AI Led the Global Conversation at CES 2024

Me, my mom, Lindy Rose, and my
colleague, Patricia Berdejo, attending
CES on Jan. 12, 2024

"AI, AI, AI," was the prominent theme at CES® 2024, which saw over 4,300 exhibitors including a record 1,400+ startups from around the globe in Eureka Park®. As in previous years, this year's CES, which took place from Jan. 9-12, 2024, showcased the innovative trends shaping tomorrow and solving the world's most pressing challenges. This post focuses on a few of observations of attending this year's event in Las Vegas, Nev.

As noted in a press release issued by the Consumer Technology Association (CTA), the organization that produces CES, artificial intelligence "led the global conversation at CES 2024. Companies highlighted the enormous potential of AI to improve our world with cutting-edge applications that will transform how we communicate, do business and take care of one another." Several AI-focused panel sessions took place during the four day event including on that explored the relationship between ethics and AI in academia, AI's impact on the creative process and content businesses, and how generative AI is leading the transformation of hardware and chips.

CTA's announcement also notes that "CES established access to technology as the eighth pillar of the Human Security for All (HS4A) global campaign, which focuses on the critical role technology plays to improve every aspect of the human experience." Tech is a catalyst for tomorrow, powering solutions to pressing global challenges." Attendees saw the release of a new report released Force for Good on tech's influence on human securities. "Aligned with CTA's CES 2024 Tech Trends to Watch, the report proved that universal connectivity and leveraging AI across human securities will improve our world," the Arlington, Va.-based organization said.

More companies are showing their commitment to sustainable solutions "through technologies, products, and services to reduce emissions and waste by streamlining electrification, developing renewable energy sources, and experimenting with new technologies such as battery recycling." As for Accessibility & Innovation for All, the CTA points out that "CES 2024 fostered a platform centered on universal design for the diverse tech industry to come together and converse on the next wave of innovation. CES featured sessions on diversity in the tech industry, a wave of new technologies that will improve lives and advances in accessible gaming. CTA also announced a new investment partnership in TFX Capital, which supports veteran entrepreneurs in tech."

As for digital health, the CTA explains that "Tools and technologies aimed at lowering costs, improving health equity and saving lives were highlighted. Innovations included digital therapeutics, mental wellness, sleep tech, women's health tech and telemedicine. At the CES Digital Health Summit, Mark Cuban and his Cost Plus Drug Company broke news about a new partnership, while capacity crowds joined the Digital Health mixer and programming with officials from the FDA and across the health policy space."

In what continues to be one of my favorite components of CES, Eureka Park grew this year with over 1,400 exhibiting startups including country and territory pavilions representing France, Hong Kong, Italy, Israel, Japan, Korea, the Netherlands, Taiwan, and Ukraine. As highlighted in the previous post on this forum, I attended an event that preceded CES that featured several European startups. During CES, I had the opportunity to getting better acquainted with the founders at the exhibit booths in Eureka Park.

Among the other exhibitors from around the globe, I was impressed with Brickify, a Nigerian startup that is turning recycled plastic waste into water-, fire-, and heat-resistant paving bricks used to construct roads and low cost homes. Ghostpass is a company based in Korea that created a decentralized remote biometric authentication solution that monitors and controls large amounts of biometric information by storing it individually on users' smart devices rather than storing it in bulk in the cloud.

Midbar, which is another firm based in Korea, created an inflatable farm that enables food production anytime, anywhere. Without heavy and costly steel frames, the AirFarm is designed to be lightweight but sturdy. The AirFarm converts moisture from the air into water in real-time. It recirculates the moisture produced by crops back to the roots, making it the world's first farm that operates without water infrastructure.

Lastly, as mentioned by the CTA, while we are experiencing "a moment of global uncertainty and rapid technology advancement, government leaders shared an optimistic view of regulation to empower tech innovation, including in AI." At the Innovation Policy Summit, over "160 international, federal, state and local government officials and staff participated in the Leaders in Technology Program, which convened top innovators and policymakers to discuss the future of pressing tech policy issues, including privacy, health innovation, trade policy, competition, artificial intelligence and self-driving vehicles."

If you attended CES 2024, what were your key moments and takeaways?​

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.

