Smartphones May Save the World, but Not Right Now
Tanzanian men show their mobile phones
In September, I attended the World Economic Forum Meeting of the New Champions in Dalian, China. This meeting is nicknamed the “Summer Davos,” and is a global conference of corporate executives, NGO leaders, and government officials that focuses on applying technology and commerce as catalysts for improving standards of living worldwide.
The Forum chose D-Rev as a 2014 Technology Pioneer, which is an exciting honor that also affords us the opportunity to attend these events. I met scores of interesting people, way more accomplished and knowledgeable than I am, many of whom are interested in delivering healthcare to low resource regions of the world. Their intentions are certainly in the right place, but I really wish people could see the medical needs of these populations through a user-centric lens.
My favorite example to illustrate this disconnect is smartphones. Sure, the smartphone is rapidly changing access to information and technology in the developed world. Citizens of wealthy countries can do so much from the palm of their hand: talk to distant relatives, pay for stuff, summon a cab, or even diagnose a disease.
Equally remarkable is the lightning fast growth of mobile phone penetration in the developing world. At Dalian, I heard people frequently quote that 80% of the population in Africa has a mobile phone. The infrastructure required to support mobile communications sprouted up almost overnight in low resource regions, rendering traditional copper cable transmission obsolete.
But here’s the disconnect: the idea that these two minor miracles are all that is necessary to revolutionize healthcare for the hundreds of millions of people living on less than $4 a day is incomplete. At the conference, I heard comments like, “smartphones with imaging applications are going to revolutionize remote diagnosis in rural villages,” and “we can just use apps to send personalized reminders to improve treatment compliance since this is such a big issue among the poor.” The truth is in the details, which can only be understood by looking more closely at the actual users. Here are some important reality checks:
Mobile phone penetration may be high in the developing world, but most of those phones are “feature phones” that do not run sophisticated operating systems like iOS or Android. In India, for example, only 8% of all phones are “smart.”
People cycle phone numbers several times a year on pre-paid SIM cards. When a SIM dies because a user lets the minutes run out, it may be months before they save enough money to get a new SIM. This makes it very difficult to “keep in touch.” We see this problem in many of the prosthetics clinics we visit – it is hard to find patients to do follow-up care because their phone numbers have changed.
Texts or Blackberry BBMs are the main mode of communication, since they are cheaper than talk minutes.
Email and web access require a data plan, which is prohibitively expensive for most low income users
Charging the phone is a constant income and time drain since most people do not have access to reliable electricity at home.
I am not an expert in mobile phone use in the developing world. I read articles, and make observations from field work in prosthetics clinics and hospitals in the developing world. However, my limited exposure is enough to know that the gap between wealthy citizens’ views of the smartphone revolution and what is actually possible today in the developing world is pretty large. Circumstances will certainly change in the future, but how long will that take? What about the people who need better health care right now?
At D-Rev, we take a different view of solving urgent problems for people living with limited resources. Rather than a top-down approach that often starts with a technology (smartphones) looking for a problem to solve (diagnosing diseases), we start with the problem statement from the user’s point of view. What is the user’s most important concern or highest priority? What tools are readily available to the user? Who is going to pay for the product or service? What other infrastructure (electricity, delivery methods, spare parts availability, etc.) would the solution require? These are simple questions that we can answer very quickly if we go talk to the people we’re trying to serve. This bottom-up, user-focused approach is what helps our products avoid the pitfalls that come with looking at the problem from the wrong perspective.