Meeting Arab Development Challenges With Mobile Technologies By Increasing Government, Telecom, And Service Provider Cooperation

Meeting Arab Development
Challenges with Mobile
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The Arab World faces many challenges in the 21st century. These challenges have been the
focus of knowledge reports on the region.

Word Cloud generated from analysis conducted on Arab Human Development Reports from 2002-2009

| 2 2

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
Average
Literacy Rate

Arab World
70.0
(%)

60.0

50.0

40.0

30.0

Source: United Nations Development Program

| 3 3

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

On a global level, literacy levels and life expectancy levels are directly related. The trend is
the same in the Arab World

80.0
Palestine **

70.0
Disability 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 90.0 100.0

Source: United Nations Development Program, World Health Organization

| 5 5

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

65.0
Disability 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

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 in
North America, North Africa and Asia P K Whelton, J He and P Muntner

| 7 7

Cellular data evolution trends in Europe indicate that messaging continues to drive revenues
but 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

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 Population
Source: Women and Mobile: A Global Opportunity, A Study on the Mobile Phone Gender Gap in Middle Income Countries

| 9 9

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 approach

Source:The World Bank mHealth Summit 2008, World Health Organization

| 10 10

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% Other
Source: Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcare
in the Developing World. UN Foundation-Vodafone Foundation Partnership, 2009.

| 11 11

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 accordingly


| 12 12

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 Workers

General 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 monitoring
Application for capturing, and displaying Remote data collection
data 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 needed

Source: Building Foundations for eHealth, 2005 World Health Organization

| 13 13

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 Prevention

Source: International
Diabetes Foundation

| 14 14

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 Asia

X out TB seeks to reduce the necessity of daily health worker monitoring of TB patients by offering patients
incentives for compliance with drug regimes critical to health and preventing spread

X 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 deadline

Potential 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-month
treatment, 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

Social investments by the mobile industry in regional mHealth could potentially have
tremendous business and social returns in increased VAS adoption and improved health
EXAMPLE

| 16 16

Literacy seems to be a key factor driving mobile usage. Disposable income is likely a limiting
factor 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

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

EXAMPLE
100% 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 06
Source: The National Report on Literacy and Adult Education (May 2008)

| 18 18

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

However, mobile literacy initiatives may not fully replace the need for an offline
teaching experience; A significant area of opportunity might be to complement existing
face to face literacy programs

Advantages of mLiteracy Disadvantages of mLiteracy

Training delivered at a convenient time for the
The learning experience is fragmented
end user

Each user can determine the appropriate pace of The training is not guided by an expert and likely
learning no Arabic mobile literacy curriculum exits

Curriculum can be customized for the needs of Small Screens that may not handle lots of
each user information

The 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

Mobile initiatives targeting learning in general and illiteracy in particular have not
received regional traction; International examples mostly leverage simple VAS and stress
literacy 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 VAS
Sources: Internal analysis, Strategy Analytics - Operator Value Added Service adoption continuum
Offerings and Consumer Needs: Kenya, Institute for the Development of
Educational Achievement at the University of Oregon

| 21 21

We need to eliminate the potential road blocks identified earlier
1
Enabling Factors

Financial
Common 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

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.

| 23 23

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
databases

| 24 24

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 Low

| 25 25

… 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 Sector
Source: Team Analysis

| 26 26

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 Low


| 27 27

An Agenda for Action
Regional Mobile Telecommunications Industry
 Form working group to learn from other initiatives (UN and Vodafone Foundation Technology Partnership)
 Thought leading research in a regional context

Mobile 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 themselves

Government/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 mHealth
solutions

Handset Makers
 Many of the successful mobile development projects have involved phone loans or free phones

Development 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

• For Further Information About This ‫للمزيد من المعلومات عن هذا العرض التقديمي‬ •
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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

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the online form or send an e-mail to
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‫وفي تحالفات مع شركة تحسين لالستشارات‬
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For media inquiries, please contact Wes ّ
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Meeting Arab Development Challenges With Mobile Technologies By Increasing Government, Telecom, And Service Provider Cooperation

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