5G to Benefit the Sub-Saharan Africa Economy by $11 Billion in 2030

In its annual report on the state of the mobile economy in sub-Saharan Africa, the GSMA says the mobile connectivity on the continent "continues to drive digital transformation and socioeconomic advancements. This underlines the need for continued efforts to address the persisting barriers that impact mobile internet adoption in the region, particularly the affordability of devices, online safety concerns and the lack of digital skills." The UK-based organization that represents the interests of mobile operators worldwide adds: "Meanwhile, authorities and enterprises see an opportunity to leverage growing 4G and 5G networks, alongside emerging technologies such as AI and IoT, to enhance productivity and efficiency in service delivery."

Findings of the report, which is available in English and Français, include:

Growing 5G momentum

"In 2022, there was a marked uptick in 5G-related activities in Sub-Saharan Africa, including 5G commercial launches in 15 countries and a growing number of spectrum allocations. This comes at a time when 3G is the most dominant technology in the region (accounting for 55% of total connections in 2022) while 4G is already dominant in other regions, implying network and customer readiness for the transition to 4G. The approach to 5G in the region will need to consider the current connectivity landscape and unique market features that could affect the rollout and adoption of the technology. 5G network ecosystem players in the region must also find ways to deliver cost-effective and efficient 5G networks, balancing investment and value creation."

Steering growth with AI

"The emergence of new AI tools and use cases is accelerating the implementation of AI across various verticals and business processes. Most AI developments are occurring in advanced markets. However, the technology can be utilized in any scenario where there is sufficient data to draw insights. As a result, several industry players are already taking steps to apply AI across a variety of use cases in Sub-Saharan Africa. The potential benefit of AI in the region is significant, given that it can help offset the impact of limited resources and poor infrastructure in the delivery of many life-enhancing services, such as healthcare and education. Mobile operators in the region have employed AI at different levels, from improving network operations and customer services to achieving efficiencies and cost savings."

Climate-related risks spur circular economy principles

"The concept of circularity has risen to the top of the agenda for policymakers and industry players in light of growing concerns around the generation of e-waste and unsustainable levels of consumption of natural resources. Although the technical lifespan of a mobile device is now between four and seven years, the average use period of mobile devices is only around three years. Governments and industry players have a role to play in incentivizing consumers. This includes building new channels and suppliers to collect, refurbish and resell devices and implementing awareness campaigns on sustainability. Some operators in Sub-Saharan Africa are already taking a lead in this regard, with initiatives to drive circularity in mobile phones and other digital devices."

Infographic: GSMA

Improving smartphone access

"Smartphone affordability is a key barrier to using mobile internet. The average selling price of smartphones in Africa has reduced significantly in recent years, with an influx of devices priced at below $100 – but the cost remains unaffordable for many. The challenge for manufacturers is to produce devices at low enough price points that align with local earning capacities and allow them to gain market share. To ease the current cost burden, operators offer a range of initiatives, including device financing plans, instalment payments and entry-level smartphones through partnerships with manufacturers."

Collaboration and innovation in fintech is on the rise

"Fintech has become increasingly prominent in Sub-Saharan Africa, driven by the need to improve regional financial and digital inclusion. The industry has seen a rise in partnerships and innovation, leading to the diversification of products on offer, particularly in the payments segments. Operators have partnered with ecosystem players to expand products and offer options such as buy now, pay later (BNPL). At the same time, the growing fintech startup industry continues to attract investors, allowing them to improve access to a variety of financial products for both individuals and small businesses, such as microlending and B2B payments."

Policies for safe and inclusive development

"As cyberattacks continue to grow in scale and scope, governments face increasing pressure to protect their citizens and infrastructure and establish a framework for the mobile industry. Sub-Saharan Africa's rapid technological evolution makes the region an attractive target for fraud and cyberattacks."

Infographic: GSMA

According to the GSMA, "5G is expected to benefit the Sub-Saharan Africa economy by $11 billion in 2030, accounting for more than 6% of the overall economic impact of mobile." While it is encouraging to learn that mobile connectivity in Sub-Saharan Africa continues to drive digital transformation and socioeconomic advances, I have concerns about the mobile internet usage gap, which refers to individuals who are not using mobile internet despite living in an area covered by mobile broadband networks. of 59%. Nevertheless, the continent holds significant opportunities for entrepreneurs to develop innovative solutions in AI, IoT, cybersecurity, EdTech, fintech, digital health, e-commerce, and enterprise services.

What opportunities are you seeing the Sub-Saharan Africa's mobile economy?

