While Mobile Technology Offers Life-Changing Benefits, Research Shows Many Persons With Disabilities Remain Unconnected and Digitally Excluded

According to a fact sheet produced by the World Health Organization (WHO), one billion people, or 15 percent of the global population, live with some form of disability. And the number of people living with disability are dramatically increasing due to demographic trends and increases in chronic health conditions, among other causes. In consideration of this information provided by the WHO, it was with great interest to read a report produced by the GSM Association (GSMA), a UK-based organization that represents the interests of mobile operators worldwide, that says "Mobile devices and services offer life-changing benefits to persons with disabilities, such as enabling access to basic services and independent living. Despite this potential many persons with disabilities remain unconnected and digitally excluded. It is estimated that around 90 percent do not have adequate access to the assistive technologies (AT) they require. Mobile-based ATs, especially smartphones, could be a valuable and cost-effective tool for persons with disabilities."

The report presents key insights into the mobile disability gap. Presenting research from the following seven low- and middle-income countries (LMIC): Algeria, Bangladesh, Guatemala, India, Kenya, Nigeria, and Pakistan, GSMA's research "revealed that persons with disabilities are less likely to own a mobile, especially a smartphone, and are even less likely to use, or be aware of, mobile internet."

In explaining the research's methodology, the GSMA says "The Washington Group Short Set of Questions was used to identify persons with disabilities. Respondents who reported that they had 'a lot of difficulty' or 'cannot do at all' in at least one of the functional domains were considered a person with disabilities revealed that persons with disabilities."

Key findings of the report include:

1. "Persons with disabilities have lower levels of mobile ownership than non-disabled persons in all countries surveyed. Bangladesh has the widest gap, where persons with disabilities are 55 percent less likely to own a mobile phone than non-disabled persons, and the smallest gap is in Kenya and Pakistan at 11 percent.
2. "Despite the life-enhancing potential of smartphones as an assistive technology and a gateway to digital inclusion, persons with disabilities are significantly less likely to own a smartphone than non-disabled persons. The disability gap in smartphone ownership is wider than the gap in overall mobile ownership in most of the survey countries.
3. "There is a significant disability gap in mobile internet use. In each of the survey countries, persons with disabilities are significantly less likely to use mobile internet than non-disabled persons.
4. "Across all survey countries, fewer persons with disabilities are aware of the mobile internet than non-disabled persons. This is a significant barrier that prevents persons with disabilities from using and benefitting from mobile internet.
5. "In India and Pakistan, mobile users with disabilities who are aware of mobile internet but do not use it reported that a lack of literacy and skills is the main barrier to usage. Other major barriers include lack of perceived relevance, safety and security and affordability."

The GSMA correctly asserts that "Key stakeholders in the mobile industry have a critical role to play in closing the mobile disability gap and ensuring digital inclusion for all. This includes policymakers, international organizations, non-governmental organizations, organizations for persons with disabilities (OPDs), mobile operators and other ecosystem players, including start-ups and device manufacturers."

What is more, the report offers the following recommendations for stakeholders interested in eliminating the mobile disability gap:

• "Understand the mobile disability gap and how to reach and serve persons with disabilities better. Accurate and reliable disability-disaggregated data is a crucial tool for stakeholders to understand and address barriers to the digital inclusion of persons with disabilities. However, in most markets, disability-disaggregated data related to the access and use of mobile-enabled products and services is lacking, and has hampered digital inclusion efforts. It is critical that policymakers, the public and private sectors and digital players invest in, and collaborate on, accurate, ethical and effective data collection. This will help to monitor progress and inform the design of inclusive and relevant products, services and innovations for persons with disabilities.
• "Raise awareness of mobile internet and its benefits for persons with disabilities. Awareness of mobile internet is lower among persons with disabilities than non-disabled persons, limiting their potential usage of mobile internet. To raise awareness of the benefits of mobile internet and smartphones as an assistive technology, stakeholders can develop campaigns targeting persons with disabilities and explore partnerships with OPDs to reach persons with disabilities and showcase how mobile services are relevant to their lives.
• "Develop inclusive products and services that meet the diverse needs of persons with disabilities. Once persons with disabilities are aware of mobile internet and its benefits, it is important that they have access to relevant products and services that meet their needs. It is important that stakeholders ensure that existing products are accessible, and that new content, products and services are created with persons with disabilities in mind (e.g. user-centered design and inclusive or universal design practices) to improve accessibility and usability.
• "Build the digital skills of persons with disabilities. Many persons with disabilities are digitally excluded because they do not know how to use mobile and mobile internet in a way that meets their needs. Stakeholders can support the delivery of mobile digital skills programs that train persons with disabilities (and their caregivers/relatives) how to use mobile internet to meet their needs. They can also explore partnerships with OPDs or other relevant organizations to teach persons with disabilities how to access and use accessibility features and mobile-enabled products and services. Stakeholders can use resources such as the GSMA's Mobile Internet Skills Training Toolkit (MISTT) to train people how to access and use mobile internet services, including accessibility features. The toolkit is a visual, easy-to-follow guide that helps trainers demonstrate the functionality and value of the internet on internet-enabled mobile phones.
• "Ensure products and services are affordable for persons with disabilities. Smartphones, which typically provide the most accessibility features and drive substantially higher mobile internet use, are often unaffordable for persons with disabilities. Mobile operators can design solutions to make internet-enabled handsets more affordable to persons with disabilities, such as innovative financing models and 'data-light' accessible versions of mobile apps and services."

