA/JPL)

Interestingly, "The remainder of the record is in audio, designed to be played at 16-2/3 revolutions per minute. It contains the spoken greetings, beginning with Akkadian, which was spoken in Sumer about six thousand years ago, and ending with Wu, a modern Chinese dialect. Following the section on the sounds of Earth, there is an eclectic 90-minute selection of music, including both Eastern and Western classics and a variety of ethnic music. Once the Voyager spacecraft leave the solar system (by 1990, both will be beyond the orbit of Pluto), they will find themselves in empty space. It will be forty thousand years before they make a close approach to any other planetary system. As Carl Sagan has noted, 'The spacecraft will be encountered and the record played only if there are advanced spacefaring civilizations in interstellar space. But the launching of this bottle into the cosmic ocean says something very hopeful about life on this planet.'"

Now there is a new initiative to beam human voices to outer space. According to an article by The Economist, "In the Cascade mountains of northern California, a cluster of 42 radio telescopes points towards the stars, scanning for signs of life. The Search for Extraterrestrial Intelligence (SETI) Institute has been listening for a signal here and elsewhere since it was founded in 1984. In that time it has scoured only a minuscule fraction of space, equivalent to a glass of water in all the world’s oceans. But Jill Tarter, its co-founder, is undaunted. A renowned astrophyisicst—and the model for Jodie Foster's character in the alien-encounter film 'Contact'—Ms. Tarter says the program's aim is not just to communicate with remote civilizations. It is also to remind humanity of its own modest, fragile place in the cosmos. Which is why, for the first time, SETI is cocking its ear towards Earth."

SETI, which is based in Mountain View, Calif., "is looking for the same thing on this planet that it routinely seeks from others: a signal that can be beamed into space to represent the species. Felipe Pérez Santiago, a Mexican musician and composer—and artist in residence at the institute—has an idea of what might work. Since song, like the human voice, is common to all languages and nations, he and Ms. Tarter have devised the 'Earthling Project': a call to people everywhere to upload snippets of song that he plans to meld into a collective human chorus. An initial composition will be launched into space this summer, inscribed on a virtually indestructible disk alongside Wikipedia and the Rosetta Project, a sampling of 1,500 human languages. Future plans and dreams include an eventual dispatch to Mars."

To participate in the Earthling Project, simply download the app and submit your voice in their registry to be heard in space.

As The Economist points out: "Some elemental melodies endure for centuries: lullabies, mourning chants, songs of love or celebration, age-old tunes that lighten toil or praise a god. [...] the project's app stands ready to receive all these, and whatever else earthlings anywhere choose to contribute. Unlike other recordings sent into space, says Mr. Santiago, 'everyone's invited. You don't have to be one of the main composers of our history like Beethoven, just someone singing in their shower.' Download the app, warble up to three songs of 30 seconds each, and your voice will be dispatched into the firmament."

"Mr. Santiago pledges to use every submission," the article notes. "The ultimate plan is to throw open the whole database for musicians anywhere to sample. Understanding that all earthlings share a common planet 'is crucial for our long future,' Ms. Tarter says. 'We face challenges that have to be solved by co-operating across the globe.' In a small but symbolic way, the Earthling Project is meant to set an example."

As I write this blog post, I am reminded of The Carpenters' "Sing," the lyrics of which are sung by most parents in the English-speaking world (I remember my mom singing it to me):

Learning about space exploration as an elementary school student, I was enthralled by the phonograph record carried by Voyager 1 and 2. And before Voyager, Pioneers 10 and 11, launched in 1972 and 1973, respectively, both carried small metal plaques identifying their time and place of origin for the benefit of any other spacefarers that might find them in the distant future (see left image). There is a certain amount of excitement to be part of something equally galactic. My wife and I will submit a 30 second opus to SETI's Earthling Project. Will you be doing the same? If so, just confirm that your phone is waterproof if making your submission from the shower.

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

AI Can Have a Transformative Impact in Low- and Middle-Income Countries, Says GSMA Report

"Around the world, artificial intelligence (AI) is automating functions and making new services possible with breakthroughs in cheap computing power, cloud computing services, growth in big data and advancements in machine learning (ML) and related processes," according to a study that aims to understand the current and potential use of AI by startups and small and medium enterprises (SMEs) in low- and middle-income countries (LMICs) in four regions: Sub-Saharan Africa, North Africa and South and Southeast Asia.

The report, which was produced by the GSM Association (GSMA), a UK-based organization representing the interests of mobile operators worldwide, asserts that "AI can radically alter and improve the way governments, organizations and individuals provide services, access information and improve their planning and operations."

Mapping "a sample of 450 start-ups by sector in alignment with the UN Sustainable Development Goals (SDGs) and, based on interviews with AI experts in LMICs," the report explores "trends and challenges in business models, barriers to innovation and the ethical and responsible use of AI." In doing so, the study answers the following research questions:

• What is the status of AI use in LMICs?
• Which sectors, geographies and business models are showing the most promise, and why?
• What are some of the barriers to implementing AI solutions in LMICs?
• How can AI be used ethically to accelerate the achievement of the SDGs?

Top AI use cases in LMIC include agriculture, administration and business processes, cities and infrastructure, climate change, disaster management, education, finance and microlending, government and public services, healthcare, and identity. In explaining the use cases by sector verticals, the report says: "Business intelligence and analytics had the highest number of use cases as it captures a wide range of business-to-business (B2B) solutions, from enhanced retail market analysis and predictive decision making to customer service. Customer service chatbots, automated IT consulting, big data analytics and automated records are some examples of AI use cases."