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

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

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

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

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

Key findings of the report include:

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

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

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

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

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

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

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

GSMA's 2021 Report on the Mobile Economy Presents Examples of IoT-Enabled Healthcare Solutions

"The Covid-19 pandemic has had a profound impact on the health and livelihoods of individuals and communities around the world," according to GSMA Intelligence. the research arm of the GSMA, a UK-based organization that represents the interests of mobile operators worldwide. Moreover, "In these trying times, connectivity has emerged as a lifeline for society by enabling many social and economic activities to continue amid unprecedented social and travel restrictions, supporting new ways for enterprises to operate safely and facilitating effective response measures from government and other stakeholders."

Titled The Mobile Economy 2021, the report further notes that "Mobile has been particularly instrumental during this period, keeping people connected and underpinning new services in response to the pandemic. Around the world, the exceptional scale and utility of mobile networks and services have":

• enabled people to work and learn remotely, stay in touch with loved ones, and perform many other everyday activities online
• supported innovative health solutions, such as remote patient monitoring and contact tracing, to control the spread of the virus
• provided a platform for people to access digital financial services, given efforts to reduce the reliance on cash
• facilitated the safe and efficient distribution of social welfare to vulnerable people
• generated valuable insights on mobility patterns from anonymized and aggregated mobile big data to inform government response measures at various stages of the pandemic.

In addition to highlighting the crucial role mobile technology will play as governments look to reinvigorate their economies and build a better, more inclusive society, the report outlines a series of policy recommendations for shaping the post-pandemic digital economy, from direct stimulus funds and balancing policies for personal data to removing barriers to network deployment.

Other key findings include:

• By the end of 2025, 5G will account for just over a fifth of total mobile connections, and more than two in five people around the world will live within reach of a 5G network.
• Although 4G has significant headroom for growth; Globally, 4G is expected to peak at just under 60% by 2023 as 5G begins to gain traction in new markets. In leading 5G markets such as China, South Korea, and the US, 4G has peaked and, in some cases, begun to decline.

With respect to the mobile industry's efforts to tackle climate issues, the report notes that "In April 2021, the mobile sector was credited by the United Nations (UN) for achieving a critical breakthrough towards its mission of combatting climate change. Being the first major sector to achieve the rigorous criteria set by the UN's Race to Zero campaign demonstrates the commitment and leadership of mobile operators in the push to meet the goals of the Paris Agreement." Importantly, "This comes at a time when political and economic leaders are giving renewed impetus to delivering a zero-carbon world. Today, 50% of operators by connections and 65% by revenue have committed to science-based targets (SBTs) on the reduction of carbon emissions."

As indicated in a previous post on this blog, while it will several years to build a global 5G network and associated services, I am optimistic about the potential benefits of 5G including hyperfast connections, improved reliability, high capacity and low latency. Telecoms operations will offer hi-tech solutions to businesses through 5G, businesses can use these technologies to transform their operations and optimize efficiency, and governments can create a robust 5G infrastructure to attract investment, create jobs and drive economic growth. GSMA Intelligence, however, points out the need to "develop compelling 5G use cases that leverage the technology's unique capabilities and to support the realization of Industry 4.0 objectives. Commercializing 5G across the consumer and enterprise segments will require the right blend of partnerships, with a combination of capabilities being key to creating value."

To help build use cases, GSMA Intelligence explains that "operators and equipment vendors have invested in 5G labs dedicated to co-creating solutions with partners to address specific needs. These labs, which often include startups, academia, cloud providers and systems integrators, and large enterprises, demonstrate how mobile operators and other ecosystem players can come together to facilitate 5G-enabled digital transformation for society."

Below are a few examples of 5G labs and focus areas by region:

Asia Pacific

• China Unicom, China Mobile and China Telecom, along with other members of the 5G Slicing Association, including Huawei, China Sports Media and TD Tech, have established a 5G lab on network slicing for enterprises.
• NTT Docomo leads a consortium to develop 5G solutions for industry verticals such as manufacturing and construction. Founding members of the 5G Global Enterprise Solution Consortium include AIS, Fujitsu and NEC.
• Vodafone New Zealand is collaborating with several organizations to explore the development of a variety of 5G use cases, including a 5G drone service for the New Zealand Police and an AI solution for retail stores.

Europe

• Europe Orange has established nine 5G labs across France, Romania and Belgium to support the development of new consumer and enterprise applications.
• Verizon has opened a 5G lab and production studio in London to support its international business and media customers. The lab allows startups, academics and enterprises to explore use cases for immersive education, AR/VR gaming, autonomous vehicles, smart cities and IoT.

MENA

• STC is collaborating with Saudi Aramco and Huawei to develop 5G use cases for the oil and gas sector and to explore use cases around MEC, 5G slicing and industrial-scale IoT.

