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.

WHO's First Global Report on AI in Health and Six Guiding Principles for Its Design and Use

According to a report published by the World Health Organization (WHO), "Digital technologies and artificial intelligence (AI), particularly machine learning, are transforming medicine, medical research and public health. Technologies based on AI are now used in health services in countries of the Organization for Economic Co-operation and Development (OECD), and its utility is being assessed in low- and middle-income countries (LMIC)."

The report, Ethics & Governance of Artificial Intelligence for Health, which is the result of two years of consultations held by a panel of international experts appointed by WHO, further says: Whether AI can advance the interests of patients and communities depends on a collective effort to design and implement ethically defensible laws and policies and ethically designed AI technologies. There are also potential serious negative consequences if ethical principles and human rights obligations are not prioritized by those who fund, design, regulate or use AI technologies for health. AI's opportunities and challenges are thus inextricably linked."

To limit the risks and maximize the opportunities intrinsic to the use of AI for health, the WHO provides the following six principles as the basis for AI regulation and governance:

Protecting human autonomy: In the context of health care, this means that humans should remain in control of health-care systems and medical decisions; privacy and confidentiality should be protected, and patients must give valid informed consent through appropriate legal frameworks for data protection.

Promoting human well-being and safety and the public interest. The designers of AI technologies should satisfy regulatory requirements for safety, accuracy and efficacy for well-defined use cases or indications. Measures of quality control in practice and quality improvement in the use of AI must be available.

Ensuring transparency, explainability and intelligibility. Transparency requires that sufficient information be published or documented before the design or deployment of an AI technology. Such information must be easily accessible and facilitate meaningful public consultation and debate on how the technology is designed and how it should or should not be used.

Fostering responsibility and accountability. Although AI technologies perform specific tasks, it is the responsibility of stakeholders to ensure that they are used under appropriate conditions and by appropriately trained people. Effective mechanisms should be available for questioning and for redress for individuals and groups that are adversely affected by decisions based on algorithms.

Ensuring inclusiveness and equity. Inclusiveness requires that AI for health be designed to encourage the widest possible equitable use and access, irrespective of age, sex, gender, income, race, ethnicity, sexual orientation, ability or other characteristics protected under human rights codes.

Promoting AI that is responsive and sustainable. Designers, developers and users should continuously and transparently assess AI applications during actual use to determine whether AI responds adequately and appropriately to expectations and requirements. AI systems should also be designed to minimize their environmental consequences and increase energy efficiency. Governments and companies should address anticipated disruptions in the workplace, including training for health-care workers to adapt to the use of AI systems, and potential job losses due to use of automated systems.

As the WHO notes: "AI for health has been affected by the COVID-19 pandemic. Although the pandemic is not a focus of this report, it has illustrated the opportunities and challenges associated with AI for health. Numerous new applications have emerged for responding to the pandemic, while other applications have been found to be ineffective. Several applications have raised ethical concerns in relation to surveillance, infringement on the rights of privacy and autonomy, health and social inequity and the conditions necessary for trust and legitimate uses of data-intensive applications."

"While the primary readership of this guidance document is ministries of health, it is also intended for other government agencies, ministries that will regulate AI, those who use AI technologies for health and entities that design and finance AI technologies for health."

The report importantly adds:

Implementation of this guidance will require collective action. Companies and governments should introduce AI technologies only to improve the human condition and not for objectives such as unwarranted surveillance or to increase the sale of unrelated commercial goods and services. Providers should demand appropriate technologies and use them to maximize both the promise of AI and clinicians' expertise. Patients, community organizations and civil society should be able to hold governments and companies to account, to participate in the design of technologies and rules, to develop new standards and approaches and to demand and seek transparency to meet their own needs as well as those of their communities and health systems.

Do you agree with the six principles as the basis for AI regulation and governance? What are you recommendations for how AI can be used for health?

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.

Tackling Diabetes and Obesity in an Age of Digital Acceleration in the Gulf Cooperation Council

"The countries of the Gulf Co-operation Council (GCC) are in the midst of a health crisis," according to a report sponsored by EY and published by the Economist Intelligence Unit (EIU). "Close to 20% of the region’s population is suffering from diabetes, particularly type 2 diabetes." Based on desk research and interviews with medical experts and technology providers conducted by the EIU, GCC Health 2.0: Tackling diabetes and obesity in an age of digital acceleration explores the role of technology in preventing and managing diabetes and obesity in the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates), highlighting the potential impact on patients and the healthcare system.