A more detailed set of recommendations for the mobile industry can be found in the GSMA's Principles for Driving the Digital Inclusion of Persons with Disabilities.

Do you agree with the recommendations for eliminating the mobile disability gap? What inclusive products and services are you developing to meet the diverse needs of persons with disabilities?

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.

Asia Pacific Will Account for Around Half of New Subscribers Globally by 2025, Says GSMA

According to a report authored by GSMA Intelligence, the research and consulting arm of the GSMA, a UK-based organization that represents the interests of mobile operators worldwide, "The Covid-19 outbreak has had wide-sweeping effects on all aspects of the [Asia Pacific] economy due to falling commodity prices, reductions in international investment, decreased incoming remittances, rising foreign debt burdens and a disproportionate impact on the informal sector (especially important in Asia Pacific). Undoubtedly, the outbreak will affect the development of the mobile ecosystem as well, despite the industry’s best efforts to cushion the impact."

The report, The Mobile Economy Asia Pacific 2020, further says "the digital ecosystem has proved vital in the response to Covid-19. Participants from the entire digital value chain – including operators, vendors, internet players and governments – are pulling together to ensure the most positive outcome possible. And as a side effect of the pandemic, mobile operators have been granted a unique opportunity with a boost in the adoption of mature/quality-based services e.g. video calling for business, online collaboration tools, video streaming, e-commerce and mobile payments. At the same time, the situation has brought to attention governments that have not taken the necessary steps to establish an inclusive digital economy."

What is more, "Across Asia Pacific, and indeed around the world, the Covid-19 outbreak has highlighted the importance of a robust digital economy." The strength of a robust digital economy will depend on the variety of information and communications technology (ICT) solutions made available for consumers and enterprises alike.

"Digitization, which was already an important target, is therefore moving up the agenda for businesses and governments alike, with many accelerating their timelines because of Covid-19. A range of businesses, particularly those in retail, transport, logistics, manufacturing and healthcare, are looking to potentially increase their investment in digital transformation to cope with the impact of the pandemic and build a stronger position for the future."

Based on conversations with colleagues in the Asia Pacific region, I concur that "[v]endors of ICT solutions, especially those operating across the entire value chain, should take this as an opportunity to strengthen their role as key ICT partners to enterprises. But timelines will vary: some enterprise customers will escalate their ICT investments immediately, while others will have to balance addressing the short-term crisis with long-term opportunities."

Below are the report's key findings:

5G Investment:

• Mobile operators will invest over $400 billion (Capex) on their networks between 2020 and 2025, of which nearly two-thirds ($331 billion) will be spent on 5G deployments;
• Asia Pacific is home to some of the most advanced 5G markets in the world, with nine markets having launched commercial mobile 5G services – including Japan at the end of March – and 12 more have officially announced plans; and
• 4G remains the dominant technology across the region in countries such as Bangladesh, India, Indonesia and Pakistan, where the focus remains in areas such as identity, digital commerce and payments, and cross-ecosystem collaboration to help create the digital societies of the future.

Regional Growth:

• At the end of 2019, 2.8 billion people in Asia Pacific subscribed to mobile services, accounting for 66 percent of the population. With nearly 500 million new subscribers added since 2014, the region is one of the fastest-growing in the world and home to over half of total global subscribers; and
• Asia Pacific will account for around half of new subscribers globally by 2025 and by this time, we forecast 266 million new subscribers to be connected across the region, bringing the total to just over 3 billion (70 percent of the population).

Socio-economic Development:

• Over the next six years, 663 million people across Asia Pacific will start using mobile internet for the first time, bringing the total number of mobile internet users in the region to around 2.7 billion by 2025 (61 per cent of the population).
• This growth in connectivity is helping the mobile industry increase its impact across all of the UN's Sustainable Development Goals and spurring adoption of mobile-based tools and solutions (e.g. in agriculture, education and healthcare) that aim to improve livelihoods in low- to middle-income countries and close the gender gap.

As reflected in the image to the right, the spread of 5G throughout the region will facilitate the adoption of connected devices (IoT). GSMA predicts that over six billion new IoT connections in Asia Pacific by 2025, accounting for half of global new additions. This creates an opportunity for those companies developing key growth verticals such as smart home and smart buildings.

Given my interest in digital health, I appreciate that "5G's role in the healthcare response to the pandemic, which utilized technologies such as telemedicine, remote ultrasound and thermal imaging, together with the benefits from the digitization of supply chains/Industry 4.0 in Asia Pacific, underscore the importance of the B2B segment." Furthermore, "Policymakers will need to provide regulatory flexibility for B2B partnerships so that operators have the freedom to innovate to realize 5G's full potential."

