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Sunday, 1 February 2015

TECHNOLOGY AND THE FUTURE OF HEALTHCARE IN AFRICA



A few weeks ago I had a chat with Emmanuel Kweyu, the Operations Director at Strathmore i-Lab about their work on e-health in Kenya. I also started delving into the world of moon shots as depicted by Larry Page, who lives by a 10X mindset. Instead of aiming to improve something by 10%, like everyone else, make it 10 times better. This thousand percent improvement on the current situation is what we term as a moon shot. It requires rethinking problems entirely and exploring the edge of what is technically possible.

Using Peter Diamandis’  “six Ds of exponentials ”, which is a way of thinking about exponential technologies and how they are affecting our world today. I wanted to investigate their proposition for transforming healthcare in Africa. 

Why? Because when you look at Africa’s state of health care as a unit, the picture is one of a generally poor population, subject to diseases that have been eradicated or under control in other continents, under-served by governments and neglected by private healthcare providers, reliant on irregular help from abroad. 

There are only 2.3 health workers per 1,000 people in Africa, less than one tenth of the figure in Europe and less than half the figure in South-East Asia. The risk of a child dying before their fifth birthday is still highest in the WHO African Region (95 per 1000 live births) – eight times higher than that in the WHO European Region (12 per 1000 live births). Africans live 14 years less than the average world citizen, and 21 years less than the average European.

This has been the popular narrative about Africa and it seemed for a long time there was no solution in sight. Western governments, in the 1980’s and 1990’s, as a means to blunt the effects of their structural adjustments programmes, gave money to NGOs, which took the role of the retrenching states. Decades later with billions spent in aid the effect has been akin to a seal pushing against the Titanic.
For Africa to achieve the eight Millennium Development Goals (MDGs) it has to innovate and also embrace exponentially advancing technologies.

“The continent consumer facing industries are expected to grow by $ 400 billion by 2020. Africa’s population, the youngest and fastest growing in the world, will be concentrated in urban areas.  This new class of consumers has a smaller family, is better educated and higher earning, and is digitally savvy. Africans are exceptionally optimistic about their economic future: 84 percent say they will be better off in two years

The continent has been the second-fastest- growing region in the world over the past decade (Exhibit E1)


The continent is poised to reap a demographic dividend, courtesy of its young and rapidly growing workforce and declining dependency ratio. Africa will add 122 million people to its labor force between 2010 and 2020. By 2035, the continent’s labor force will be larger than that of any nation, including China or India. Over the same period, the number of children and retired people that each worker supports will fall from the highest level in the world today to a level on a par with the United States and Europe in 2035. 


   

I believe the mobile phone and the infrastructure behind it played a large part in the compound annual growth rate experienced in Africa between 2000-2010. The ability to communicate and collaborate faster and more effectively with more people over the mobile phone has largely driven commerce and empowered Africa. This to me was the first wave of development that Africa experienced that was driven by exponentially advancing technologies.

“The future of Africa is not going to be based on a linear and easy to predict assertion. It is going to be exponential and explosive. “
The core of this statement lies in Peter Diamandis’ thoughts, that point to computing, medicine, manufacturing, robotics and artificial intelligence being transformed overnight.

3D printing has the potential to transform manufacturing given the ever-decreasing list of things it can’t produce. It drastically reduces waste and costs, and personalizes the manufacturing process.  And while there are hurdles to be crossed they are not insurmountable.  

The Internet of Things (IOT) is another technology that is literally digitizing the physical world. Imagine everything we see having an Internet address. Exponential progress in sensor technology is making this possible for pennies or less.

The same is true with drone technology, which has just recently gone mainstream with people being able to buy personal drones. The use of drones to transport cargo is likely to become feasible earlier in Africa, due to missing road networks, inaccessible terrain and lack of legal and political hurdles, as compared to western countries. Its value proposition is a moon shot in itself for most African countries.   

With all these exponentially advancing technologies, the thing you notice is the dropping price of the products or services they support, increasing computing power and the way they fundamentally disrupt society.

Humans are linear and local in thinking, this has been our reality for centuries, and only recently with the Internet, as we interact with people from all over the world at the speed of thought are we thus being forced to conform to a world that has become global and exponential. 

Will exponential trends in certain technologies require us to adopt or face the stress of disruption?  Here lies room for us to look at disruptions as opportunities to advance different causes for the sake of Africa. 
Source: Exponential Finance 2014 - Disruptive Stress/ Opportunity

Peter Diamandi’s framework of 6 “Ds” (Deceptive, Disruptive, Digitized, Dematerialized, Demonetized and Democratized) gives a roadmap on how these exponential growth processes in technology can be observed and harnessed to transform healthcare in Africa.