I strongly agree with the findings of the report:

• Technology is facilitating a shift in approach to tackling diabetes and obesity: from being reactive to proactive. Apps, wearables and virtual health systems allow patients and medical professionals to proactively monitor key health metrics, from weight to glucose levels, to take the steps necessary to prevent symptoms from worsening. New technologies are making testing more convenient and less invasive, which will help people better understand and manage their condition.
• Apps and wearables on their own cannot solve health issues such as diabetes. A common perception among patients is that the more apps they use, the more weight they will lose, but technology can only play a supporting role. The onus lies on the patient to use these technologies consistently and to modify their behavior and dietary habits to deliver genuine results.
• The new wave of technological innovations provides an opportunity for health authorities in the region to transform their healthcare system. Reducing the need for in-patient consultations through remote monitoring and self-management can alleviate existing pressures on healthcare capacity in the Gulf, particularly the shortage of physicians. Many apps and wearables that encourage healthier lifestyles can be effective in preventing diabetes and obesity, generating cost savings by avoiding the need for expensive medical procedures and treatment in the future.
• Insurance providers must be encouraged to cover new technologies. Providing coverage of technologies that will prevent symptoms from worsening or, preferably, prevent the disease altogether, will reduce overall costs to insurers in the medium-to-long-term.

Diabetes and obesity is a problem worldwide, not just in the GCC. According to the World Health Organization's factsheet on obesity, worldwide obesity has more than doubled since 1980. In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese. Furthermore, the Geneva, Switzerland-based organization notes that most of the world's population live in countries where overweight and obesity kills more people than underweight. 41 million children under the age of 5 were overweight or obese in 2014. Importantly, "Obesity is preventable."

On the topic of diabetes, the WHO says the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014" and the global prevalence of diabetes among adults over 18 years of age has risen from 4.7 percent in 1980 to 8.5 percent in 2014. Moreover, diabetes prevalence has been rising more rapidly in middle- and low-income countries and diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Sadly, the WHO projects that diabetes will be the 7th leading cause of death in 2030.

However, the WHO proclaims that a "healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes." Encouragingly, "diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications."

While "new technology, by itself, cannot prevent and treat diabetes and obesity," according to the EIU report, using technology can assist individuals to live a health lifestyle. "For health providers, technology can support designing and delivering more effective and efficient services." As Alan Russell, highmark distinguished professor and director Carnegie Mellon University's Disruptive Health Technology Institute said in an interview for the report: "'Diabetes and obesity are issues that cut across all of society. Medicine alone cannot solve the problem, nor can technology. Innovative technology needs to play a supporting role.' "

Do you agree with the findings of the report? What role does technology play in the prevention and management of diabetes and obesity?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of Solutions for a Sustainable World.

Exploring the Recent Progress and Challenges of Tackling Tuberculosis

In the previous post in this blog, I discussed a report published in 2014 by The Economist Intelligence Unit (EIU) that investigates the health challenge posed by tuberculosis (TB) and ways to improve the effectiveness of the global response to it. On Oct. 26, 2016, The EIU announced the publication of an updated report, which evaluates "the progress made in the global response to TB since The EIU’s 2014 study." The 2016 report, Tackling tuberculosis: Recent progress and challenges, first considers "the socioeconomic and political context of tackling TB and then look at policy and progress in the areas of prevention, diagnosis and treatment. Moreover, four country case studies shed light on recent progress and challenges in tackling TB in Ethiopia, Kenya, Nigeria and South Africa."

On the chapter titled "The Political and Socioeconomic Context," the report explains that "the prospects for improving TB prevention, diagnosis and treatment efforts are intrinsically linked to socioeconomic and political factors. For a start, a country's level of development has a strong influence on its response to the disease."

According to Michael Kimerling, director of the technical services division at the Netherlands-based KNCV Tuberculosis Foundation, which works to strengthen health systems in the fight against TB, "As you build up primary health infrastructures, the stronger these become, the better TB can be managed. It's such a classic disease of public health. Development is important for overcoming TB."

A stronger political will to tackle TB is necessary as "the disease continues to receive relatively less attention than other higher-profile diseases, the experts interviewed for this report say." Mario Raviglione, director of the Global TB Program at the WHO, is quoted as saying, "Fundamentally, what needs to be recognized is a lack of political commitment. As we mentioned in [the UK medical journal] The Lancet a few years ago, TB is not a main priority among any of the main UN agencies; it does not have a special UN program, is not in UNICEF's portfolio and is not a special presidential initiative in the US. It does not have strong support from the pharmaceutical industry."

