Niti, I wanted to pose the question to you, how are you seeing mobile health play out, in your experience, in the African continent?

As you said when we started the conversation, mobile health is seen as something that’s scalable and probably affordable in the developed world. Which has more infrastructure both in terms of bandwidth, connectivity, affordable devices, and healthcare infrastructure. What I’m seeing, and I’m speaking now from the context of sub-Saharan Africa, rather than broad emerging markets which tend, these day to encompass Latin America, India, Southeast Asia. From the African context where it’s getting interesting is while wellness seems to be the focus of- and health, since I’m calling in from Europe, for example in Europe the emphasis is on fitness, on diet, nutrition, and of course, monitoring. That’s particularly for those who may already have an existing disease or for the elderly. There’s a lot of applications, in fact there’s going to be a European mHealth summit in the middle of May in Latvia.

So it’s moving forward, in Africa I’m seeing it in three broad spaces. One space is supported, meaning two of these spaces are broadly supported by the GSMA which is the mobile operator and mobile industry association, the GSM association. Their mHealth initiatives focus on a large variety of elements, it could include data gathering, it can include monitoring, like you said the device has become ubiquitous. The penetration rates in sub-Saharan Africa are now, in some countries, let’s say Ghana, Nigeria, South Africa, Kenya, within a point or two of the penetration rate of the US, just to give you context. These are not backward countries and mobiles are definitely in everybody’s hand. Even smartphones and iPhones, just for a side note the numbers have it, they’re reaching one-third of the phones are smartphones, affordable smartphones at the sub $100 level have come in, Android phones are there. You’ve got the technology, now how best can we use it, is the next step.

We’ve got infrastructure and support services, data and statistics as you know, is a huge gap in Africa. There’s that whole cluster of activities, it can be things like monitoring maternal health, monitoring child mortality, that entire space. Then there’s the space of start-ups, a lot of the previous stuff that I mentioned, the ones supported are what falls under M4D, Mobile For Development. They may be donor funded programs or they may be not-for-profit solutions or large scale top-down solutions. The next space that I’m seeing a lot of activity is the start-up space.

I don’t know and maybe that’s a conversation for another day, but start-ups, particularly on the mobile platform are generating like weeds. And the large hubs for this clusters are Lagos in Nigeria, in fact Mobile West Africa just finished in Lagos then Nairobi, of course, in Kenya. South Africa has some amount of cluster and Ghana. These are the larger, better known ones then you’ve got smaller, incubators and accelerators coming up in Rwanda and Cameroon. It’s all over the place. The point is, there’s start-ups happening, some of them may be plant supported, they may not be pure VC plays or pure profit plays, that’s always the case in environments like this where social enterprises or the need to provide services for those without is as much of a driver as monetization. These two things are often held- their intention, this couple of nice chats, if you want, I can share them with you, particularly from the healthcare services angle, I don’t know if it’s mobile specific but certainly it maps out the tension between needing to do good and needing to be a sustainable business. They’re very often not pure commercial enterprises.

One top-of-mind that comes of such a start-up, one example that comes to mind is TotoHealth from Kenya, primarily because, I’m based here, in Helsinki at the Startup Sauna which is the Finnish version of the incubator and accelerator for the start-up ecosystem. It’s out in Otaniemi which is kind of where GSM and GPRS and SMS and all of those things were invented. It’s the closest thing we’ve got to a mobile Silicon Valley, if I may be so bold as to say that. TotoHealth was selected by Startup Sauna, last year to join their program and I did meet them, they’re focusing on maternal healthcare and child mortality. The solutions differ so you can have 20 different start-ups or pilot programs focusing on maternal health and they’ll all be under that topic, but they’re not all doing the same thing. It ranges, it can range from the monitoring, as I mentioned earlier, to reminders to information services, sometimes as simple as reminding mothers it’s time to vaccinate your child. May I take a moment to share a really cool invention, in this space?

What it does is it also rewards mums with bonus points, so it almost acts like a loyalty card, like you’d have at the supermarket which then gives you discounts when you’re shopping or whatever.

Now from the start-ups, because any reasonably viable start-up, these days at least in the key centers, like I mentioned Lagos and Akra and Nairobi, because there are now numerous hubs and incubators and accelerators, the ecosystem for start-ups is being nurtured. If a start-up is even reasonably viable and they get into one of these programs, more likely than not they will be nurtured into viability. It’s still early days, nothing’s gone wireless as far as I know but I could be wrong because these things are coming out everyday. I might not have the latest information but I know that in the example of TotoHealth, they were focused on health, they were doing something different but because the basic concept was attractive, after having been through mLab which is a World Bank initiated, I guess it’s an incubator I don’t know the right wording, but a support system in Nairobi and then through the Startup Sauna here in Finland, they’ve evolved into something more viable and most recently they just picked up, either it was another award or a grant that helps them take things further. With the start-ups we’ll see what happens.

Analogy would be agriculture based start-ups, which took a few years, they looked like they were sputtering but now you hear of iCow and mFarm really stabilizing and becoming sustainable and scaling. If these healthcare start-ups follow the same type of path, there will be the good ones, the viable ones, the ones that pivot and evolve and respond to the needs in terms of their business model and the service, I’d say I see them scaling. On the other hand the social enterprise coming from the outside top-down development orientated ones, they stumble and I have yet to see anything scale and I would love to be proven wrong, if one of your listeners would like to send something in say “here it is”, I’d like to be proven wrong. But there’s no user-centeredness going on there. Coming back to Dr. Wamalwa’s invention, it was an innovation. The pilot phase was funded by a grant because it was viable but it’s scaling and it’s growing. It increased the uptake of vaccination services from 55% to 95%. We can see this scaling. It’ll probably be picked up either by the government or by a healthcare program of some sort and it will scale.

Healthcare in these markets can’t afford to be private sector, insurance driven to the degree that it is in the United States. I don’t know if I’m saying which is blasphemous or which is heresy because I am sitting in Finland and the Nordics are famous for state supported healthcare, I don’t know if I’m risking anything by stepping into any ideologies here but from the very pragmatic point-of-view there are public goods. Too much of the population lives on too little for these things to ever be completely privatized.