E-Health for the World’s Rural Poor

The British microprocessor design giant ARM has tweeted 15 predictions for 2015. Some of them are incomprehensible geekspeak: “Benchmark data will shift end-user choice to purpose-optimized servers versus monolithic approaches”. But not this:

Mobile operators will deploy smartphone services as de facto healthcare for rural areas.


How should they know? ARM just makes and licenses processor designs. Licensees incorporate them in complex chips (SOCs); the licensees’ customers incorporate the SOCs in gadgets; the gadgets are sold to final customers. It’s a long chain. But ARM’s business model requires it to keep abreast of these final markets, so it can steer its design programme. That’s why ARM puts a lot of effort into designs for the booming automotive market, and very little into the stagnant one for desktop PCs. The chances are they know what they are talking about.

Sure enough, Google quickly finds an example in Kenya:

“Safaricom has employed a wide-network infrastructure across and there is therefore opportunity for us to layer on services that make a difference to the Mwananchi,” Safaricom’s Enterprise Business General Manager, Sylvia Mulinge said in a recent statement. (Mwananchi is the Kiswahili word for “Common man” or “Citizen.”) “We have set up 800 digital villages and target to push the number to 5,000,” she said.

The company has partnered with Cisco to roll out e-health services across Kenya so as to enable patients in rural areas consult with doctors in urban areas. Through its e-health services, small clinics will be stationed in digital villages, where patients can consult doctors via video conferencing facilities.

In case you are worried that this is just feelgood PR, the telcos are into e-health for the money, like Adam Smith’s butchers and bakers. Health ministries even in Africa have budgets, and a major delivery problem; if e-health is value for money, they will pay for it. 800 digital clinics is not greenwashing. 5,000 will be major change.

If this works in Kenya, it will be rapidly replicated. The mobile phone revolution in Africa has wirelessed the continent – with >700m subscriptions, probably 80% of Africans have access to a least a basic mobile phone. Smartphones and 3G networks are following (another ARM prediction is 64-bit smartphones for under $70). Current Internet penetration is 26% for Africa as a whole, with 51m Facebook accounts. The operators are parts of big multinational groups: Safaricom is 40% owned, and operationally controlled, by Vodafone. The company launched the mobile phone payment system M-Pesa in Kenya in 2007, and has now spread it to 10 countries, including India. M-Pesa has rivals, like this one sponsored by India’s Airtel operator.

The mobile operators have found themselves in the unlikely position of being the first universal utility to reach half of the world’s population. They have already become de facto banks. If e-health takes off, they will become healthcare providers too.

Safaricom’s digital clinics don’t quite match ARM’s prediction. The clinics will presumably piggyback on the high-quality microwave links the operators have set up to their cellphone towers, and there’s no mention of smartphones. But mobile telcos are run by IT types, with no preconceptions about the proper way to deliver health care, and a keen understanding of their own technology. Why not set up a Kenyan WebMD, in Swahili, Luo, Masai, and Kikuyu? A smartphone is a very capable multimedia communications device: it has a microphone you can link to a stethoscope; a camera you can link to visual probes; and wifi you can connect to a cheaply pre-equipped blood pressure or blood sugar monitor. That’s a lot of diagnostic kit already.

This sort of health care was pioneered years ago in the days of radio in the sparsely populated Australian Outback, and more recently in the Canadian North. These are tiny niches in terms of the population covered. Telemedecine in the developing world is about to change the lives of billions of Mwananchi.

[Cross-posted at The Reality-Based Community]

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