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Meeting Arab Development Challenges With Mobile Technologies

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Many of the countries in the Arab World will deliver the highest mobile use growth rates. We believe that social programs leveraging mobile technologies could have both economic and social benefits …

Many of the countries in the Arab World will deliver the highest mobile use growth rates. We believe that social programs leveraging mobile technologies could have both economic and social benefits such as increased mobile adoption and higher revenues for telecom providers, in addition to higher literacy and heath levels.


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  • 1. Meeting Arab Development Challenges with MobileAbout Us Technologies Tahseen Consulting is an advisor on strategic and organizational issues facing governments, social sector institutions, and corporations in the Arab World. You can read more about our capabilities at tahseen.aePublic Sector ▲Social Sector Increasing Government, Telecom, and Provider CooperationCorporate ResponsibilityCONFIDENTIAL AND PROPRIETARYAny use of this material without specific permission of Tahseen Consulting is strictly prohibited www.tahseen.ae | 1 1
  • 2. The Arab World faces many challenges in the 21st century. These challenges have been thefocus of knowledge reports on the region.Word Cloud generated from analysis conducted on Arab Human Development Reports from 2002-2009 | 2 2
  • 3. Only four countries, representing just 4% of the 300 million Arabs, have literacy rates of 90% or higher 100.0 Average Developed Countries 90.0 80.0 AverageLiteracy Rate Arab World 70.0 (%) 60.0 50.0 40.0 30.0 Source: United Nations Development Program | 3 3
  • 4. Of the 112 million youth in the Arab World, the majority are literate, with a regional youth literacy rate of 83-85%. However, some countries still have high illiteracy rates, particularly amongst females. There remain approximately 17 million illiterate youth in the Arab world. They are concentrated in Morocco, Mauritania, Sudan, and Yemen. Iraq and Egypt also have relatively lower youth literacy rates than their Levant and GCC counterparts, but higher than the others. The gap between boys and girls in Yemen (26%), Morocco (17%) and Sudan (14%) is considerable (UNICEF)Source: The MDGs in the Arab Region 2007, UN-ESCWA | 4 4
  • 5. On a global level, literacy levels and life expectancy levels are directly related. The trend isthe same in the Arab World 80.0 Palestine ** 70.0Disability Adjusted Life UAE Expectancy (Years) Saudi Arabia Oman Qatar Algeria Tunisia Bahrain Morocco Kuwait 60.0 Lebanon Egypt Syria Jordan Libya Iraq Yemen 50.0 Comoros Sudan ** Palestine data is life expectancy Mauritania These countries rate unadjusted for disability but is have the highest believed to be representative 40.0 literacy rates and life Somalia Djibouti expectancy in the Arab region. 30.0 Literacy Rate (%) 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0Source: United Nations Development Program, World Health Organization | 5 5
  • 6. Disability adjusted life expectancy in the Arab World lags behind the more developed countries by more than 10 years 80.0 75.0 Average 70.0 Developed World 65.0Disability Adjusted Life Expectancy (Years) 60.0 Average Arab World 55.0 50.0 45.0 40.0 35.0 30.0 Source: World Health Organization. Palestine data is life expectancy rate unadjusted for disability but is believed to be representative | 6 6
  • 7. As developing countries make improvements in the spread of communicable disease, average income levels increase along with average life expectancy. A slight increase in income shifts the focus of the healthcare system to chronic diseases. EXAMPLE Current Global and The Future Egypt is still plagued by Healthcare Demographic Healthcare preventable Situation trends Picture communicable diseases • Communicable diseases • GDP growth increases • Current healthcare issues continue, but spending on healthcare chronic diseases emerge (diabetes • Example communicable mellitus, obesity, hypertension, diseases which may have • Traditional diseases controlled hyperlipidemia now represent about 26% the scale needed for an (TB, smallpox) and new of all annual deaths related to chronic mHealth initiative in Egypt: diseases appear (SARS, H1N1) diseases in Egypt) mHealth can address these challenges using  Tuberculosis (20,000 new • Declining birth rate