Can broadband alone improve healthcare across the continent? (Image c/o Amira Elwakil on Flickr.)
In December this year there is set to be a massive improvement in internet connectivity across Western Africa. A French Telecom led system will, at a cost of $700m, link Europe with eighteen countries across the west coast of Africa, as well as Mali and Niger. This is a substantial development in a continent beset by slow connections and unreliable connectivity. It also provides the continent with a vital first step in closing the digital divide with more prosperous regions of the world.
There have, of course, been other efforts to try to close the digital divide between developed and developing nations. Identifying the reliance on mobile phones in South Africa, Gustav Praekelt has sought to provide mobile solutions to the problems faced across the country, particularly in terms of access to healthcare.
Praekelt notes that mobile penetration in South Africa is at around 95%. Internet penetration comes in at around 10%. The solution is clear, whilst internet connectivity remains so low, mobile solutions must be provided. As Praekelt notes:
For most people in the country, searching online for information on health, education or HIV treatment is just not a viable option, but mobile phones offer an effective way to provide valuable and life-saving information to people on a large scale.
Praekelt goes on to point out that when a short message about HIV was added to one network’s “Please call me” text message (a free message that can be sent if the user is out of credit), around 1.5 million subsequent calls were made to the National HIV hotline – a pretty staggering response.
As a result of the success of the HIV message, he next set about launching YoungAfricaLive (YAL), a mobile phone based community forum which enables young Africans to engage with experts and discuss a range of issues around sexual relationships. According to Praekelt this resulted in over 970,000 seeking guidance and support from peers and counsellors. Next the plan is to launch a mobile service that provides expert advice for mothers (MAMA South Africa).
Whilst internet connectivity remains so low (and mobile ownership so high), the focus on providing mobile solutions is obviously key to addressing the many substantial healthcare issues that beset the region. There is no doubt that such a focus will lead to substantial benefits for those that have been left behind in the global race to get connected. Of course, connectivity issues still need to be addressed but in the meantime solutions such as these can go a long way towards making up for the poor level of connectivity experienced across South Africa and the continent as a whole. The growth of mobile solutions, as well as the attempt to bring high-speed broadband to West Africa, provide hope that Africa may see a rapid growth in connectivity over the coming years, potentially bringing substantial social benefits along with it. The question is, will it really bring such benefits?
There has been, quite rightly, a real focus on providing Africa with the means to get online. Mobile solutions have been rolled out and efforts have been made to ensure reliable and fast broadband connections, all to ensure that the international digital divide is significantly reduced. This focus has been built on the belief that by providing reliable internet connections, faster broadband and greater connectivity, there will be substantial improvements in health, education and governance. Indeed, the Broadband Commission for Digital Development describes information and communication technologies (ICT) as a “tool of unprecedented power” (PDF). Whilst I would not deny that it can make a substantial difference to the lives of those without access, is it really powerful enough to make a substantial difference on its own?
Commenting on the efforts to bring faster broadband to West Africa, Charles Kenny (of the Center for Global Development think-tank) claimed that:
“There are definitely ways you can use ICTs [information and communications technologies] to help improve health and education outcomes, for example, but the statement that they are the most powerful tool as a group … is hyperbole. If you want to reduce child mortality, for example, you need vaccination programmes and bed nets. ICTs can help deliver these goods, but it is the vaccines and bed nets themselves that are the tools of unprecedented power.”
And herein lies the problem. Connecting people across the continent is only part of the solution to the problem, it will not solve the many health, education and governance issues on its own. The technology is useless unless there is also the “real-world” infrastructure to go with it. Take healthcare for example. Counterfeit drugs are a very real problem across the region. As recently as January this year, The Guardian reported on scientists’ concerns about the malaria drug crisis in Africa. These drugs, which appear to offer vital hope in the fight against an illness that kills 3,000 children per day across the continent, are circulated by criminal gangs and are almost entirely ineffective. Furthermore, experts claim that it is virtually impossible to determine how widely they are being distributed, threatening the lives of millions.
So long as problems like this exist, it is hard to see how internet connectivity alone can alleviate the problems of the continent. The technology will certainly make it easier to access information on healthcare and, therefore, increase awareness of treatments and preventative measures. However, so long as counterfeit medicines are in circulation, will this really make a difference? Of course, one could argue that if they have access to the information they require online, then they would also have access to information about counterfeit medicines. But if these medicines are widely distributed across the system, with even experts unable to determine their penetration, how can those who have obtained information on treatment be confident that the medication they purchase is authentic? This situation is exacerbated by the fact that, according to the WHO, “30% of drug regulatory authorities don’t function…” and, as a result, it is difficult for them to “control the import or introduction” of such counterfeit medicines.
It is easy, however, to see why certain institutions are pushing broadband across the continent and talking up its potential for creating change and social improvement. The World Bank, for example, claim that a 10% increase in broadband penetration also led to 1.38% increase in economic growth. But is it really possible to claim that broadband penetration alone was the cause of this economic development? Whether this is the case or not, there will no doubt be many who will happily claim that this is exactly the case. For these people, Africa is seen as a ‘gap in the market’ and, where there is a gap in the market, there is money to be made. Selling the idea that connectivity will solve social problems provides an opportunity for corporations to make money in a continent that has a history of being used and abused by the rich and powerful. And the World Bank has hardly been Africa’s friend in recent years. Connectivity will only mask the more substantial social problems that need to be tackled, it will not resolve them.
So, will increased, reliable broadband penetration alleviate the problems in Africa? It will certainly go some way to easing some of the problems the continent faces. But the problems faced across the continent go much deeper than that. As has always been the case, there needs to be a concerted and sustained effort to address the inadequate infrastructure in many regions across the continent. Bringing reliable broadband to the region may superficially make a difference to the region (and perhaps ease our consciences slightly), but the deeper problems will remain. Without solving these issues it is hard to see how, despite the claims of the World Bank and the Broadband Commission, broadband really will be a “tool of unprecedented power” for the people of Africa. Whilst bringing broadband to the continent should very much be a key focus, it should not be at the expense of seriously addressing some of the deeper underlying problems faced in the region. Broadband is part of the answer, but it certainly is not the single, all powerful answer that some seem to claim it to be.
Ian Clark
A qualified librarian and co-founder of a leading national library advocacy campaign, I have written articles for The Guardian and the Open Rights Group on a range of professional issues.
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