Pakistan Has High Aspirations to Become a Digital Nation, Says GSMA Report

Over the course of my professional career, I had the opportunity to visit Pakistan a few times. Despite the security concerns that are prevalent throughout the South Asian country, I was routinely impressed by the strong desire Pakistanis had in utilizing life-enhancing digital technologies. It was, therefore, with great interest that I read a report published by the GSMA, UK-based organization that aims to unify the mobile ecosystem to discover, develop and deliver innovation foundational to positive business environments and societal change, that says Pakistan is poised to unlock its economic potential through accelerated digital transformation.

The report begins by noting how "Countries around the world and in Asia Pacific, including Pakistan, have stepped up efforts to become digital nations. This entails integrating digital technologies and services into every sector of the economy as a means of building resilient economies with finite resources and achieving sustainable and inclusive economic growth." GSMA Intelligence, the research arm of GSMA, has identified the following "five key components that must be in place for countries to realize their digital nation aspirations."

1. Infrastructure: Foundation upon which digital services and applications are created, stored, distributed and consumed;
2. Innovation: Ability to create and integrate new technologies to enable a variety of new solutions and use cases for the economy;
3. Data Governance: High data governance standards, with efforts to become more transparent, participatory and accessible.
4. Security: Advanced cybersecurity measures to help businesses to operate safely in a fully digital environment.
5. People: Change in culture and personal behavior, and the right levels of digital literacy and skills to be able to navigate an evolving digital world.

As the report points out:

These components are interconnected and must be developed together to avoid potentially costly gaps and delays in the implementation of digitalization initiatives. For example, a lack of adequate infrastructure could offset efforts to support innovation, while a lack of trust due to poor data governance and security could delay the full use of infrastructure investments. It is important to note that developing the components of a digital nation collectively requires significant investments from both the public and private sectors, particularly for capital intensive projects, such as the deployment of next generation telecoms infrastructure, as well as enabling policies and regulations to ensure the sustainability of those investments.

With respect to assessing Pakistan's digital nation aspirations, the report explains that "Digital Pakistan is the flagship initiative of the government of Pakistan to expand the knowledge-based economy and spur socioeconomic growth using digital technologies. Launched in 2018, the overarching goal of the initiative is to promote connectivity, improve digital infrastructure, increase investments in digital skills, and promote innovation and tech entrepreneurship. Over the years, the government of Pakistan has introduced various policies and initiatives to support the realization of Digital Pakistan and, by extension, set the country on the path to becoming a digital nation."

The report contains a table that maps the contribution of these policies and initiatives to the development of the components of a digital nation in Pakistan. The content of the table is listed below.

1. Infrastructure: Pakistan is taking strides towards digital transformation with the approval of the Digital Nation Pakistan Act 2024. This legislation lays the groundwork for a digitally empowered nation by establishing two crucial bodies:

• National Digital Commission: As the policy-making hub, this commission, chaired by the Prime Minister and comprising federal and provincial representatives
• Pakistan Digital Authority: This operational arm will be responsible for translating the commission's policies into action.

While the potential benefits of this digital transformation are immense, challenges in infrastructure development must be addressed to ensure a successful transition.

2. Innovation: The government has been a driving force behind Pakistan’s startup ecosystem, with initiatives such as the Pakistan Startup Act and the establishment of incubators and accelerators across the country, providing an enabling environment for startups.

3. Data Governance:

• The Prevention of Electronic Crimes Act 2016 is currently the primary legislation that provides a legal framework in relation to various kinds of electronic crimes and extends to unauthorized access to personal data.
• After a four-year consultation period, the government is in the final stages of developing the Personal Data Protection Bill (introduced in 2021). The bill is anticipated to be presented to the cabinet for approval soon.

4. Security: The National Cyber Crime Policy 2021 was approved by parliament in July 2021. It provides objectives aimed at addressing cybersecurity challenges and risk factors prevalent in Pakistan.

Computer Emergency Response Teams (CERTs) have been established to address the emerging needs of security and safety with increased digitalization.

5. People: Much of the government's focus is on eliminating the digital skills barrier for unconnected populations. There is an opportunity to drive skills trainings at both the academic and professional development levels to create a digital-ready workforce.