and • Shift from late stage treatment to tools currently available. cases annually) climbing life expectancy prevention and detection For example, SMS alerts  Hepatitis - Egypt has are useful in raising highest prevalence in the • Adoption of “developed country” • Example chronic diseases which may public health awareness world - 5.3 million people. behaviors have the scale needed for an mHealth of communicable initiative in Egypt: diseases. Middle-income countries are seeing a shift  Egypt has 3.9 million diabetes sufferers from communicable diseases toward expected to be 7.8 million by 2025 chronic diseases. In these countries, there  Obesity - 40.6% among women in urban is evidence that mHealth programs are areas to 6% among men in rural areas addressing a wider range of chronic non-  Hypertension – 26.3% prevalence communicable diseases, with a focus on early treatment.Sources: Gutiérrez-Robledo, L.M. Looking at the Future of Geriatric Care in Developing Countries. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57:M162-M167, 2,American Journal of Gastroenterology 2006, USAID Egypt estimates of TB cases, Estimates from the Non Communicable Disease Surveillance Survey 2006, Diabetes Atlas second edition,International Diabetes Federation, 2003, Kaluski, D. N., Berry, EM. (2005) Prevalence of obesity in Israel. Obes Rev. 6: 115–116., Prevalence, awareness, treatment and control of hypertension inNorth America, North Africa and Asia P K Whelton, J He and P Muntner | 7 7
  • 8. Cellular data evolution trends in Europe indicate that messaging continues to drive revenuesbut value added entertainment and content services are becoming more important. W. European Cellular Data Revenues Western Europe cellular Data Revenue Distribution 120 100 80 60 40 20 0 00 01 02 03 04 05 06 07 08 09 10 20 20 20 20 20 20 20 20 20 20 20 Messaging Information Services Location-Based Services Entertainment Other Source: Strategyanalytics | 8 8
  • 9. Women are 24% less likely to own a mobile phone in the Arab World, resulting in almost $1.5 billion in lost incremental revenue. This gender gap is comparable to levels in sub Saharan Africa 26 million women 76 million 102 million subscribers subscribers 165 168 Million Females Million Males Total PopulationSource: Women and Mobile: A Global Opportunity, A Study on the Mobile Phone Gender Gap in Middle Income Countries | 9 9
  • 10. mHealth is the use of mobile communication technologies as an integral part of healthcare delivery  mHealth aims to improve healthcare delivery through eCare, eServices, eSurveillance, and eLearning  No evidence of mHealth programs in the Arab World, but several initiatives globally to learn from  Macro healthcare trends which have driven the emergence of mHeatlh globally – Poor spend a lot of money on health – Most on acute care, little on long term care or prevention – Demand is very sensitive to price – Demand is very sensitive to distance  Lack of money and knowledge are constraints but do not fully explain health behavior  Not just an issue for poor, in rich countries people do not:  Complete their courses of antibiotics  Take iron pills  Wash hands  Barriers to mHealth  Lack of Knowledge about applications of mHealth and public health outcomes  Operating Costs for voice communication, data transfer, electricity too high  Underdeveloped Infrastructure such as unreliable mobile network  Policy – country or regional eHealth policy does not include mHealth as an approachSource:The World Bank mHealth Summit 2008, World Health Organization | 10 10
  • 11. A 2009 global survey found 51 operating mHealth programs. These programs are more prevalent in India, South Africa, Uganda, Peru, and Rwanda # of mHealth programs % distribution by geography by geography Africa (excluding South South Africa 21% India Africa and Uganda) 9 6 Uganda 6 20% Latin America Worldwide 1 Latin 10 1 Eastern 18% Africa America Europe No evidence of 7 14% Asia mHealth programs Asia (excluding India) in the Arab World 12% Uganda 11 India 12% South Africa 4% OtherSource: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcarein the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009. | 11 11
