A View from Seth Berkley
How Cell Phones Are Transforming Health Care in Africa
Mobile communications can help bridge a huge knowledge gap and reimagine healthcare across Africa.
In a little over a decade, Africa has gone from a region with virtually no fixed-line telecoms infrastructure to a continent where one in six of the billion inhabitants now owns a cell phone. But as this mass adoption of technology continues to gather momentum, it is causing a fundamental shift that goes beyond merely connecting people; it is creating one of the largest, low-cost distributed sensor networks we’ve ever seen, one which has the potential to completely transform global health care.
Since 2000, when the number of cell phone subscriptions in Africa outstripped landlines, the enthusiasm with which people across the continent have embraced this technology has been unparalleled. Nigeria alone has gone from a nation of just 30,000 cell subscriptions in 2000 to more than 140 million today, or roughly 87 percent penetration. Given how vast Africa is and the entrepreneurial nature of its people, perhaps that’s not so surprising. But what is unexpected is the life-saving role these handsets are beginning to play in helping to bridge gaps in our knowledge.
Historically we have had very little solid real-time disease surveillance and monitoring data on Africa, and as such have had to rely upon a few sentinel sites and modeling estimates to track the spread and prevalence of disease. As a medical doctor and an epidemiologist who spent some years working in Uganda in the 1980s, I can tell you this is extremely frustrating. You can see all the evidence around you, but in most places there is no infrastructure to monitor and evaluate it. Since then it has been clear to me that one of the biggest obstacles to improving the lives of the world’s poorest people is the ability to accurately measure in real time the burden of ill-health. Because if we can’t measure it, how can we do anything about it?
Cell phones are changing that. For the first time we are seeing good quality data that can tell us who is dying and from what, who is sick, and where clusters of disease are occurring. By removing the guesswork, this information has huge potential to inform global and national health strategies.
Indeed, this is already happening. At its most basic level it is providing a way of getting a more accurate headcount. It’s a terrible reality, but many infants are born and die without ever officially existing. Cell phones are now making it possible for parents to very easily register the birth of their child, thereby reducing the number of children that end up slipping through the net, and allowing governments to more accurately plan interventions, such as vaccination schedules.
Cell phones are also helping by improving vaccine supply chains. By allowing real-time data of stock levels in remote facilities to filter back up the chain, it is possible to prevent unnecessary stock-outs and ensure that vaccines are available when infants and children are brought in to be immunized. Meanwhile, health-care workers in the field are now able to access health records and can schedule appointments using their phones. They can even issue automated text reminders to parents about when vaccine clinics are being held. These are simple measures, yet highly effective.
Working in partnership with Vodafone, these are some of the avenues that are now being explored by my organization, the GAVI Alliance, a public-private partnership based in Geneva, Switzerland, that spends billions of dollars making vaccines more accessible to children in developing countries.
Further down the line, we can expect other advances through technological developments at the device end. Researchers like Jonathan Cooper at the University of Glasgow, in Scotland, are now developing ways to shrink huge, complex laboratory equipment onto tiny, disposable, acoustically driven microfluidic devices which can be plugged into a cell phone to turn it into a portable lab. Similarly, Aydogan Ozcan at the University of California, Los Angeles, is doing remarkable work enabling the cameras of cell phones to be used to perform fluorescent flow cytometry for diagnostic imaging. Eventually these kinds of technologies may enable health-care workers to carry out on-the-spot diagnostics for diseases in even the most remote of regions.
But ultimately the biggest impact may well come from the rich data the network of cell phones can provide. Last year organizations like Ushahidi and Healthmap showed how crowdsourcing and automated data aggregation could be used to map the death toll from the Syrian uprising. And a paper published in Science last fall demonstrated how cell phone data from 15 million people in Kenya could be used to help reveal how human travel patterns can contribute to the spread of malaria (see “How Cell Phone Data Could Slow the Spread of Malaria”). This really is just the beginning. With 630 million cell phone subscribers in Africa, and 93 million already using mobile internet, we know the data is there. And because it is part of this vast sensor network, distributed across the entire continent, we now have a way of getting hold of it. The innovation challenge now is finding the best way to go about it, empowering entrepreneurs to work on it, and then figuring out how we can best use this data to save lives.
It’s early days, but people like Nathan Eagle have already made some progress in showing us how to get the data. Provided privacy is protected and with the right incentives, such as by channeling advertising budgets into compensation-based direct-marketing schemes, consumers are often more than happy to share their data. Indeed, this is exactly what Eagle’s cell phone-based company Jana is doing in emerging economies (see “Innovator Under 35: Nathan Eagle” and “Innovator Under 35: Caroline Buckee”).
Once we have that data, it’s difficult to say with any great clarity what the full long-term benefits will be. However, companies like the crowdsourcing data analytics firm Kaggle offer a hint. They have shown that with the right algorithms, this kind of big data should not only give us a much more accurate picture of what is happening now, but make it possible to predict future global health trends. And the more data there is, the more accurate that picture is likely to be.
In global health terms, where even slight improvements in modeling go a long way, that is an extremely exciting proposition. Even if cell phone data were to improve upon existing models by just 1 percent, that would translate into the prevention of the deaths of 69,000 children under age five a year. Now that’s got to be something worth calling about.
Seth Berkley is CEO of the GAVI Alliance and was formerly with the U.S. Centers for Disease Control and Prevention and the Rockefeller Foundation before going on to become founder, president, and CEO of the International AIDS Vaccine Initiative. In 2009 he was nominated by Sergey Brin as one of Time magazine’s “100 Most Influential People in the World.”