The report's authors importantly note that "Despite these developments, current realities on the ground suggest that that the vision of Digital Pakistan may not be achieved, thereby slowing the country's progress towards becoming a digital nation. For example, Pakistan has witnessed rapid expansion in mobile broadband networks over the last decade, with 81% of the adult population now residing in areas covered by 3G or 4G networks, compared to just 15% in 2010, however, only 23% of the population currently subscribe to mobile internet services. This indicates a gap in actual usage versus availability and underlines the scale of the challenge to bring unconnected people online."

The report also emphasizes the importance of financial reforms and strategic initiatives. Recommendations include eliminating the 15% Advance Income Tax and the 19.5% sales tax on mobile services, addressing high spectrum prices, and introducing a smartphone financing policy to improve access to affordable devices. Additionally, the GSMA advocates for a rational approach to spectrum pricing ahead of the planned 5G spectrum auction in early 2025.

What are your thoughts about Pakistan's high aspirations to become a digital nation?

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.

A Toolkit for Startups in the Utilities Sector Seeking to Partner With the Public Sector

"Cities in low-and middle-income countries are home to one billion people lacking access to affordable, reliable, safe, and sustainable utility services," Max Cuvellier, GSMA's Head of Mobile for Development, writes in the Forward of a toolkit that was created for startups in the utilities sector that are seeking to partner with the public sector. He adds: "This urban service gap is being exacerbated by rapid urbanization, climate change and widening inequalities posing complex challenges to city authorities, municipalities, and utility service providers."

In its press release announcing the publication of the toolkit, the GSMA, a UK-based organization that represents the interests of mobile operators worldwide, notes: "Partnerships between start-ups and the public sector have emerged as an innovative and impactful way to address critical gaps in essential urban services – particularly when it comes to reaching low-income urban populations in informal settlements. They have the potential to combine the technology, innovative financing, and agility of start-up ventures with the public sector’s scale, service mandate, and resources."

The GSMA's announcement further says: "Over the last decade, through the GSMA Innovation Fund, we have supported more than 100 start-ups and SMEs working across LMICs. In that time, we have observed how central partnerships are to startups' scaling journeys and wider social impact. We have also seen how partnership formation between stakeholders with different organizational cultures, time horizons, and strategic priorities can pose challenges. Meanwhile, there has been little research and few resources tailored towards start-ups and early-stage private sector innovators pursuing partnerships with the public sector."

This toolkit therefore aims to:

1. Highlight the role of start-up-public sector collaboration in the context of the many challenges facing cities in LMICs;
2. To provide a conceptual framework of how to think through, frame, and define startup-public sector partnerships;
3. To offer practical tips and tools to startups navigating these complex partnerships; and
4. To highlight additional resources that might be relevant to those aiming to catalyze startup public sector collaboration.

The toolkit presents the following conclusions:

• Innovation: Digital solutions have demonstrated their value for improving urban services in LMICs. However, more innovation is needed to develop business models that can be deployed on a wide scale and account for the financial constraints of utilities and municipalities, as well the needs of low-income customers.
• Urbanization and climate change: Though the startup-public sector partnership landscape for improved urban utility services is still nascent, trends such as rapid urbanization, urbanization without structural formation, and climate change will mean that municipalities and public utilities will have to collaborate with startups and private sector innovators to close the urban service divide. While there has been more attention placed on the opportunities related to startup-public sector partnerships for urban utility services, it is also clear that there are many barriers to such partnership models, particularly when it comes to taking such partnership models to scale.
• Pioneers and challenges: Examples in countries that have pioneered these partnerships such as Kenya, India, and Bangladesh highlight that start-up-public sector partnerships can support cities in making urban utility service delivery more affordable, reliable, safe, and sustainable. Despite these successes, it is important for startups to be aware of the challenges and complexities associated with public sector collaboration, and better assess where synergies with the public sector lie and how their service can support the public sector in meeting its objectives.
• Collaboration: This toolkit sought to highlight the role of startup-public sector collaboration in the context of many challenges facing cities in LMICs (Section 1), provide a conceptual framework of how to think through, frame, and define startup-public sector partnerships (Section 2), offer practical tips and tools to start-ups navigating these complex partnerships (Section 3), and highlight additional resources that might be relevant to those aiming to catalyze startup-public sector collaboration (Section 4). Given how nascent many partnerships and the wider start-up public sector ecosystem are, it will be critical to continue to conduct research on the developmental, commercial, and social impact of these innovative partnerships, and use case studies to generate granular insights.
• Drivers for change: Trends will continue to drive startup-public sector partnerships for improved urban utility service provision. These include increasing devolution and public sector programs that encourage and incentivize startup participation in urban service delivery, the increased relevance and maturity of circular economy use cases, increased adoption and availability of frontier technologies and digital payments, as well as increased availability of funders and funding models to support multi-stakeholder partnerships.
• Digital Utilities Partnership Hub: The GSMA Digital Utilities program convenes startups, relevant public sector organizations such as state-owned utilities, and other relevant corporates such as MNOs to catalyze innovative partnerships and collaboration for urban utility service provision. Alongside this toolkit, the GSMA Digital Utilities program is launching the Digital Utilities Partnership Hub. The hub is GSMA's comprehensive source of information on the role of digital solutions and innovative partnerships for improved urban service delivery, highlighting key insights and case studies from our work with public and private sector stakeholders over the last decade.
• Support: The GSMA Digital Utilities program is committed to supporting startups and their public sector partners aiming to form, sustain, and scale partnerships for improved urban utility service delivery. To achieve GSMA's objectives, the program engages in:
• De-risking and catalyzing innovative urban utility services: Providing grants to private sector innovators to test and demonstrate the role of digital urban service solutions;
• Research and insights: Generate rigorous evidence on innovative solutions to essential service provision by gathering insights from Innovation Fund grantees and conducting research with partner organizations with deep expertise in utility service provision; Partnership facilitation and convening of key ecosystem stakeholders: Drive replication and scale through convenings and leveraging our own networks as well as those of key partners who work to enable similar solutions; and
• Technical advice to MNOs, municipalities, and utility service providers: Provide advice on the role of digital innovation for improved utility service provision and insights on how to achieve multi-stakeholder partnerships.
• Enabling Forums: GSMA's market engagement team is looking forward to convening public sector stakeholders and startups for our next digital urban utility forums in Bangladesh and Kenya in Q4, and GSMA's program is looking forward to leveraging their strategic partnerships with key enablers and funders such as Imagine H2O Asia, the International Water Association, GOGLA, the World Bank, the Asian Development Bank, the World Resources Institute and other partners to continue to drive public-private collaboration to close the urban service divide.

Do you see value in this toolkit for startups in the utilities sector? What recommendations do you have for how startups and the public sector can partner?

​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.

How to Make Internet-Enabled Phones More Affordable in Low- and Middle-Income Countries

According to a report published by the GSMA, "Owning an internet-enabled handset can be life changing. Yet, for many living in low- and middle-income countries (LMICs), they are still unaffordable. For the 3.4 billion people who live in areas with mobile broadband coverage but are not using mobile internet, affordability is a key barrier."

The GSMA explains that its "report provides an overview of approaches and business models that are improving the affordability of handsets for various underserved populations in LMICs. It explores some of the nuances among these groups, considerations for meeting their different needs and variations between markets in Sub-Saharan Africa and South Asia." Moreover, the report "also provides practical recommendations for stakeholders to make internet-enabled devices more affordable and an analysis of how the policy environment can contribute."

The report is structured into four chapters. The first one aims at defining handset affordability. The second and third chapters discuss the two key supply-side levers to deliver more affordable handsets: reducing the price of a handset through efficiency gains and cost savings in the value chain and improving customer access to financing. In the final chapter, the GSMA provides eight policy considerations, highlighting the importance of strengthening the enabling environment to improve handset affordability.

Below are the report's key findings:

1. The affordability barrier is not just about the economic cost of purchasing a handset relative to income. "It is just as important to consider the cost of a handset in relation to a person's needs, preferences, and perceived value to their life. Non-income-related constraints also have an influence, such as awareness of mobile internet, digital skills, mobile-related safety and security and the social norms that constrain certain groups from accessing and using mobile and mobile internet, recognizing that some of these constraints disproportionately impact on certain groups of the population, including women."