US

• AT&T is working with universities and vendors to develop 5G applications across a variety of areas, including manufacturing and autonomous car applications.
• Verizon is pursuing initiatives with the NFL, Emory Healthcare, Responder Corp., and the US Department of Energy. Focus areas include use cases for healthcare, first responders, autonomous mobility, smart cities, education and retail.
• T-Mobile is a founding partner of the 5G Open Innovation Lab, alongside global tech players, including NASA, Intel and Microsoft, and academic institutions.

Lastly, in explaining how Covid-19 cast a spotlight on IoT applications in healthcare, the report says: "In the wake of the pandemic, healthcare service providers have relied on technologies to enhance service delivery and improve efficiency in the delivery of medical supplies, amid increased demand and social-distancing requirements. IoT underpins many innovative digital health products and solutions for consumers and enterprises, as well as new ways of treating patients remotely. For example, wearable IoT devices, such as smartwatches, are increasingly being used for remote and contactless vital signs monitoring.

The report presents the following examples of IoT-enabled healthcare solutions utilized to support patients during the pandemic:

• Remote patient monitoring: Healthcare professionals use IoT devices to track heart rate, blood pressure and blood glucose levels of patients remotely, particularly the elderly and other vulnerable patients that have had to shield during the pandemic.
• Contact tracing: A number of contract tracing systems implemented around the world rely on IoT-based solutions to track the movement of patients and enforce social distancing in public areas.
• Vaccine cold chain monitoring: IoT platforms have been used to develop cold chain monitoring systems that track the temperature and location of vaccine carriers. For example, the Electronic Vaccine Intelligence Network, developed by the United Nations Development Program (UNDP) and the Indian government, has reduced vaccine stock-outs by 80%.
• Hospital sanitization: Non-surgical robots connected to IoT systems have been used to clean patient rooms and to disinfect and sterilize surfaces from Covid-19 contamination with a special UV light and chemicals.
• Automated temperature screening: IoT-enabled thermal imaging systems have been used to identify people with elevated body temperatures before they enter buildings, such as airports, office spaces, schools, shopping centers and hospitals, for further screening.
• Facilities and PPE stock management: IoT system have been used to provide supply-chain planners and policymakers with actionable information on the availability of hospital beds and personal protective equipment (PPE) for medical staff for the efficient allocation of resources.
• Healthcare delivery drones: IoT-enabled drones have been utilized to deliver test kits and results, PPE, medicines and other vital medical supplies, especially in developing regions with poor logistics infrastructure. For example, in Ghana, connected-drone company Zipline is supporting the delivery of vaccines to remote parts of the country.

What IoT-enabled solutions are you seeing or developing?

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.

Telemedicine Consultations Could Be Key to Addressing Growing Economic Cost of Treating Diabetes in the Gulf Region

"Saudi Arabia and the United Arab Emirates (UAE) are two Gulf nations witnessing an explosive growth in the prevalence and incidence of diabetes, having some of the highest rates in the world," The Economist Intelligence Unit (The EIU) explains in a briefing paper. In addition, "According to 2019 reports, prevalence is as high as nearly one in five adults (18.3%) in Saudi Arabia and about one in six adults (15.4%) in the UAE. Telemedicine has been an important part of care in these countries' evolving healthcare services to keep affected patients healthy and costs down."

Supported by Abbot Laboratories, an American company that produces health care products, Telemedicine and diabetes care in Saudi Arabia and the United Arab Emirates explores how healthcare systems in these two countries have used telemedicine to remotely monitor people living with diabetes during the pandemic. The paper suggests that the "experience and lessons may serve as a helpful guide for other countries in the Gulf."

The paper presents four "reasons why the rollout and adoption of telehealth for diabetes in Saudi Arabia and the UAE have been particularly noteworthy, and why these successes are worth continued examination:

"Diabetes care has been in dire need of enhancement: it is well known that Saudi Arabia and the UAE have a high prevalence and projected increase in diabetes among their populations. The resulting healthcare costs are significant. It has become imperative to national health, as well as healthcare budgets, that better, more innovative and sustainable management and prevention tools are explored to their fullest.

"The legal framework is expanding possibilities: telemedicine has long been on the radar as a cost-effective option, but only recently—and just prior to the covid-19 pandemic—have regulation and legal

frameworks allowed it to take shape. Leading up to the pandemic, adoption was already picking up.