On the topic of policy and progress on prevention, diagnosis and treatment, the report notes the World Health Organization's goal of reducing TB by 90 percent by 2030 "will require new tools that are currently lacking . . . including better prophylaxis, the development of vaccines and new treatment regimens, especially for MDR TB."

With respect to improving diagnostics and prevention, the report asserts that "reliably identifying vulnerable populations that are most likely to go on to develop TB would allow for a more rapid management of the disease and avoid exposing those at lower risk to treatment regimes that involve significant side effects, Dr Raviglione says. He adds that current tests only show whether a person has been exposed, but not whether they are likely to develop full-blown TB. Around one-third of the world's population has latent TB—where they have been infected with mycobacterium tuberculosis but have not developed the active disease —according to the WHO."

The report's conclusion notes: "Two years on from our original report there is evidence of some progress on the global response to TB, including, for example, efforts to shorten treatment regimens. At the same time, however, public-health experts observe that TB retains a relatively low disease profile in terms of R&D, both compared with diseases such as HIV/AIDS and in proportion to the impact of the disease. Major political and socioeconomic challenges remain, notably the lack of universal access to health coverage in many endemic countries, insufficient political will and deficient national TB control plans."

And I agree with the report's final paragraph: "Ultimately, progress will depend on the political will to underpin greater investment in research and the willingness of more countries to commit to both national policy frameworks and cross border partnerships."

Lastly, given the interest of colleagues and I have regarding the development of mobile software solutions to prevent infectious diseases such as TB, I would be reminiscent not to mention how the EIU's 2014 report or 2016 update addresses this topic. Below is an excerpt from the 2014 report:

The Kenyan Ministry of Health, along with Safaricom, one of the country's major mobile-phone companies, and a number of other partners have developed a data management system called TIBU, which means 'cure' in Swahili. Since November 2012, this has allowed the direct entry of details on new TB infections, using tablet computers at the point of diagnosis, into a national database that currently holds details on around 90,000 patients. The information can then be used in a wide variety of ways. At the national level, it enables the monitoring of trends, as well as indicating if any districts are performing poorly and need support. Local clinicians can use it to determine in real time if drug stocks are able to meet local need and to order new medication where required. It allows the treatment of individual patients to be followed even if they migrate to a different part of the country, and sends SMS messages to anyone who does not attend a clinic, reminding them to take prescribed their pills. Finally, TIBU is linked with Kenya’s mobile payments system, M-Pesa, to allow faster dispersal of support payments to those with MDR TB who continue to adhere to treatment.

Do you agree with the findings of the report? What is your recommendation on achieving WHO's goal of reducing the incidence of TB by 90 percent by 2030? What role should mobile technology play in achieving this goal?

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.

A Time for Greater Action Against Tuberculosis

On Oct. 26, 2016, The Economist Intelligence Unit (EIU) announced the publication of a report that notes: Although tuberculosis (TB) "was responsible for around 1.5m deaths in 2014, down from nearly 1.8m in 1990, it is now the leading infectious disease killer worldwide, surpassing HIV/AIDS," according to the World Health Organization. The EIU report is intended to serve as an update to a 2014 report, Ancient enemy, modern imperative: A time for greater action against tuberculosis. This post, however, will focus on the 2014 report, which investigates the health challenge posed by TB and ways to improve the effectiveness of the global response to it. I will address the findings from the 2016 report in a subsequent post on this blog.

Supported by Janssen, the EIU's 2014 report "draws on interviews with 17 public health officials, funders, academic and medical experts, researchers, and activists as well as on extensive desk research to consider the state of the TB challenge, barriers to further progress, and how efforts need to evolve." The report's key findings include the following:

1. Despite important successes, progress against TB is still slow and significant weaknesses remain;
2. Drug-resistant TB has become a public health crisis that is receiving too little attention and shows up failings in current efforts;
3. To date, TB efforts at various levels have often suffered from a lack of compelling ambition and interest;
4. A high level of stigma still affects those with the disease and hampers efforts against it;
5. Efforts against TB remain overly provider-centered and set apart from health systems; and
6. Improved success against TB will require changes on a number of levels.