2. New technologies have emerged, disrupting the market and offering new opportunities to make handsets more affordable. "Over the past few years, two main innovations have driven down the cost of handsets: the development of lightweight operating systems (OS) and remote handset locking technologies. Lightweight OS have enabled the development of handsets that are less costly to manufacture, particularly smart feature phones and ultra-low-cost smartphones. This has narrowed the price differential between a basic 2G phone and a 3G or 4G handset. Similarly, the emergence of remote handset locking technologies has enabled a wider range of providers to offer financing with no or limited credit scoring by using the handset as collateral."

3. Lower prices can be offered by providing customized smartphones that meet local needs. "Several mobile operators, manufacturers and PAYG solar companies have been designing smartphones that are customized to the needs of end users in a specific market or region while simultaneously optimizing the costs of smartphone components."

4. Procurement, distribution and marketing should not be overlooked when lowering handset costs. "It is possible to reduce handset costs by passing on the savings from more efficient procurement, distribution and marketing. The convergence of commercial interests to increase the availability and affordability of internet-enabled handsets has created new opportunities for partnerships, for instance, between the mobile industry and organizations that have developed last-mile distribution networks. Marketing partnerships can not only help reduce costs, but also reach a wider audience and raise awareness of the availability of affordable handsets and finance schemes."

5. The emergence of refurbished phone business models not only opens access to quality phones at a reduced price, but also helps the planet. "Keeping handsets in use for longer or giving them a 'second life' can improve affordability. Those selling their handset receive money in exchange, thereby increasing their buying power. Those purchasing a refurbished handset can benefit from 10 per cent to 80 per cent discounts compared to buying one new."

6. Innovative finance schemes and payment models better suited to the livelihoods of people in LMICs are being developed. "There are context-specific factors to consider when developing an appropriate inclusive handset finance business model. Finance schemes that use alternative data for credit assessments or accept a handset as collateral allow customers to repay the handset in instalments, thereby reducing the upfront cost. Offering flexible payment terms, such as daily micro-repayments, are particularly well-suited to those who earn income on a daily basis."

7. Strengthening the enabling environment is key to improve handset affordability. "This report provides eight key policy considerations to improve access to internet-enabled handsets ownership for underserved populations. This includes reducing sector-specific taxes, providing subsidies to target user groups, developing public-private partnerships to de-risk handset financing, and stimulating demand by increasing awareness and willingness to pay."

8. There is no one-size-fits-all solution. Implementers should be mindful of the context in which they are operating and who they are aiming to reach. "Depending on the region or country, some solutions may be easier to implement than others. For example, a thriving mobile money ecosystem makes it easier to offer handset finance and good infrastructure is necessary for the collection of used phones in a refurbishment business model. Meanwhile, regulations such as high taxes on imported handsets and laws forbidding device locking inhibit innovation."

Referencing the 2021 GSMA Consumer Survey, the report notes that "the affordability of handsets remains the top-reported barrier to mobile ownership in LMICs and a key barrier to mobile internet adoption, particularly for women and rural populations. Ensuring that handsets are affordable for different underserved segments of the population is critical to enable access to mobile broadband and close the digital inclusion gap."

What is more, "Mobile internet connectivity has a strong macroeconomic impact; an increase of 10 percent in mobile internet penetration results in an increase in 1.8 percent of GDP in middle income countries and 2 percent in low-income countries. However, without a compatible device to access mobile internet, millions of people cannot reap the potential benefits mobile internet has to offer."

Lastly, the report importantly points out that "[m]ost of the unconnected live in LMICs and certain groups are more excluded than others, including women and those living in rural areas. Although smartphone adoption continues to increase across LMICs, penetration varies significantly by country and region. For example, in Sub-Saharan Africa, smartphones account for less than half of total connections while in South Asia they account for just over 60 percent."

Do you support the report's findings? What are you recommendations for making internet-enabled phones more affordable in low- and middle-income 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.

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.

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.