"Cost models are shifting: in many ways, telemedicine has reduced costs for patients and doctors and supported social distancing during covid-19. For patients, less travel to clinics has added convenience as well. Better adherence to health recommendations can also lead to fewer costly co-morbidities and complications like stroke and amputation. For doctors, the experience has also been positive. However, some concerns have been raised regarding the increased influx of data from these apps, which requires additional time and effort for analysis, followed by explanations and tailored recommendations to patients which is more intensive, and may require updates to how providers are compensated. Going forward, advances in predictive modelling may improve the efficiency and quality of care. Clinics will also have to determine the safest and most cost-effective hybrid model of in-person and virtual clinic interactions.

"No going back: according to those interviewed and studies published, the rapid rollout and adoption of telemedicine for diabetes have been largely welcomed and deemed successful by many patients, doctors and the wider health system. Emerging evidence suggests telehealth is helping this population to achieve better self-care. More long-term studies will be needed to judge its true safety and efficacy, as well as cost-effectiveness, but doctors and patient groups we spoke to are keen to progress this care pathway based on the experience during covid-19."

The paper concludes that "The covid-19 pandemic and its lockdowns have meant a sudden change in the delivery of healthcare, with telehealth and digital solutions becoming the go-to options. In Saudi Arabia and the UAE, the transition of care to telehealth and remote services for people living with diabetes has been supported by patients and doctors alike."

"The experience has meant that patients are now more comfortable sitting in front of a screen and streaming data in real time to their doctors. In return, they have become familiar with continuous monitoring and virtually received advice on better self-care."

Importantly, "Telehealth diabetes care has been given a boost by covid-19, and it is vital that Saudi Arabia and the UAE seize it to its fullest in order to mitigate the worrying trajectory of their national diabetes trends. But indications suggest that new hybrid models of care will emerge in future involving in-person care, remote care and predictive modelling supporting real-time care."

My colleagues and I have followed the growing telemedicine sector in the Gulf region (see "Tackling Diabetes and Obesity in an Age of Digital Acceleration in the Gulf Cooperation Council," "An Analysis of 'Diagnosing Health Care in the GCC'," and "Report Explores How Digital Technologies Are Shaping the Middle East's Healthcare Ecosystems"). This paper by The EIU presents the latest evidence that telemedicine consultations could be key to addressing growing economic cost of treating diabetes and other non-communicable diseases.

What are your thoughts about the paper's findings? Do the experience and lessons serve as a helpful guide for other countries in the Gulf?

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.

347 African Tech Startups Raised $1.4 Billion in 2020, Says Africa Tech Venture Capital Report

347 African tech startups raised a total of US$1.43 billion in 358 equity rounds in 2020, according to the 2020 Africa Tech Venture Capital Report published by Partech Partners, a venture capital firm with offices in San Francisco, Paris, Berlin, and Dakar. This was an increase of 250 rounds by 234 startups in the previous year, which represents a year-over-year (YoY) growth rate of 44% in deal count.

"This is quite remarkable," the report says. "In such a challenging year, more startups have closed rounds than in any previous year. Activity has grown by almost half. No other region in the world has seen anything like this. The global interest for the African tech ecosystem remains strong even in the context of the global crisis driven by the pandemic."

However, not all is rosy. The equity funding raised by African tech startups in 2020 totaled US$1.429 billion compared to US$2.02 billion in 2019, a YoY decline of 29%. As the report explains: "Despite a strong growth in activity, the total amount raised by African startups decreased for the first time after nearly a decade of accelerating growth. While it is still higher than 2018 and before, this sharp drop clearly marks the impact of the pandemic and subsequent lockdowns."

What is more, "Activity has drastically reduced for mega rounds (above US$50M), barely grown on large-size deals and accelerated on venture-type rounds."

More encouragingly, however, "As the table above shows, the activity level has increased for almost any deal below the US$50M size. Deals between US$200k and US$1M have actually almost doubled, keeping up with previous trends. The main drive for the lower total amount of equity funding raised seems to be the disappearance of mega-rounds. Indeed, when we exclude rounds above US$50M, this total equity amount raised is flat between 2019 and 2020. Thus, this explains to a great extent the drop in funding amount."

Focusing on a breakdown by country, the report maintains that "As in previous years, VC Funding is still concentrated in few markets, but we see strong signs of diversification as half of African countries are now in play."