As for healthcare, this rapidly growing sector "had the second highest number of use cases and clearly benefits from AI solutions, including sophisticated diagnosis and treatment options, hospital management systems, lifestyle change recommendations and healthy eating habits." The report further notes that "[f]ood and agriculture, financial services, education and retail and consumer goods followed these sectors. Food and agriculture employs a range of AI-based services, including services for identifying and remedying crop diseases, linking producers more effectively to buyers and markets and helping farmers maximize crop yields based on climatic and soil conditions."

As for use cases by country and region, the report identified a few AI innovation hotspots (see map above). "India," for example, "was the most represented country in our sample. The country accounted for over 40 percent of the sample (180 use cases), indicating a high level of innovation and AI uptake in the country. Far more cases were identified in India, but were excluded due to limited alignment with development outcomes, apart from general economic development. Nigeria and South Africa were the next two most represented nations in the sample with 42 and 38 use cases, respectively. China was excluded from the study, along with the rest of East Asia, which are emerging as centers of AI innovation and investment. For example, in 2017, China submitted approximately 1,300 AI and deep learning-related patents, compared to 220 by the United States."

Data, ICT infrastructure and hardware challenges create barriers to implementing AI in LMICs. Such challenges include the availability, accessibility and quality of data, access to reliable and affordable internet, lack of access to sufficient computing power, increasing digital inclusion and connectivity including device access, ownership and capability, and unreliable power infrastructure.

Human capital and lack of funding and automation present additional barriers. According to the GSMA, "While there is growing access to upskilling and training in AI, many countries still lack a steady pipeline of home-grown talent and skilled AI development talent. [...] The lack of mentorship available to start-ups developing AI-based solutions is also a constraint in many countries."

Regarding the lack of investment, the report explains that "AI-based solutions typically need a lot of investment. Unlike countries such as China and the United States, investment and funding are extremely limited in most LMICs. Countries in Africa and South and Southeast Asia that appear to have higher levels of investment include India, Kenya, Malaysia, Thailand and South Africa."

On the topic of the ethical use of AI in LMICs, the report points out that "To genuinely contribute to the SDGs, AI innovators need to eliminate the potential negative impacts of their AI processes. AI applications should be ethical by design to prevent and mitigate any potential negative impacts on users, workers, communities and the environment."

Moreover, "The application of existing laws, regulations and privacy principles, such as the GSMA Mobile Privacy Principles, can help mitigate privacy and ethics risks associated with AI. In addition to these frameworks, the GSMA recommends the adoption of the following principles by all stakeholders using AI for social good."

• "Do no harm: Development and deployment of AI systems should respect human rights and should not cause human rights harm to individuals or groups. Particular care should be given to preventing harm to vulnerable individuals or groups."
• "Be inclusive: AI stakeholders should support inclusion and equity, and should strive to ensure that the benefits of their AI-based technologies are broadly accessible.
• "Be fair: AI systems should incorporate human oversight. All stakeholders should strive to ensure that the data used in AI is accurate and not unfairly biased. AI should not be used to make decisions that may affect any group or individual in an unfair or discriminatory way (e.g. discrimination based on protected characteristics such as race, gender, etc.).
• "Ensure transparency: Individuals should be informed when they are communicating with AI-powered systems instead of a human (e.g. conversational AI). Decisions made with AI should be clearly explained to the individuals affected.
• "Embed accountability: All AI stakeholders should be accountable for their use of AI and should promote these principles with the third parties they engage for social good purposes.
• "Adopt privacy and ethics by design: AI systems should be designed and deployed according to privacy and ethics by design ethos or methodology at each stage of the life cycle, with input from relevant teams.
• "Advance security and safety: Access to AI systems and their underlying data should be controlled and subject to audits or other accountability measures. State-of-the-art security measures should be used wherever possible. All AI experts and practitioners should implement best practices in security.
• "Support sustainability and societal well-being: Sustainability and societal well-being should be considered in the development and deployment of AI systems."

Maintaining business interests in many of the countries covered in this report, I concur with the GSMA that AI can have a transformative impact on LMICs. Such transformation, however, will require investments from the private sector and governments to overcome the aforementioned barriers to implementing AI. What is more, media sources are starting to present reports about the misuse of the technology. It is imperative that all stakeholders using AI adopt the GSMA's recommendations for using AI for social good.

Do you agree with the report's findings? How are you engaging in the development of AI solutions in LMICs?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

Democracy Was Dealt a Major Blow in 2020, Says EIU Report

"Democracy was dealt a major blow in 2020," according to a report produced by The Economist Intelligence Unit (The EIU). Providing "a snapshot of the state of democracy worldwide in 165 independent states and two territories," the 13th edition of the Democracy Index, which was edited by Joan Hoey, Regional Director, Europe at The EIU, "covers almost the entire population of the world and the vast majority of the world's states (microstates are excluded)." The report disappointingly records a decline in their overall score, as country after country locked down to protect lives from a novel coronavirus.

The EIU explains that its "Democracy Index is based on five categories: electoral process and pluralism, the functioning of government. political participation. political culture, and civil liberties. Based on its scores on a range of indicators within these categories, each country is then itself classified as one of four types of regime: 'full democracy.' 'flawed democracy,' 'hybrid regime' or 'authoritarian regime.'"

What is more, "The main focus of the report is the impact of the coronavirus (Covid-19) pandemic on democracy and freedom around the world. It looks at how the pandemic resulted in the withdrawal of civil liberties on a massive scale and fueled an existing trend of intolerance and censorship of dissenting opinion. The report also examines the state of US democracy after a tumultuous year dominated by the coronavirus pandemic, the Black Lives Matter movement and a hotly contested presidential election. The results by region are analyzed in greater detail in the section entitled 'Democracy around the regions in 2020.'"