  • 12. Based on the 51 mHealth projects globally, there are 6 key deployment areas Disease & Epidemic Outbreak Tracking Global Deployment of Diagnostic and Treatment Support Major mHealth Use mobile devices to send and receive data on disease incidence, outbreaks and public health Applications Use the mobile phone as point-of-care device to empower community health workers. Patients are able to emergencies to produce real time surveillance receive treatment in their villages and homes, averting the need for hospital visits Communication and Training for 7 9 Health Care Workers Connect health workers with Education and Awareness sources of information , training, serious games, and the ability to 5 SMS/text messaging in support of public communicate with their colleagues health and behavioral change campaigns. SMS alerts have proven effective in targeting Easier to hard-to-reach populations and rural areas, 6 where the absence of clinics, lack of healthcare implement Remote Monitoring workers, and limited access to health-related information prevent people from making Maintain care giver appointments or Easier to informed decisions about their health ensure medication regime adherence implement via Diagnostic & Treatment Support. Consists of one- or two-way 10 communications to monitor health conditions, maintain caregiver Remote Data Collection appointments, or ensure medication regimen adherence 14 Applications using mobile devices to collect real-time patient data, often where patients live, enabling public officials to gauge the effectiveness of healthcare programs, allocate resources more efficiently, and adjust programs and policies accordinglySource: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcarein the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009. | 12 12
  • 13. In a 2005 survey of Egypt’s eHealth needs, hospital Information Systems, national electronic registries, national drug registries, telehealth, and virtual libraries were highlighted by respondents as extremely useful if implemented Preferred generic eHealth tools to be provided by WHO mHealth (5 = the most useful) deployment area EXAMPLE Electronic health records 5 Remote data collection Hospital information systems Communication and 5 Training for Health WorkersGeneral practitioner information systems Diagnostic and 5 Treatment Support National electronic registries (eg. Cancer, diabetes, blindness etc) 5 Remote data collection Diagnostic and National drug registries 5 Treatment Support Directories of healthcare professionals Diagnostic and and institutions 5 Treatment Support Automated or semi-automated systems Diagnostic and that support decision making. 5 Treatment Support Telemedicine or the use of remote medical expertise. 5 Remote monitoringApplication for capturing, and displaying Remote data collectiondata related to geographic coordinates. 5 Communication and Advice on human resources development for eHealth 4 Training for Health Workers Diagnostic and treatment support and data collection appear to be the most neededSource: Building Foundations for eHealth, 2005 World Health Organization | 13 13
  • 14. Of the top 10 countries with the highest prevalence of diabetes, 6 are Arab; Diabetes prevention and monitoring has the scale to be a core mHealth offering as increased wealth necessitates prevention of chronic diseases An example of a diabetes control application from the Centers for Disease Control and PreventionSource: InternationalDiabetes Foundation | 14 14
  • 15. At the same time many Arabs in low to middle income countries are afflicted by communicable diseases, such as tuberculosis, which are treatable An example of Tuberculosis remote monitoring and regime adherence in South AsiaX out TB seeks to reduce the necessity of daily health worker monitoring of TB patients by offering patientsincentives for compliance with drug regimes critical to health and preventing spreadX out TB solves this by Reminder—phone rings to remind patient to take pill Monitoring—urine strips generate code (if patient has been taking their meds) Less reliance on workers—monitoring done by patient and phone Deadline—patient enters code by SMS before deadline Up front incentives—patient receives free minutes if correct code entered before deadlinePotential Impact in the Arab World Many of the Arab countries lack healthcare in rural areas, this technology would compensate for shortfalls 45% of the cost of standard TB treatment, which costs about $75-125 over the course of the six-monthtreatment, can be eliminated – For new incidences this would amount to $1.25 million in savings for Egypt Medication adherence incentives of free mobile minutes grow the market for mobile value added services | 15 15