• Nigeria remains Africa's top destination with US$307M invested (21% of all equity funding) with Kenya following closely behind with US$305M.
• Egypt completes its rally toward #1 in equity deal count, with 86 deals (+83% YoY), almost a quarter of the continent's VC transactions.
• African VC investment remains centered around 4 top countries attracting 80% of the volume invested. However, we see more diversification as Ghana reaches a solid #5 spot, with a 102% increase in equity funding to reach US$111M and in total an unprecedented 26 countries have attracted capital.

As indicated in the image above, fintech is still the leading vertical with 25% of funding (despite a 57% YoY drop in volume). The 2020 highlight, however, is on the rising investment in the digitization of key economic sectors with agritech (US$179M), logistics and mobility (US$157M), offgrid/energy (US$148M) and health tech (US$141M).

"When we further breakdown funding in each vertical by markets, it's clear that investors in each vertical focus on a few countries":

• "Fintech investment is quite concentrated with Nigeria (38%), Egypt (28%) and Ghana (13%) attracting together nearly 80% of all the funding in this vertical.
• "Agritech is even more concentrated with 79% of the equity funding in this vertical flowing into Kenya. However this is partly driven by a single large deal at US$85M.
• "Nearly half of Enterprise funding goes to South Africa. And the same applies with half of funding in Logistics, Mobility and Edtech flowing into Egypt."

Focusing on gender, the report reveals that female-founded startups raised 13% of the rounds in 2020, a four point decrease from 17% in the previous year. But they accounted for 14% of the total equity funding just above 13% in 2019.

Moreover, female-founded startups raised US$204 million in equity funding in 2020, a 22% drop from the previous year. Interestingly, startups in Kenya accounted for 65% of this amount keeping with a similar trend in 2019 when 78% of funding to female-founded startups occurred in Kenya.

As for giving a breakdown of the investors, "Africa's tech ecosystem is not only attracting more investors (+24% YoY), but they are also more committed to the market, with 108 of them involved in 2 or more deals and 22 very active in 5+ deals." Furthermore, "443 unique equity investors were involved in the 359 equity rounds raised by African startups in 2020. It was around 87 when we started tracking this metric in 2017, a 5x growth in 3 years."

"Looking at the investors' distribution per stage, early stages' attractiveness is strongly confirmed with 421 active investors involved in Seed+ transactions (228 rounds), 229 investors in Series A (through 86 rounds), 80 investors in Series B (29 rounds) and 43 active investors in the 16 Growth rounds."

Partech Partners provides the following explanation to its methodology noting that the firm reports on tech and digital VC equity deals above US$200k, in African startups:

1. The numbers are about equity deals. This means Partech excludes everything else: grants, awards, prizes, conventional debt, venture debt, loans, Initial Coin Offering (ICO), non-equity/technical assistance, post-IPO and M&A deals. Examples: Twiga Foods US$29.4M debt from IFC announced in Oct 2020 is not counted. Lumos Global's debt round of US$45M from DFC announced in September 2020 is also not counted.
2. The numbers only include equity funding rounds higher than US$200k. This includes deals that Partech categorize as Late Seed (Seed+) to Growth stage equity rounds. Angel deals and smaller Seed deals below US$200k (numerous on the continent) are omitted voluntarily. Example: Credit startup Swipe's round of US$120k funding from YC as part of the W20 batch in March 2020 is not counted.
3. Partech focuses solely on VC deals that are in the tech and digital spaces. This means Partech only count companies where the value is built around digital technology. Example: In May 2020, the Series A of US$11.2M of insect-based feed and fertilizers company, NextProtein, was not counted.
4. The firm covers African start-ups that they define as companies with their primary market, in terms of operations and/or revenues, in Africa but not based on HQ or incorporation. When this company evolves to go global, Partech will still count it as an African company. Example: Gro Intelligence’s US$85M Series B round is counted as an African deal, as it was founded in Kenya before expanding to the USA.

Having been engaged in the African market as an investor for over two decades, I am encouraged to see the steady rise in the number of tech companies that are raising funds as well as the increasing number of investors who are investing in the continent. As addressed in previous posts on this forum, I remain optimistic on the potential opportunities in high-growth sectors including fintech, agritech, digital health, e-commerce, connected devices (Internet of Things or IoT), and logistics technology and mobility. Challenges remain, however, including the disproportionate number of female-founded startups receiving support from investors. While not mentioned in the report, challenges I have encountered as an investor in Africa include systemic corruption, burdensome government regulations, and an inadequate supply of infrastructure, just to name a few.

What do you think of the report's findings? Which sectors will present the greatest opportunity for investors in Africa?

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.

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.