As indicated in the table above, "only about half (49.4%) of the world's population live in a democracy of some sort, and even fewer (8.4%) reside in a 'full democracy,'" according to The EIU's measure of democracy. "[T]his level is up from 5.7% in 2019, as several Asian countries have been upgraded. More than one-third of the world's population live under authoritarian rule, with a large share being in China."

The report adds that "75 of the 167 countries and territories covered by the model, or 44.9% of the total, are considered to be democracies. The number of 'full democracies' increased to 23 in 2020, up from 22 in 2019. The number of 'flawed democracies' fell by two, to 52. Of the remaining 92 countries in our index, 57 are 'authoritarian regimes,' up from 54 in 2019, and 35 are classified as 'hybrid regimes,' down from 37 in 2019."

Discouragingly, The EIU notes: "democracy has not been in robust health for some time. In 2020 its strength was further tested by the outbreak of the coronavirus (Covid-19) pandemic. The average global score in the 2020 Democracy Index fell from 5.44 in 2019 to 5.37. This is by far the worst global score since the index was first produced in 2006." Furthermore, "The 2020 result represents a significant deterioration and came about largely—but not solely—because of government-imposed restrictions on individual freedoms and civil liberties that occurred across the globe in response to the coronavirus pandemic."

In explaining the map above, The EIU says:

The deterioration in the global score in 2020 was driven by a decline in the average regional score everywhere in the world, but by especially large falls in the "authoritarian regime"-dominated regions of Sub-Saharan Africa and the Middle East and North Africa. Their scores declined by 0.10 and 0.09, respectively, between 2019 and 2020. Western Europe and eastern Europe both recorded a fall in their average regional scores of 0.06. The score for Asia and Australasia, the region which has made the most democratic progress during the lifetime of the Democracy Index, fell by 0.05. Latin America's average score declined by 0.04 in 2020, marking the fifth consecutive year of regression for the region. The average score for North America fell by only 0.01, but a bigger decline of 0.04 in the US score was masked by an improvement in Canada's score.

In 2020 a large majority of countries, 116 of a total of 167 (almost 70%), recorded a decline in their total score compared with 2019. Only 38 (22.6%) recorded an improvement and the other 13 stagnated, with their scores remaining unchanged compared with 2019. There were some impressive improvements and some dramatic declines . . . with Taiwan registering the biggest improvement and Mali the biggest decline. There were 11 changes of regime category, seven negative and four positive. Three countries (Japan, South Korea and Taiwan) moved from the "flawed democracy" category to be classified as "full democracies" and one country, Albania, was upgraded to a "flawed democracy" from a "hybrid regime" previously. France and Portugal experienced a reversal, losing the "full democracy" status they had regained in 2019, re-joining the ranks of "flawed democracies." El Salvador and Hong Kong were relegated from the "flawed democracy" classification to that of "hybrid regime." Further down the ranking, Algeria, Burkina Faso and Mali lost their status as "hybrid regimes" and are now designated as "authoritarian regimes."

With a score of 9.81, Norway ranks #1 in the Democracy Index followed by Iceland (9.37), Sweden (9.26), New Zealand (9.25), and Canada (9.24). Rounding out the bottom five are Chad (1.55), Syria (1.43), Central Africa Republic (1.32), Dem. Republic of Congo (1.13), and North Korea (1.08) as the least democratic nation. As a citizen of the United States (7.92), I am disappointed to find my home country classified as a "flawed democracy" with a ranking of 25.

During a webinar to discuss the findings of the Democracy Index, Ms Hoey explained that the aim of the Democracy Index is not aimed to serve as an advocacy tool but to "provide an independent and robust measure of the state of democracy around the world and to shine a light on positive and negative developments. In doing that, we can play a role in holding governments to account." She added: "I think we also would like to stimulate a debate about the problems of democracy and potential ways in which governments and citizens improve matters."

What are your thoughts about the report's findings?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

E-Commerce Can Create Opportunities for Young People, Women, and Entrepreneurs in Iraq, Says UN Report

Even before the coronavirus pandemic, e-commerce was disrupting the brick-and-mortar retail industry. Not only did digital retail explode in industrialized markets, but developing countries are seeing signs of the industry's growth. The potential for a thriving e-commerce industry in developing countries has long existed provided that the necessary mechanisms (i.e., smartphones, mobile broadband, physical infrastructure and trade logistics) are in place. For example, while performing due diligence on Iraqi businesses that applied for business development funds provided by the United States government in the late 2000s, I had the opportunity to see role e-commerce can play in the development of the country's private sector. I witnessed how a thriving private sector powered by micro, small and medium-sized enterprises (MSMEs) is necessary for stabilization and sustainable development. Therefore, it was with great interest that I read a report by the United Nations Conference on Trade and Development (UNCTAD) assessing Iraq's e-commerce and digital trade readiness.

Highlights from the report include:

The e-commerce ecosystem in Iraq, while emerging, is still facing major challenges.

• The country lacks a unified vision on e-commerce and the coordination required among stakeholders to accelerate the Iraqi digital development agenda.
• Years of conflict in Iraq have caused major damage to physical infrastructure. Rebuilding ICT infrastructure and improving trade logistics – especially in terms of customs' clearance processes – are key to building the foundations for e-commerce and the digital economy in Iraq.
• The customs' operational model in Iraq also needs an update, as time and costs to export and import goods in Iraq are among the highest globally. Some improvements have been made, by introducing new regulations on electronic processing of moving goods, but further reforms are needed.
• Other challenges are the limited role of Iraqi Post in the digital economy and the low integration of postal services with other e-commerce stakeholders, for both national and cross-border transactions.