  • 16. Social investments by the mobile industry in regional mHealth could potentially havetremendous business and social returns in increased VAS adoption and improved health EXAMPLE | 16 16
  • 17. Literacy seems to be a key factor driving mobile usage. Disposable income is likely a limitingfactor in highly literate countries like Lebanon and Palestine. 230 UAE Mobile cellular subscriptions per 100 Bahrain 180 High disposable income, high literacy countries are avid mobile users. inhabitants (2008) Saudi Arabia 130 Qatar Literacy in addition to Oman disposable income may be limiting factors to mobile adoption in these countries. Kuwait Algeria Tunisia Jordan 80 Libya Morocco May lack disposable Mauritania income to have Iraq higher mobile Egypt adoption rates. Syria Lebanon 30 Sudan Palestine Yemen Djibouti Somalia Comoros 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 -20 Literacy Rate (in %) Implications • Literacy rates appear to be reflective of a country’s mobile use and anecdotally ARPU. • We believe that countries with higher literacy rates are more likely to utilize sophisticated VAS delivery platforms and services.Source: United Nations Development Program, International Telecommunication Union | 17 17
  • 18. Face to face literacy initiatives of the Egyptian government have failed to maintain a high level of attendees or successful graduates, indicating the need to reevaluate the approach to the curriculum and method of teaching to make it more accessible EXAMPLE100% Students cited the need to be at work and the lack of connection between the curriculum and their needs as two of the main reasons for not following through with the training 90% Attendees/ Enrolled 80% Graduates/Attendees 70% 60% 50% 40% 97 98 99 00 01 02 03 04 05 06Source: The National Report on Literacy and Adult Education (May 2008) | 18 18
  • 19. Studies suggest that rural Egypt would stand to benefit the most from mobile literacy initiatives Illiteracy in rural Upper Egypt hovers around 60%, indicating the need for investment. However, mobile phone penetration does not exceed 30%. Therefore, any mLiteracy initiative should feature free handset dispersion or a phone loan while the user is in training. To ensure uptake by mobile operators and sustainability of the program, the training should include banking or agriculture training. This may increase the circle of partnerships beyond mobile operators and NGOs. EXAMPLE 70% Illiteracy rate % mobile phone ownership 60% 50% 40% 30% 20% 10% 0% Urban Lower Egypt Lower Egypt Upper Egypt Upper Egypt Frontier Governorates (Urban) (Rural) (Urban) (Rural)Source: The National Report on Literacy and Adult Education (May 2008) | 19 19
  • 20. However, mobile literacy initiatives may not fully replace the need for an offlineteaching experience; A significant area of opportunity might be to complement existingface to face literacy programs Advantages of mLiteracy Disadvantages of mLiteracyTraining delivered at a convenient time for the The learning experience is fragmentedend userEach user can determine the appropriate pace of The training is not guided by an expert and likelylearning no Arabic mobile literacy curriculum exitsCurriculum can be customized for the needs of Small Screens that may not handle lots ofeach user informationThe cost of teachers, supervisors and facilities Steep cost associated with securing handsets,can be saved developing materials, sending text messages The cost associated with hiring Research suggests that all basic teachers, supervisors and m-literacy training initiatives facilities exceeds 60%of total involve dispensing free mobile training costs. handsets to users. | 20 20
  • 21. Mobile initiatives targeting learning in general and illiteracy in particular have notreceived regional traction; International examples mostly leverage simple VAS and stressliteracy maintenance as opposed to literacy acquisition Reading Literacy Illiterate Full Literacy Build Accuracy and Fluency Social Return on Promote Literacy • Word recognition Engagement and Interest Investment • Match speech with letters General Skills Build Vocabulary • Support skills and strategies (Example literacy framework • Convert written word into • Phonemic Awareness • Expressive vocabulary developed through experiences based on the work of the spoken word. • Alphabetic Understanding • Receptive vocabulary and enrichment Institute for the Development of • Use basic conventions of • Phonological Recoding • Engage and develop the love of Educational Achievement