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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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.

Smart Investment in Emerging Technologies Can Help Address the Challenges Faced by the Global Giving Sector

Emerging technologies such as artificial intelligence (AI), blockchain, and internet of things (IoT) is having a profound effect on how businesses worldwide operate. However, less is known how these technologies are impacting the giving sector. A report produced by The Economist Intelligence Unit (The EIU) and supported financially by the Bill & Melinda Gates Foundation presents the key findings of a research program on the potential impact of ten emerging technologies in the giving sector. Venture into the future of giving: The potential of emerging technologies in the giving sector highlights ways that smart investment in emerging technologies can help address the challenges faced by the global giving sector.

The report argues that "Fourth Industrial Revolution technologies are transforming the development assistance and giving sectors, from using AI and machine learning to diagnose diseases to implementing drone-based humanitarian logistics. However, their potential impact on the giving process remains underappreciated to date."

Having served in leadership positions of various nonprofit organizations, I understand that "[w]ithin the giving sector, donors, intermediaries and implementing organizations operate in a complex global giving supply chain, which encompasses a wide variety of stakeholders including corporations, academic institutions, watchdogs and governments, among others. Each participant in the supply chain faces both unique challenges and challenges that are common across the sector. For the purposes of this report, we focus on three of the sector's most noteworthy shared challenges: 1) building and sustaining trust, 2) increasing efficiency, and 3) measuring and maximizing impact."

"There are ten key emerging technology applications," the report explains, "that have the potential to enhance the workings of the giving supply chain: big data, AI analytics, virtual reality (VR), augmented reality (AR), cryptocurrencies, blockchain payment infrastructure, the IoT, drones, smart contracts and impact tokens. All of these applications are powered by four core technologies: AI, virtual intelligence (VI), blockchain and the IoT."

Moreover, "These technologies can be applied to five key links in the giving supply chain: matching donors and recipients, motivating and informing giving, facilitating transactions, tracking outcomes and validating performance."

Below are the report's key concluding points:

To support donor and recipient matching, big data and AI are helping charitable organisations to understand more about the views, behaviors and opinions of current and future donors, and about trends in the giving sector. A key challenge is determining how to take advantage of the benefits of analytics in a way that does not impinge on privacy and is compliant with relevant regulations like the GDPR.

To motivate and inform giving, VR and AR are allowing donors to see the impact of their investments, overcoming the marketing and communications challenges faced by the sector in the past. A key challenge is the potential for misuse and manipulation when using a powerful tool to unlock empathy.

To facilitate transactions, blockchain and cryptocurrency can add a new rail to financial infrastructure, with tech companies using these facilities to reduce transactions costs.

To improve outcome tracking, sensors, drones and the IoT can be used to gather data that humans cannot, including on environmental and pollution challenges.

To validate performance, impact evaluation can be facilitated by smart contracts, which promote transparency and enable automated pay-outs when a social program reaches a performance threshold. This gives donors greater control over performance-related disbursements. Tokens can also help to monetize measures of impact and create new economic incentives for donors beyond tax exemptions. 

As I am continually learning how emerging technologies work, I appreciate the report's assertion that [w]hile no single technology can overcome the challenges inherent to the giving process, smart investment in appropriate solutions can ensure that all participants in the ecosystem make optimal use of their resources. The structured analysis of technologies undertaken in this study seeks to provide a guide for groups that are willing to experiment and invest to ensure that the sector's sizable contribution to economic and social development can be deepened and sustained in the years to come."

Although I agree with the report that smart investment in emerging technologies help address the challenges faced by the global giving sector, I am disappointed the report does not address the topic of cyber security. It is important for those stakeholders to understand the cyber threats that exist and have a system in place to keep their technologies secure from hackers. Not doing so will negate the value of any "smart investment."

Do you agree with the report's findings? Will smart investment in emerging technologies help address the challenges faced by the global giving sector?

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.