While not mentioned in the report, per se, it is important to note that companies developing hardware and services as a result of an improving technology infrastructure must implement the most stringent cybersecurity measures.

Infographic: GSMA Intelligence

What impact do you think the Covid-19 will have on Asia Pacific's digital economy? What ICT solutions are you developing for this rapidly growing region?

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.

Mobile Industry Uniquely Positioned to Realize Bangladesh's Vision 2021 Goals

"The mobile industry in Bangladesh has scaled rapidly over the last decade to become the fifth largest mobile market in Asia Pacific, with 85 million unique subscribers in 2017 – half the population," GSMA notes in a country overview of the Bangladesh mobile industry. The London, England-based organization further says that "[b]y helping to promote digital inclusion and support the delivery of essential services, the mobile industry makes a vital contribution to the economy of Bangladesh and plays a crucial role in supporting the achievement of the government's Digital Bangladesh and Vision 2021 initiatives, as well as the UN's Sustainable Development Goals (SDGs)."

The GSMA country overview outlined several key findings, including:

Affordability can be major barrier to mobile uptake

• A higher cost of mobile access will more greatly impact the poorest consumers, as it represents a higher share of their monthly income.
• High levels of taxation and fees would directly raise the retail prices faced by consumers, and thus represent a significant barrier to digital inclusion.

A forward-looking regulatory environment is essential

• Through review, reform and modernization of regulation in key areas, policymakers and the regulator in Bangladesh can play a major role in expanding access to and adoption of mobile broadband.
• A predictable roadmap should be created for future assignments of spectrum (e.g. 700 MHz), in consultation with industry players to ensure fair and reasonable policies and regulations while also supporting effective pricing of spectrum.
• Reforming mobile sector-specific taxation towards a more balanced and efficient structure can increase affordability of mobile products and services by lowering the tax burden on consumers and mobile operators

Spectrum barriers reduce operators' ability to invest

• The February 2018 spectrum auction saw high auction reserve prices and associated licence fees, which resulted in some spectrum going unsold. This highlights the importance of setting reserve prices for future spectrum auctions that consider operators' ability to not only finance access to spectrum, but also to deploy infrastructure accordingly.
• The government should ensure the timely release of spectrum and fair prices for access to that spectrum to facilitate better quality and more affordable services.

The report importantly notes the mobile industry makes a vital contribution to the Bangladeshi economy. "In 2015, the mobile ecosystem generated 6.2% of GDP in Bangladesh, a contribution that amounted to around $13 billion of economic value added. This figure includes the direct economic impact of mobile operators and the broader ecosystem as well as the indirect impact and the productivity increase brought about by the use of mobile technologies."

Moreover, "We expect that the economic contribution of the mobile ecosystem in Bangladesh will continue to grow. In value-added terms, we estimate that the ecosystem will generate $17 billion by 2020. This will be driven by a combination of productivity improvements brought about by continued mobile internet expansion (both in terms of coverage and uptake), as well as by the growth in content and services, which will bring Bangladesh closer to the development of the mobile ecosystem in neighboring countries."

Mobile continues to transform the lives of millions of Bangladeshi. "As more people come online over the next decade," the report explains, "the way they engage with mobile is changing as devices get smarter, services expand and societies become more connected, enabling seamless interaction between all aspects of an individual's digital life. Beyond core connectivity, the mobile industry in Bangladesh can provide services that are vital to the progress of a digital society."

Impact of Reforming Mobile Sector Taxation

The GSMA also commissioned EY to study the economic impact of potential tax reforms on the Bangladesh mobile sector. The report, Reforming mobile sector taxation in Bangladesh, analyzes developments in the mobile sector and its tax treatment in Bangladesh, and estimates the impacts of potential options for tax policy reform on the mobile sector, the wider economy and the government's fiscal position. The positive fiscal gains over a five-year period would be:

• $29 million from the reduction of the corporation tax for non-public mobile companies from 45 percent to 40 percent and for public mobile operators from 40 percent to 35 percent.
• $397 million from the elimination of the supplementary duty of 35 percent and VAT of 15 percent on SIM cards.
• $397 million from the elimination of the supplementary duty of 5 percent levied on mobile services.

Based on these proposed tax reforms, the Bangladeshi government may face an initial cost in the first year following the reform, but ultimately, the reforms would be more than self-financing. They would also likely boost productivity, leading to higher GDP and taxation revenue in the medium term. By promoting investment, reducing the cost of mobile ownership and incentivizing usage, the tax reforms will help to connect individuals, particularly those in low-income groups, to mobile services.

What strategies should be implemented for government and the mobile industry to work together to unlock digital transformation for millions of Bangladeshi?

Aaron Rose is an advisor to talented entrepreneurs and co-founder of great companies. He also serves as the editor of Solutions for a Sustainable World.