at the writing (e.g., prints upper- Letter reading University of Oregon) Formation, and lowercase letters) Delivery Platform Text interface makes it SMS IVRs WAP Portals difficult to use VAS. Asia: Illiterate adults are Existing Mobile CSR given free phones for the Asia: An individual can Africa: Interactive period after their literacy Africa: An initiative that aims Initiatives material is loaded onto training to aid in the play a game of Snakes and at increasing literacy rates Ladders on the phone by Current Activities phones and given to retention of information. via SMS to encourage answering multiple-choice users for free. Material Individuals receive reading. Users pick themes No evidence questions about which includes the alphabet, engaging content via such as elections or of mLiteracy words begin with a numerical sequences SMS on different topics business terms to direct programs in particular letter in the and phonetic exercises. and are quizzed on their their learning. the Arab alphabet understanding of the World content. None (Material Delivery Method preloaded on the SMS WAP SMS handset) These programs do not migrate users along the VASSources: Internal analysis, Strategy Analytics - Operator Value Added Service adoption continuumOfferings and Consumer Needs: Kenya, Institute for the Development ofEducational Achievement at the University of Oregon | 21 21
  • 22. We need to eliminate the potential road blocks identified earlier 1 Enabling Factors FinancialCommon Goal resources Business Case Work together to Collaboration leverage mobile technology to address Social development Commitment challenges Political/ Regulatory Support Technology 2 Potential Road Blocks •Common Goal •Collaboration •Political Commitment and Leadership | 22 22
  • 23. Case studies and input from industry experts reveal several success factors Build a long-term funding plan - Continuing the 1 project beyond the seed funding can be accomplished by aligning with long-term national development goals. Forge strong partnerships 2 Be accessible - 6 - Partners from multiple Communication is more sectors bring diverse effective when tailored to strengths to the project. specific social, ethnic, and demographic groups. Successful Development Initiatives Using Mobile Technology Collaborate with other Design with the end user in 5 3 organizations – Moving mind and maintain a focus on forward means sharing usability - Applications and techniques and applications. devices must take the users work environment into account in the design phase. Ease of use is Set measurable goals - By setting 4 essential. interim goals and benchmarks, project principals can identify and quickly correct a particular course of action if targets are not met.Source: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcarein the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009. | 23 23
  • 24. mHealth programs such as remote data collection, access to client records, access to health information databases, census taking, and electronic health records creation and storage require two-way service applications and a sophisticated partner value chain Hardware Vendors Higher-level solutions entail higher App Developer project cost and participant PDAs, involvement which are likely presently Handsets prohibitive Regulatory Platform Developer Laptops Ministry of Health Doctors / Health providers Internet Funders Project Owner/ Patients/ Developer Mobile Subscriber Donors Mobile Service Content Providers Provider Content Aggregators Company CSR Initiatives Health Systems Electronic Content Health Developers Record, other Non-profits health databasesSource: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcarein the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009. | 24 24
  • 25. A more realistic approach may be to partner with equipment vendors, mobile operators, and heath providers to offer one-way messaging applications Examples of mHealth solutions based on one-way messaging applications include • Medication regimen adherence and monitoring programs • Education/support programs based on one- or two-way SMS alerts Equipment Vendor Doctor/ Health Providers Project Application/Solution Developer Management Several open source aps are available for mHealth Patients/ Platform Operator Mobile Subscriber Mobile Operator Scale required for sustainability High LowSource: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcarein the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009. | 25 25