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.

eRegistrations Platform for Registering New Businesses Will Help Nations Build a Formal Private Sector

The previous post on this blog focused on how entrepreneurs in developing countries are able to use their mobile device to register their new business using eRegistrations. A document prepared by the UN Conference on Trade Development (UNCTAD) explains that "eRegistrations is an eGovernment system, designed to computerize simple or complex administrative procedures. It can be easily adapted and configured to any administrative process and may apply to procedures such as company registration, construction permits, foreign trade procedures or the transfer of a property title."

Developed by UNCTAD's Division on Investment and Enterprise in Geneva, Switzerland, the document notes that "eRegistrations is suited both to operations involving only one administration (such as registering at the business registry) and to simultaneous operations at multiple administrations (such as registering a company at the tax office, with the municipal council, with social security, at the labor department and at the business registry). It acts as a single electronic window." Importantly, the system "can be installed at the municipal, national or supra-national levels."

For government agencies utilizing eRegistrations, minimum technical infrastructure is required: "Administrations willing to offer their services through the system are not required to have computerized processes. The only requirement is to have computers and an internet connection."

Moreover, "A law on electronic signatures is not mandatory either. eRegistrations was conceived to make use of electronic signatures in countries where it is regulated. In others, the system proposes a secured technique to certify digital documents issued by the administrations."

With respect to database and application hosting, the document says that the "local counterpart has a choice between hosting the database and the application on a local server or on a distant cloud server. Cloud servers are latest generation and high-speed, with expandable storage space, automatic back-up, secured (https), large band-width internet connection and 24 hour service. Similar specifications are recommended for local servers."

And regarding maintenance of the platform, "eRegistrations comes with a 'bug-free' warranty, any bug in the original version is repaired within 48 working hours."

The document points out that "Source codes, in java script language, as well as the MongoDB database are made freely available to the municipal, national or supra-national entity that administers the project. A complete technical documentation is also provided, so that local computer experts can easily make changes to the system, e.g. modify the forms or the list of requirements, or incorporate new administrative procedures."

A separate publication entitled "How UNCTAD's e-government platform helps countries stay open for business during COVID-19," points out how "global pandemic countries are using UNCTAD's e-government platform to continue providing essential services and new COVID-19 fiscal rescue measures to businesses though online single windows while offices are closed."

UNCTAD's online platform is directly supporting goal number #8 (promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all) and #16 (promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels) of the United Nations' Sustainable Development Goals (SDGs). And eRegistrations indirectly supports SDG #1 (end poverty in all its forms everywhere) and #17 (strengthen the means of implementation and revitalize the global partnership for sustainable development).

Lastly, an article published on Dec. 7th, 2020 explains how "Over 25,000 small and medium enterprises (SMEs) in Cameroon have joined the formal sector by registering their operations through UNCTAD's eRegistrations online platform launched in the country in 2016.

"The platform has allowed residents of Douala, Yaoundé, Garoua and surrounding regions to conveniently register businesses and create jobs even amid the economic crisis caused by the COVID-19 pandemic.

"Funded by the European Union, the platform is marketed by the national SME promotion agency (APME) as mybusiness.cm, via its network of business creation centers (CFCEs)."

The article further says "Cameroonian SMEs mostly operate in the informal sector, limiting interactions with public authorities. By formalizing their operations, the SMEs and their employees may have access to loans, insurance and legal protection, and contribute taxes and social security."

Importantly, "The use of the platform has also led to the standardization of operations in the CFCEs. The automation of business registration online means the process can be finalized within 72 hours."

As I wrote in my post, "Role of the Private Sector in Stabilization: Providing Sustainable Employment in Afghanistan", a thriving private sector is crucial in nation stabilization and sustainable development. In my private sector development work in countries like Afghanistan, Peru or Uganda, I have witnessed the challenges local citizens encounter when registering a new business. Access to capital is often a barrier for citizens to launch their own business, but it is not the only one. Cumbersome processes to registering a new business such obtaining the necessary documents from the government office, which may be located a long distance away, prevent would-be entrepreneurs from starting the process to increase the standard of living for themselves, better provide for their family, and potentially create jobs those living in the surrounding community. Online platforms like UNCTAD's eRegistrations will play a crucial role for a country to build a thriving formal private sector.

What do you see are the benefits and challenges of a country deploying the eRegistrations platform? What other services should a country utilize to build its formal private sector?

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.