Despite these challenges, there are important opportunities for Iraq to tap into the potential of e-commerce for development:

• The assessment shows that e-commerce would help stimulate domestic demand, boost trade and diversify Iraq's largely oil-based economy. Increased productivity and competition would push local industries to create new jobs, especially for the youth, who represent nearly 60% of the population.
• With the improved security environment, Iraq has a chance today to leverage digital technologies for economic diversification and for supporting more sustainable and inclusive development.
• The assessment can help the Government of Iraq mobilize the resources needed for the implementation of the key policy actions, thus moving the country towards its digital economic and social transformation.

On the topic of e-commerce skills development, the report asserts that Iraq's "entrepreneurial ecosystem is still nascent and shallow. Private sector institutions, companies and employees - especially MSMEs - lack the knowledge and expertise to effectively engage in e-commerce. Among MSMEs there is a general lack of awareness about the benefits of e-commerce; this is reflected in their priorities and plans that do not consider the potential benefits of online commerce, including access to new markets. Among the general population, trust in online transactions remains low."

Moreover, "The Iraqi public sector also lacks the skills and knowledge to develop an enabling environment for e-commerce and digital economy, which has been identified as a major challenge. This reality prevents public sector institutions from developing the necessary policies and programs to support the private sector, which relies on an enabling environment to drive innovation and introduce new products and services. Without an enabling environment supported and enhanced by the public sector, the potential of the private sector is constrained."

Once an enabling environment by the public sector to support private sector development is established, "the lack of access to financing for e-commerce startups and MSMEs, from the formal banking system and the non-banking financial system, is another barrier to the development of e-commerce in Iraq," the report explains. "The main reasons include the limited use of formal financial institutions by citizens and MSMEs, and the inability of financial institutions and financing initiatives to address the needs of customers such as startups, small businesses and women-run enterprises. Typically, the products and services offered by these financial institutions are geared towards large established firms in traditional sectors."

While "the Iraqi entrepreneurial system remains nascent," the report notes that "promising developments are emerging. Five innovation hubs have been established across the country and there is growing interest in digital innovations from local incubators and accelerators, the telecommunications company Zain, the donor community and other stakeholders."

The report optimistically concludes that the "emergence of e-commerce in Iraq is very promising and has the potential to create jobs, diversify the economy, stimulate domestic demand and increase exports. As the country continues to rebuild after years of conflict, e-commerce can provide a boost to many existing industries and create new opportunities for young people, women and aspiring entrepreneurs." Although it is unknown how covid-19 has impacted these innovation hubs, the drive to build a thriving e-commerce sector and digital economy in Iraq and throughout the Middle East region remains strong based on discussions with my colleagues in the region.

What are your recommendations for how Iraq can develop a thriving digital economy?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

Boards Should Build Organizational Resilience in Their Company's Future-Readiness Plans

"Resilience," as defined by Merriam-Webster, is "an ability to recover from or adjust easily to misfortune or change." Although not part of the lexicon of many business leaders prior to the coronavirus pandemic, the word now appears regularly in articles and is mentioned during most webinars focusing on how covid-19 is impacting businesses of all sizes. And while not specifically mentioned in posts on this blog including "EY's Six Priorities for Boards in 2021" or "Six Ways a Board of Directors Can Ensure Future-Readiness," resilience is the underlying theme. It was an article, however, Dr. Linton Wells II authored for BoardTalk, the official blog for the National Association of Corporate Directors, that prompted me to think about what it means for a company to be resilient and the boards' responsibility to build organizational resilience in a company's future-readiness plan.

"Resilient companies produce impressive results," Dr. Wells writes. "They have shown positive earnings and sales growth during recessionary years, improved their corporate image by effective strategic responses to natural disasters, raised dividends for several consecutive decades, and won back market share against low cost and online competitors." Crucially, companies "also invest wisely."

Dr. Wells, an Executive Advisor to the Center for Resilient and Sustainable Communities (C-RASC) at George Mason University and chairs the Advisory Group of the C4I and Cyber Center there, notes that "the examples mentioned above support the claim that organizational resilience is an important concept for corporate boards and senior executives, but companies often don't include it in executive planning exercises. Instead, many mistakenly categorize resilience as disaster recovery plans or business continuity plans, leaving the details to mid-level operations."

He also explains that "Others see resilience as a part of corporate succession planning, risk management, or other programs that are important. However, in today's dynamic, disruptive operating environments, organizational resilience requires that companies integrate features that others' plans and programs lack."

What is more, "To succeed, leadership, supported by the board, must resource and incent resilience into the infrastructure and the culture of the company. Similar to other cultural paradigms like workplace safety, resilience matures and becomes integral to people, processes and technology. Suggestions for doing so follow."

With respect to the board of directors' role of building the capacity for resilience in the companies they serve, Dr. Wells says: "Successful corporate directors are keen to build resilience. Only senior leadership, supported by the board, has the breadth of vision and the experience to address these issues comprehensively. Far more important than compliance checklists, the board members' strategic impact on business and cultural resilience can help leadership build valuation through quality control incentives and measurements like MOE" or measurements of effectiveness.