On the topic of improving success against TB will required changes on a number of levels, the report says that "further progress against TB is essential, but will mean new strategies that address current weaknesses while not throwing away gains to date." These new strategies include: 

• Finding and treating people where they live. To find the nearly-3m new cases of TB every year, health systems in countries with a high incidence of TB need to look across the entire population, and even those with a lower prevalence have to find better ways of going into, and working with, sometimes marginalized populations;
• Taking TB control out of existing silos. TB needs to treat the whole person, including addressing common co-morbidities such as HIV/AIDS, and co-ordinating public and private health provision;
• Harnessing cost-effective technology. Although progress in the field of TB remains frustratingly slow, new tools available today—both medical and non-medical—have the potential to transform treatment;
• Raising the profile of TB. Perhaps most important, activists and other stakeholders must find better ways to elevate national and global ambitions to deploy the tools at hand with sufficient intensity to make more rapid progress against this disease.

The 2014 report concludes by stating "TB strategies need to move in practice beyond medical silos to work in and with communities on finding cases and improving treatment outcomes. This involves a range of changes, including those listed below:

• Seeking and treating the ill in new ways, where they live. Clinic-based efforts alone will not reach the nearly 3m undiagnosed TB cases. In high-burden countries, the search will need actively to look for TB across the population as a whole. Even in lower burden ones it will involve finding effective ways to target and treat the disease in sometimes challenging marginal populations;
• Integrating care to take account of the whole human being. Those with TB frequently have co-morbidities and lack the social or economic resources to be able to complete their treatment—especially of MDR TB—over the long term. Effective TB care means finding ways to overcome these barriers;
• Taking advantage of the resources of health systems as a whole. National TB programs are an effective way to focus attention on the disease, but they should not become a TB care silo. The whole health system needs to be involved in finding TB, and medical facilities— including HIV clinics and private care providers— are proven ways to help address the disease; and
• Harnessing new technology (both medical and non-medical). Medical advances in TB are still frustratingly slow, so those that come along need to be applied in the most useful way. The WHO has encouraged the use of GeneXpert and such a test will be essential in rapidly diagnosing and defeating MDR TB. Health systems need not rely solely on medical technology, however. Mobile information technology and integrated databases show great promise in being able to understand the challenge that TB poses at both national and local levels, as well as in tracking patients and helping to avoid issues with drug stocks.

A video produced in conjunction with the 2014 report, which may be viewed below or through this link, correctly explains that "combating tuberculosis globally required finding and treating people where they live, involving the health system as a whole, and harnessing cost-effective technology."

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.

EpiSurveyor: A Data Collection Tool Transforming Public Health for Underserved Populations

Mobile phones are widely used throughout the African continent and we are seeing unique services in health care, banking, and education. This blog has presented different telemedicine services and I think there is value in discussing an innovative solution that uses mobile phone technology and the Internet “to deliver more effective public health services throughout the developing world,” according to a Voice of America (VOA) report by Natalia Ardanza. This report provides another prime example of using information and technology (ICT) solutions in providing essential services for the world’s underserved populations. Click here to watch Ms. Ardanza’s video report. (Photos: DataDyne.org)

Joel Selanikio and Rosa Donna co-founded DataDyne.org, a nonprofit dedicated to providing sustainable information technologies in poor areas. Ms. Ardanza says that with financial support from the United Nations Foundation and the Vodafone Foundation, Selanikio developed EpiSurveyor -- a free, mobile, Web-based and open-source data collection tool that is transforming the way public health is practiced in under-served areas of the world.” EpiSurveror was developed in collaboration with the Kenyan Ministry of Health and DataDyne’s website notes that its “multiple-award-winning EpiSurveyor.org is the first web 2.0 application for international development and global health.”

Furthermore, according to Ms. Ardanza, “EpiSurveyor replaces cumbersome and costly paper-based data collection that can take months, and sometimes years to produce results. ‘Instead of collecting data today to plan for a campaign next year, changing from that to collecting data today to plan for what we do tomorrow,’ Selanikio explained. ‘That is a pretty radical change.’ Public health relies on the rapid collection of accurate data to track disease outbreaks, monitor vaccine supplies and other similar functions.” Watch a demonstration video of EpiSurveyor on YouTube at http://www.youtube.com/watch?v=5aS6R1fUCBU.

DataDyne provides consulting services combining information technology, mobile phones, epidemiology, public health, and clinical medical care into a valuable service in treating underserved populations in developing nations. According to DataDyne’s website, the Washington, D.C.-based organization creates and implements ICT solutions for a clinical setting, evaluating a public health program, or building a SMS-based drug notification system.

DataDyne’s EpiSurveyor is now used as a World Health Organization (WHO) standard method of data collection. In addition, more than 500 organizations in over 100 countries are using EpiSurveyor in areas such as agriculture and public opinion polling. In 2009, Dr. Selanikio was the recipient of the $100,000 Lemelson-MIT Award for Sustainability.