6Ds of Exponential Framework

Digitization
Anything that can be digitized will essentially enter exponential growth. The following digitized technologies are essential in aligning healthcare with this framework: mobile connectivity, sensors, artificial intelligence, robotics, 3D printing, big data, synthetic biology, material sciences and digital medicine.

The more important question is how can we consolidate the already digitized technologies to bring about new solutions. Qualcomm Tricorder X Prize, set up a $10 million incentive to develop a mobile device that can diagnose patients as well as or better than a panel of board certified physicians. It should be able to scan, analyze and record a patient’s data. Already solutions like Scanadu promise to disrupt the medical profession and turn doctors into medical information analysts.

Deception
After a technology is digitized, it goes through a deceptively slow growth, which is linear at first, but then takes a knee and curves upward. This is true with 3D printing, which has been around for 30 years, but only just recently become well known and has started disrupting different industries.
In healthcare the above mentioned technologies  have already gone through deceptive growth.

Source:  Singularity University's Exponential Medicine Conference, Nov. 2013 - Linear Vs. Exponential Growth


Disruption
Once a technology passes the knee of curve as noted above, it begins to disrupt established industries and systems.  

Dematerialize

A technology becomes disruptive when it dematerializes other technologies. The smart phone has achieved this by replacing the VCR player, cassette player, video camera, radio, GSM phone, calculator, Dictaphone, speakers, record collection, GPS system and the list goes on.  All these technologies were dematerialized into apps in a smart phone.
Source: Exponential Thinking (Peter Diamandis) - Exponential Finance - Dematerialized by smart phone

What will these exponentially advancing technologies dematerialize in the healthcare sector in Africa? 

Structured healthcare data
Is it going to be the diagnosis process? Making the process highly accurate, irrespective of their proximity to world-class healthcare institutions.





Healthcare data categories
Will it be the information being analyzed to diagnose a disease? In the near future we may use proteomics to identify proteins associated with a disease and develop drugs that inactivate these proteins. 

Today, such analysis and drug development requires extensive tracts of data and mind numbing processing power only available in today’s supercomputers, which is expensive. But if you look at computing trends, today’s supercomputer capabilities will be in the hands of users in less than 10 years.  

Having exascale computing in the next decade could dematerialize how we perceive this process.   
In order to digitize the way healthcare information is sourced we will need to solve the following challenges:
  1. Cover the whole world with the Internet, currently 60% with 2014 estimates, remains uncovered. Google are using high-altitude balloons and OneWeb are pursing micro-satellite clusters.  The challenge is solvable in the next five years.
  2. Worldwide access to ultra high speed Internet with speeds of more than 100 Mbps. Currently being done in Japan to achieve telepathology using a WINDS satellite, which exceeds 155 Mbps. Can Google or OneWeb achieve this, or do we have other contenders
  3. Smartphones must achieve 5G connections. This will allow sensors, smart phones and other technologies to connect at greater speeds onto the Internet.   

Demonetized

Everything that is dematerialized essentially becomes free, and is thus demonetized. Cost of healthcare services and products will drop radically and astronomically, at least in theory due to exponentially advancing technologies like self-diagnostic medicine, 3D and molecular printing, autonomous transportation and off the grid energy. Many associated professions will thus become obsolete and redundant. 

Examples of demonetized industries

Will a sensor attached to a person’s body scan them, analyze their state of health, diagnose them with 100% accuracy, send the data across the Internet prompting a 3D printer to manufacture exact medication for the person then have a drone deliver the medication at their current GPS position in less than a day at no cost at all? 


Democratization
When a technology really explodes and becomes available to everyone, it’s said to be democratized. A good example is the mobile phone in Africa and its associated applications in banking, money transfer and healthcare.

With this understanding, the possibilities become innumerate. The visual below gives a depiction of different technologies and when they will be commercialized. Their true test will be if and when they democratize for the masses. 
Source Frost & Sullivan technologies in healthcare

The 3 billion question
What will happen when more than 3 billion people join the Internet in this global and exponential world? What ideas will they bring to fore? And will they alter the very fabric of how we perceive healthcare in Africa? 

Source: Exponential Finance 2014: 3 billion question


As Africa grapples with pestilence, war, endemic poverty and other challenges, technology offers us the golden chance to advance out of this predicament. My hope is that most of us will realize the old, local and linear mindset will not serve us well, and will strive to think globally and exponentially.

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