In describing the essence of resilience, Dr. Wells importantly notes that "resilience involves strategy. It's not just a plan. It includes two critical concepts: organizational capacity and," citing a speech Dr. Judith Rodin, former president of the Rockefeller Foundation, gave at the National Disaster Resilience Competition Summit in 2014, "the ability to 'adapt and grow from a disruptive experience.'" Below is Dr. Rodin's full definition:

Resilience is the capacity of any entity—an individual, a community, an organization, or a natural system—to prepare for disruptions, to recover from shocks and stresses, and then to adapt and grow from a disruptive experience.

Covid-19 is impacting businesses in ways most business executives never anticipated. While my own ventures have plans for how to prepare for any number of risk factors, the global pandemic is testing their resilience. Companies cannot avoid uncertainty and volatility, but they should take specific actions to build greater resilience. In Dr. Wells' words: "Be prepared to bounce forward better."

"Resilience: Building an Essential Corporate Capacity" is the first of a series of articles by Dr. Wells that explore the board's role in corporate resilience. Additional articles in the series include "Looming Risks Are Driving the Need for Resilience," "Defining Resilience," and "Identifying Strong Resilience Practices."

How is your company building greater resilience?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

GSMA Report Unpacks the Health Systems and Digital Health Solutions in Response to COVID-19 in Bangladesh, Myanmar, Pakistan, Benin, Nigeria and Rwanda

The previous post focused on a report by the GSMA on a report about utilizing digital health as a health system strengthening tool for developing countries. This post explores a subsequent report published by the UK-based organization representing the interests of mobile operators worldwide, which unpacks the health systems and digital health solutions in six developing countries: Bangladesh, Myanmar, Pakistan, Benin, Nigeria and Rwanda.

The report explains that "the state of play of digital health in each country . . . varies quite considerably. Bangladesh and Rwanda treat digital health as part of a whole-of-government approach and seek to leverage government-wide infrastructure and standards. Pakistan and Nigeria, which have a strong federal tradition, have a more fragmented approach. In Myanmar and Benin, digital health is still in early stages and relies more heavily on contributions from development partners."

What is more, "Several insights were gleaned from our key informant interviews (KIIs). A common theme was that broad stakeholder involvement in digital health ecosystems is a growing trend that should be fostered, but how this is done varies from country to country. While some respondents want governments to create an enabling environment, others see start-ups and mobile operators playing a greater role. Another emerging theme was the lack of shared understanding among stakeholders of policy requirements and frameworks."

I concur with the report's assertion that the "COVID-19 pandemic is a challenge confronting all countries, and the report briefly reviews some of the digital health approaches each country has taken." Given their importance, I have included each country's digital health approach below.

Bangladesh ‒ Digital health: COVID-19 response

"Digital tools and digital health solutions have provided critical support to Bangladesh's COVID-19 response, enabling access to essential information and health services. The government's digital health strategy focuses on developing instant and quality healthcare services via mobile apps, and tapping into the country's large number of mobile subscribers to establish a countrywide digital health system.

"The government has encouraged public-private partnerships (PPPs) since the beginning of the crisis, emphasizing close collaboration with digital health start-ups. The surge in demand for telemedicine has led to the advent of 15 digital healthcare providers providing these services. The launch of virtual hospital HelloDoc in April 2020, and the launch of the Daktarbhai telemedicine platform, have both supported the development of a telehealth system during COVID-19. In May 2020, the government collaborated with ride-sharing platform Pathao, digital health solution Maya and Praava Health to provide instant healthcare services via the Pathao Health mobile app. Pathao Health connects users to an online COVID-19 symptom checker and provides one-on-one medical services through phone and video consultations. Users can also obtain prescriptions and order medicines through the app. Bangladesh has also begun to use surveillance, reporting and contact tracing features in a COVID-19 module for DHIS2, as well as Go.Data for contact tracing in the Rohingya refugee camps in Cox's Bazar.

"Data is a critical resource for supporting public health actions across the different phases of the COVID-19 pandemic. Mobile operators are working with key stakeholders, including a2i and the National Telecommunications Monitoring Centre, on a COVID-19 Collective Intelligence System. More details can be found in GSMA's report, Keeping Bangladesh connected: The role of the mobile industry during the COVID-19 pandemic."

Myanmar ‒ Digital health: COVID-19 response

"In April 2020, the Myanmar Computer Federation (MCF) developed the country’s official contact tracing app Saw Saw Shar to help contain the spread of the virus. The app was developed in partnership with the COVID-19 Control and Emergency Response ICT team under the Ministry of Transport and Communication and the Ministry of Health and Sports. In addition to monitoring symptoms, the app provides timely notifications of nearby areas that have positive cases and are potentially high risk, as well as official COVID-19 hotline contacts and the closest fever clinics and quarantine centers. The app also has a dashboard that visualizes COVID-19 transmission and infections by region in Myanmar."

Pakistan ‒ Digital health: COVID-19 response

"Technology has played a significant role in Pakistan's response to COVID-19, and the development of digital health platforms has been a priority for the government.38 Pakistan’s Ministry of National Health Services Regulations and Coordination (MoNHSRC) is working with software companies such as CIT Solutions, telemedicine companies such as Sehat Kahani and doctors247online and start-ups from the tech hub National Incubation Centre.

"The mobile industry has been contributing to the digital health response to COVID-19. Mobile operators have provided free calls to emergency numbers, helped distribute information and alerts via SMS and expanded a polio hotline for COVID-19 enquiries. The government also worked with mobile operators to replace the standard call ringtone with COVID-19 messaging, and established a mobile track-and-trace system and dashboard that centralize COVID-19 data, both of which are active. Live data on hospital capacity is generated, and an app is available for citizens to identify nearby hospitals and their capacity. Data on index cases is mapped onto population centers using geotagging to identify hotspots and inform a smart lockdown strategy. Social media and traditional media have also been used to raise awareness and distribute information on sanitization techniques, handwashing and social distancing.

