This article is the result of a co-creation between Dr. Khama Rogo and the Joep Lange Institute. The foundation of this article is built on the interview we conducted with Dr. Khama Rogo for the Great Escape documentary. The message aligns with Dr. Rogo’s ambition: “Reaching everybody is about letting nobody fall through the cracks. So far, we haven’t been able to create a safety net that is strong and nimble enough not to let people fall through. A digital safety net can be the answer.”
Africa is at a crossroads. Mobile technology is disrupting every layer of society at an unprecedented pace. “The biggest social equalizer now in this part of the world, I believe is a cell phone,” explains Dr. Khama Rogo, Head of Health in Africa Initiative, IFC/World Bank Group in the documentary titled The Great Escape.
Almost everyone, over 90%, has access to a mobile phone, even people living in the slums or in remote areas. The mobile phones provide a lifeline to many Africans. People gain access to services, facilities and financial systems they were previously excluded from through their phone. Kenya illustrates this most strikingly. Its largest network provider, Safaricom, manages the mobile banking system M-PESA. It has become a core part of Kenyan daily lives: with more than 26 million users over one hundred million dollars is transferred through M-PESA each day. In 2016, 157 service providers are delivering mobile banking in 42 countries in Africa.
Even though the mobile phone has enabled countries in Africa to leapfrog certain developments, Dr. Rogo still sees one major challenge: tackling the enormous inequalities in society. “Let’s ask ourselves whether the systems that are there at the moment can really work for somebody who lives in the slums. My humble answer is no.”
The Great Escape
According to Dr. Rogo, there has to be a seriousness of disruptive thinking. As so many remain excluded from basic services, we should leverage on digital technologies to improve access to healthcare. Africa on the Rise This can drive exponential change for millions of people, helping them realize their Great Escape. This refers to the enormous test for the future that Joep Lange identified in the article Africa on the Rise written just days before the fatal MH17 disaster in 2014.
“To those who regularly visit Sub-Saharan Africa, the pace of change is indeed astonishing, and there are many reasons to be optimistic about the region.
We should, however, also realize that very little has changed for the poor in rural settings, and that the lives of those who left for urban slums are extremely difficult. To include the latter two groups in the ‘great escape’ from poverty is the big challenge ahead.”
And Joep Lange is not the only one who called for action to take responsibility to tackle this injustice. In the words of Angus Deaton, the Nobel Prize Laureate from whom Joep Lange borrowed the ‘great escape’ phrase: “Inequalities effect progress. The health inequalities are one of the great injustices of the world today. The desire to escape is always there. Yet, the desire is not always fulfilled. New knowledge, new inventions and new ways of doing things are the keys to progress.”
Godsend“The mobile phone in the manner in which it has spread in Africa gives us, for the first time, an opportunity to give identity to an individual.”
The mobile phone is according to Dr. Rogo is a godsend. It is an invention that allows us to organize ways of doing things, for instance healthcare, in a totally different way. In a direct, transparent and efficient manner. Dr. Rogo: “The mobile phone in the manner in which it has spread in Africa gives us, for the first time, an opportunity to give identity to an individual. Locate that individual in terms of where they are and most interestingly provide you with an activity record of what that individual does. Since it is already there, anybody who wants to reach the poor has to ask. Why can I not use this?”
Currently in various African countries, the opposite is the case. Rather than being well funded, transparent and accessible, health systems are taunted by a vicious cycle: a reinforcing lack of quality care, demand, trust and funding results in a poorly functioning system. Health is not accessible for many. In Kenya, for example, an estimated two out of five don’t have funds to pay for health services. With public services often inefficient and unreliable, people seek treatment in private clinics. Although the care in these facilities is often not much better.
We believe that now is the time to leverage on this mobile technology to disrupt the health markets and make them work for people like Gladys. By building a digital platform on mobile technology, the current health systems can be challenged. Firstly, it allows us, for the first time in history, to give everyone a face and to reach everybody. This means healthcare services can be accessible to everyone. Secondly, it provides for new and better ways to arrange the healthcare delivery system and potentially radically changes the way services are delivered on the ground.
“We have the opportunity to turn this century into a century that Africa leads.”Dr Khama Rogo, Lead Health Sector Specialist with the World Bank and Head of the World Bank Group’s Health in Africa Initiative
In the documentary, Gladys Akinyi symbolizes the struggle of millions of people that are left behind. Gladys is 27 years old, single mother of 5 children who lives in the slums of Nairobi. Gladys has had an incredible life story. She has seen set back after set back and has no safety net whatsoever. This has it made it hard, not to say impossible, to escape poverty. Nonetheless, Gladys gets up every day to make something of her life.
According to Dr. Rogo “She is a victim of a dysfunctional system. In the slums out there, she is just a number. She is a nobody.”“She is a victim of a dysfunctional system. In the slums out there, she is just a number. She is a nobody.”
Even though Gladys is on her own, she shows the situation is not completely hopeless. One of the few things that Gladys can trust is her mobile phone. It allows her to stay in close contact with her family, transfer and receive money and store it safely.
Leveraging on this mobile technology, Gladys can now also access healthcare directly with her mobile health walle,t called M-TIBA. In 2016, the digital health exchange platform ‘M-TIBA’ was launched in the Kenyan market by PharmAccess, CarePay and Safaricom. M-TIBA connects patients, healthcare providers and funders, and exchanges money and data between them. For people like Gladys the advantages are immediately apparent.
The health wallet allows people to save, pay and access healthcare through their mobile phones. And it gives donors and governments the possibility to contribute directly to the health wallet. “The money stays in the wallet, you can’t even take one shilling from it. When you go to the hospital, they press the phone and you are admitted. They deduct the charges and the balance is left,” explains Gladys. Despite this empowerment, the change came too late for Gladys, who succumbed to AIDS not long after this interview was filmed.“If we are willing, all of us, to be like Joep Lange. Challenge the status quo. Ask why it is not happening, and not happening fast enough. Then we have enough resources to make a difference.”
But for millions of people like Gladys, this development can still open up new possibilities of enforcement, sharing of information and empowerment. For Dr. Rogo it is clear that this is the future for many countries in Africa “If we are willing, all of us, to be like Joep Lange. Challenge the status quo. Ask why it is not happening, and not happening fast enough. Then we have enough resources to make a difference.” Dr. Rogo concludes at the end of the documentary: “We have the opportunity to turn this century into a century that Africa leads.”