  • 26. … while subsequently convening key stakeholders to enlarge the initiative in terms of health issues and regional scale once there is proof of concept Telecom Vodafone, Orange, ITU others GSMA /CTIA Intl. Society for Industry Orientation Telemedicine & eHealth Samsung, LG, Ericsson, Qualcomm, others mHealth Initiative UNICEF, UN Digital Health Health IT Companies World Health National Health Organization Healthcare Departments companies Hospitals Health Gov. Hospitals Public Private Business SectorSource: Team Analysis | 26 26
  • 27. Due to the lack of an Arabic literacy curricula, a partnership to complement an existing literacy program would provide access to curricula and generate users Work with literacy program to develop curricula Equipment Vendor Existing Literacy Program Project Application/Solution Developer Management A literacy curricula needs to be developed Literacy Program Platform Operator Participant/ Mobile Subscriber Mobile Operator Scale required for sustainability High LowSource: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcarein the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009. | 27 27
  • 28. An Agenda for ActionRegional Mobile Telecommunications Industry Form working group to learn from other initiatives (UN and Vodafone Foundation Technology Partnership) Thought leading research in a regional contextMobile Operators Position mobile phones as a life enhancing tool which creates education, health, employment etc. Combine mHealth and mLiteracy with delivery of other mServices to grow the market for mCommerce Pricing segmentation - people with 2 to 3 US$ daily income spend 5-8% of their income for ICT Specifically address women and underserved communities Leverage handset maker relationships - Low-cost phones are key to increasing access to mServices Application gateways that allow for different organizations involved to build the applications themselvesGovernment/Policymakers Structured health data requires standardization and interoperability Define what mHealth means within the national health system Incent telecom providers for provision of mHealth services and fund universities studying mHealthsolutionsHandset Makers Many of the successful mobile development projects have involved phone loans or free phonesDevelopment Community Design program with scale in mind - millions of users, not hundreds or thousands. Join forces with companies that are already offering mServices and propose a joint effort Provide proof of concept by using the simplest available technology on existing infrastructure | 28 28
  • 29. • For Further Information About This ‫للمزيد من المعلومات عن هذا العرض التقديمي‬ • Presentation ‫للحصول على العرض التقديمي الكامل لهذا العرض التقديمي‬ To get a copy of the full presentation or to ‫يرجى االتصال بوليد العرادي على العنوان‬ discuss the findings, please contact Walid walid.aradi@tahseen.ae Aradi at walid.aradi@tahseen.ae• For Inquiries About Our Services and ‫• لالستفسار عن خدماتنا ولعرض أفكاركم علينا‬ Requests for Proposals ‫لالستفسار عن خدماتنا أو عرض أفكاركم علينا يرجى االتصال‬ To inquire about our services or submit a ‫بنا عبر اإلنترنت باستخدام النموذج أدناه أو إرسال بريد إلكتروني‬ request for proposal, please contact us using fikra@tahseen.ae ‫إلى‬ the online form or send an e-mail to fikra@tahseen.ae• For Organizations Interested in Alliances ‫• بالنسبة للمنظمات التي لديها اهتمام بالدخول في اتفاقيات شراكة‬ ‫وفي تحالفات مع شركة تحسين لالستشارات‬ We are interested in opportunities where our technical skills and expertise can be used to ‫إننا مهتمون بالفرص التي يمكن من خاللها استخدام مهاراتنا‬ complement or diversify those of potential ‫وخبراتنا الفنية لتكميل أو لتنويع مهارات وخبرات شركائنا‬ partners to pursue specific government funding ّ ‫المحتملين بما يمكن من السعي للحصول على تمويل حكومي أو‬ opportunities, commercial contracts, or RFPs. To begin a discussion about entering into an ‫عقود تجارية. لبدء نقاش حول الدخول في تحالف مع شركة‬ alliance with Tahseen Consulting, please contact ‫تحسين لالستشارات يرجى االتصال بوليد العرادي على العنوان‬ Walid Aradi at walid.aradi@tahseen.ae walid.aradi@tahseen.ae• For Members of the Press or Media ‫• بالنسبة للعاملين في الصحافة أو في وسائل اإلعالم‬ For media inquiries, please contact Wes ّ ‫لالستفسارات المقدمة من قبل وسائل اإلعالم يرجى االتصال بـ‬ Schwalje at wes.schwalje@tahseen.ae wes.schwalje@tahseen.ae ‫ويـزلي شـوالييه على العنوان‬ 29
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