"Provincial governments have set up phone helplines for COVID-19-related enquiries and advice. The Yaran-e-Watan telehealth platform was launched in partnership with Sehat Kahani to harness the expertise of Pakistani health professionals living outside the country and to connect them with appropriate institutions in Pakistan. Health professionals can deliver teletraining sessions, provide consultations and triage assistance using telemedicine and participate in research collaborations. Telehealth and tele-education have been used extensively. The Government of Pakistan recently launched a COVID-19 telehealth portal on Twitter, as well as a website. Pakistani doctors and health professionals have been invited to register and volunteer to help COVID-19 patients.

"The Sindhi government developed the CoronaCheck app that allows users to check their symptoms through a screening tool that utilizes an AI-assisted chatbot. It also provides information from the World Health Organization (WHO) and lists relevant services."

Benin ‒ Digital health: COVID-19 response

"A centralized, government-led platform that provides frequent COVID-19 updates is freely available to all mobile subscribers in Benin, and there are a range of awareness-raising videos and press releases on various social networks. An interactive WhatsApp messaging system has been set up and helps the national COVID-19 response team to communicate directly with citizens.

"Sèmè City, with support from UNFPA Benin, has created Taskforce Innov COVID-19 Benin to mitigate the challenges presented by COVID-19. This initiative aims to develop local solutions that deliver healthcare services to women and strengthen the economic resilience of youth entrepreneurs. The task force is comprised of various players (start-ups, SMEs, large corporates, academics and scientists, government agencies and NGOs) that are developing innovative solutions adapted to Benin's social and economic context. Sèmè City is responsible for coordinating the task force's activities. Digital health start-ups, including KEA Medicals and REMA, are part of the task force, working closely with the government during the pandemic."

Nigeria ‒ Digital health: COVID-19 response

"The Nigeria Centre for Disease Control (NCDC) launched a COVID-19 eTraining course on Infection Prevention and Control. The online course is available to the public and is aimed at healthcare workers to reduce the risk of transmission of COVID-19 and other infectious diseases while administering healthcare in Nigeria.

"Since the first COVID-19 case in Nigeria was confirmed in February 2020, the NCDC has supported the training of about 17,436 health workers in Infection Prevention and Control (IPC), and works in collaboration with the Department of Hospital Services and the Department of Food and Drugs under the FMoH. Since February2020, Nigeria has increased its molecular laboratory network for COVID-19 testing, from two laboratories to 28 in states across the country. To achieve this, the NCDC collaborated with private sector partners, such as start-up 54Gene and eHealth Africa, which were instrumental in expanding testing capacity for COVID-19.

"LifeBank, a blood delivery digital health start-up, has collaborated with the Nigerian Institute of Medical Research to develop rapid testing kits and create a shared database to track available medical equipment. Wellvis Health created COVID Triage,54 a digital self-assessment tool that helps users test whether they have been exposed to the virus and take the next steps. In turn, the NCDC collects this data to see who might be at high risk of contracting COVID-19 and isolate them. GloEpid by Tech4Dev has developed a contact tracing tool that uses a smartphone, GPS and Bluetooth connection to trace the movements of those who have been potentially exposed to the virus."

Rwanda ‒ Digital health: COVID-19 response

"Digital health has been a key enabler for Rwanda's COVID-19 response, particularly in terms of access to information and healthcare. The government has set up a toll-free national helpline and a USSD platform for self-triage. Information from the WHO was disseminated via SMS and drones, and AI-enabled drones operated by technology company Zipline have been used to deliver medical supplies to more remote areas of the country. Mobile money transaction fees have been waived to increase uptake and encourage cashless payments.

"The following digital solutions have helped the government respond effectively to the COVID-19 outbreak:

• "Contact tracing: Infections are being traced through the paperless Open Data Kit app that can be downloaded on a mobile device. Data is collected for analysis by outbreak investigation teams.
• "COVID-19 surveillance: A digital reporting surveillance system for health facilities is being used to monitor influenza-like illnesses and severe acute respiratory infections in real time to provide early warnings of suspected COVID-19 cases.
• "Infection prevention: Robots have been used in healthcare settings to perform simple tasks, such as checking temperatures and monitoring patients to reduce healthcare workers' exposure.
• "Data visualization: Geographic Information System (GIS) is being used to monitor COVID-19 cases at the household level to assess the need for lockdown measures, to focus public health interventions where there is evidence of community transmission and to monitor at-risk populations."

Lastly, the report explains that its final section "features case studies from each country. Again, while these are just snapshots, taken together they illustrate some of the progress that is being made in strengthening health systems with digital health solutions."

COVID-19 has significantly impacted health systems in countries worldwide. During my travels to developing countries prior to the global pandemic, I saw just how fragile these health systems are. Since the start of the pandemic, my colleagues who live in these countries have shared how COVID-19 has exasperated the health system's vulnerabilities in providing quality healthcare to the general population. The GSMA report, however, provides much encouragement on how governments, civil society, and the private sector can collaborate in creating sustainable digital health solutions.

What are your thoughts about the report? What digital health solutions are you seeing that were created as a result of the COVID-19 pandemic?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

Utilizing Digital Health as a Health System Strengthening Tool for Developing Countries

"The coronavirus (COVID-19) pandemic has magnified existing weaknesses and gaps in health systems. Developing countries have been severely affected," according to a report published by the GSMA, a UK-based organization representing the interests of mobile operators worldwide. "From under resourced health facilities to poor data and information coordination, weak health systems pose serious challenges for developing country leaders and development partners working to mitigate the impact of COVID-19 and other health issues."

Titled Digital Health: A health system strengthening tool for developing countries, the report further says that "there is a pressing need to strengthen health systems in developing countries. Reducing and mitigating the impact of these challenges will require a holistic approach that recognizes health systems as complex and adaptive, functioning at multiple, interconnected levels with a range of stakeholders."

In outlining its objectives and scope, the report explains: "Our research aimed to reveal the transformative impact digital health can have in developing countries. This report unpacks the challenges facing health systems in developing countries and how they have been exacerbated by the COVID-19 pandemic. It examines digital health as a strengthening tool for health systems, featuring different private sector business models, and highlights the role of digital health in managing COVID-19. Finally, we share strategies for reaching those at the bottom of the pyramid (BOP) and conclude with strategic recommendations for digital health stakeholders during and beyond the COVID-19 pandemic."

Shaped by interviews with health and digital experts across seven developing countries (Benin, Nigeria, Rwanda, Somalia, Bangladesh, Myanmar, and Pakistan), below are the report's strategic recommendations for key digital health stakeholders including development partners and nongovernmental organizations (NGOs), start-ups, mobile operators, investors, and governments and health ministries.

Development partners and NGOs

Align efforts and support the government to build capacity to deliver policy and strategy

• Consider committing and adhering to collaborative donor actions like the Principles of Donor Alignment for Digital Health.
• Commit to having a digital agenda as part of any development partner-backed intervention, giving digital health the same status as gender/social inclusion.
• Provide a platform for all health and digital health stakeholders to discuss and share requirements, best practices and solutions.
• Work with governments to enable them to track progress on their initiatives.
• Create a strategic plan with the government based on health systems rather than a programmatic approach, and design the digital health architecture, blueprint or roadmap needed to deliver it.
• Support the government to build the technical capacity it needs to develop and deliver the digital health agenda.
• Support governments to slow the spread of COVID-19 and provide social protection for vulnerable populations, promoting a whole-of-government and whole-of-society response to complement efforts in the health sector.
• Share timely and accurate data with data privacy in mind.
• Collaborate with government and other health stakeholders to assess the unique social and economic impacts of COVID-19 in a country, take urgent recovery measures to minimize the long-term impacts and help societies to recover.

Work collaboratively to enable sustainable solutions

• Be clear about what is to be delivered and show how it can become sustainable and scalable.
• Be more agile with decision making and willing to try new solutions.
• Improve coordination and share strategic documents and information to avoid siloed solutions.
• Work collaboratively with start-ups and mobile operators to solve problems together, rather than innovating separately.
• Cooperate with innovators who are working on sustainable solutions.
• Be open to matched funding models in which development partners provide a grant if the start-up also has an equity investment.

Help to extend the reach of digital health

• Work with all stakeholders to help extend the reach of digital health services to the BOP.
• Take the first financing and planning steps to extend the reach of service provision.
• Provide the skills and introductions for start-ups to make contracts with the government.
• Help map out the benefits of investing in digital health.
• Support in the provision of tools and resources for strengthen their health systems. This includes helping to procure much-needed medical supplies, leveraging digital technologies and ensuring health workers are paid.
• Leverage existing and established digital health platforms and digital technologies to avoid reinventing the wheel and link these to the national system. A proliferation of new tools, such as information collection systems, can complicate efforts to align information infrastructure and threaten sustainability.

Start-ups

Focus on problems that people care about

• Create a proof of concept based on local ideas, but build for broader (potentially global) ecosystems.
• Be innovative in developing solutions that are good for patients/staff and the bottom line.

Understand the processes involved in supporting innovations in digital health

• Polish the proof of concept and use incubation centers to test ideas and potentially attract funds.
• Combine digital with analogue models for health solutions. This is more likely to work than converting entirely to digital.
• Build trust and engage with the government to influence policy. Soft skills, perseverance and dedication is also needed.

Leverage partnerships

• Identify mutual benefits for start-ups and mobile operators, as collaboration can deliver customized digital health services.
• Understand mobile operators' cost structures.
• Align services with the corporate social responsibility (CSR) activities of development partners.
• Have demonstrable products and a roadmap to attract attention from the government.
• Approach mobile operators with a proven product. Acting as a consortium (e.g. development partners) can be more powerful.

Develop realistic business cases

• Be focused and do not attempt to run several businesses simultaneously.
• Understand that investors and banks are averse to risks in digital health, and be prepared to deal with an unsupportive policy environment.
• Investigate the market and how to grow – who is going to buy the service and how is it aligned to the country's needs. Be aware of national and international regulatory barriers.
• Understand the implementation landscape and realize that investors are more likely to focus on companies that use brick-and-mortar as part of their solutions.

Mobile operators

Pursue partnerships

• Be open to partnering and collaborating with start-ups. Working with them to extend the reach of digital health can be beneficial and profitable for both mobile operators and start-ups.
• Partner with digital health platforms to leverage existing ecosystems, infrastructure and personnel.
• Continue to open APIs and customer bases to innovators.
• Gather feedback on user growth and offer these insights to the start-ups.

Make a long-term, large-scale business case for digital health

• Adopt best practices from mobile operator-led/supported digital health solutions (examples include Tonic in Bangladesh and M-Tiba in Kenya)
• Explore providing preferential rates and decreasing costs per call as volume increases.
• Adopt a three- to five-year view. There is huge potential to grow and reach millions as everyone needs healthcare.
• Leverage relationships with the government on behalf of other stakeholders.

Make digital health services more user friendly

• Simplify payment processes and ensure dependable connectivity
• Nurture local ecosystems, for example, by providing basic health education to customers when they come to distribution centers to recharge their phones.

Extend the reach of digital health services

• Understand that digital health is a channel for attracting new customers. Like identity, civil registration and rural connectivity, digital health is also a way to build a customer base.
• Use CSR to extend reach, for example, by providing more toll-free hotlines, and by showing the government how it will benefit from the CSR resources being committed.
• Share non-confidential data so that all stakeholders can find ways to partner and extend digital health to the BOP.
• Recognize emerging opportunities for collaboration with the government and development partners/NGOs in the areas of disease prevention and health promotion, provided coordination mechanisms with the government are in place.
• Foster well-performing, widespread network coverage to aid long-term recovery, disseminate information and support technology in healthcare infrastructure.

Investors

Understand the investment climate

• Adopt a long-term view and be willing to take more risks. The digital health sector takes at least three to five years to see returns, in terms of both finance and impact.
• Understand the dynamics and regulations of the digital health market.
• Recognize that digital health provides ample opportunity for social impact investors to support millions of people.
• Coordinate investments to avoid a proliferation of similar digital health tools.

Understand the local context

• Understand the implications of local startups having to take unconventional, innovative approaches to improve service delivery.
• Refrain from investing in digital health companies without understanding the local context. What works well in one country may not in another.
• Remember that what works well in an incubator environment may not scale if local conditions have not been fully considered.

Nurture the investment climate

• Be clear with all stakeholders about the conditions for investment, for example, that government must be clear about its policy priorities.
• Capitalize on positive feedback. When end users spread the word that an innovation is working well, find ways to accelerate the spread of that information to open up other monetization channels and encourage return on investment.
• Recognize that certain countries are positioning themselves to be leaders in digital health.

Governments and Ministries of Health

Develop digital health policies and strategies

• Develop health and digital health policy and obtain approval from stakeholders, including the Ministry of ICT.
• Create an enabling environment for digital technologies through new workflows, new policies, and institutional changes and capacity.
• Map out where technology is likely to have the greatest benefit, and ensure there is a policy ecosystem in place to support it, such as legislation that requires patient records to be stored electronically.
• Secure agreement from all stakeholders, including mobile operators, on the digital health architecture, blueprint or roadmap needed to deliver the strategy.
• Help development partners identify where they are in the value chain. This will help start-ups and investors understand what to focus on, and how to contribute (such as opening up their APIs).
• Appoint a high-level digital health officer(s) who may have interim external funding to build capacity for digital health policy and strategy, to support the government and to ensure development partners and NGOs understand what they need to achieve.
• Take a strong technical leadership position and act as a central point for collecting, analyzing and disseminating information for COVID-19 and future disease outbreak.

Laws and regulation

• Draft laws and regulations that address sector-wide information and data governance issues, and address specific sub-sectors of digital health, such as telehealth, online prescriptions and microinsurance (so that small, affordable premiums can be collected electronically). Data platforms, training and innovation are also areas where laws and regulations are needed.
• Establish enforcement mechanisms provided by digitally enabled services, such as inspection and regulation of the quality of care and information management.

Behavior change

• Identify stakeholders' challenges and make arrangements to work with all stakeholders to devise solutions.
• Collaborate and adhere to governmental roles and responsibilities.
• Be more open to collaborating with the private sector and actively promoting digital health innovations and partnerships. Be willing to work with innovators directly and avoid creating bureaucratic processes that delay decisions.

Encouraging investment

• Advise development partners on how they can support and strengthen the government's management capacity.
• Recognize the value of existing data and improve assessment of the impact of digital health, including success stories, which will help to attract investors.
• Encourage more investment in the public health sector to bring them up to private sector levels (which only serve those at the top of the pyramid). Keep in mind that improvements to private sector quality can take 10 to 15 years.

The report also discusses the role of frontier technologies and healthcare: "Frontier technologies are powerful tools with transformative potential to deliver healthcare in developing countries. These technologies, when combined with mobile, have the potential to bridge gaps in health systems and enhance health outcomes."

Moreover, "Artificial intelligence and big data enable complex healthcare data and information to be analyzed and used to predict future care plans, as well as expedite and increase the accuracy of triage, diagnosis, screening and interventions. They can also aid the management of disease spread patterns and optimize the time of health workers."

The report encouragingly adds: "Blockchain has the potential to secure healthcare data systems and enhance the management of EMRs. The nature of healthcare, which has distributed stakeholders, calls for a decentralized management system. Blockchain technology can help make data and patient records more secure, private and transparent, and enable traceability and authentication of medical and pharmaceutical products."

Regarding connected devices, "Internet of Things (IoT) and drones have the potential to increase the number of patients that can be treated. IoT-enabled remote diagnostic capabilities can maximize existing capacity and extend care to isolated areas where hospitals and doctors are scarce. One advanced IoT solution is the use of drones for transporting medical supplies. Drones have the capacity to transport vital medical necessities to underserved and rural areas, resolving access issues or easing the challenges associated with a lack of hospitals and pharmacies. Drones are expected to have a critical impact on the health systems of developing economies."

I concur with the report's assertion that "[d]igital solutions have proven to be excellent tools to address systemic challenges, particularly by enabling communication within and between various parts of the healthcare value chain." Do you agree with the report's recommendations on how to utilize digital health as a health system strengthening tool for developing countries?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.