An unintended consequence of innovation?

I spoke on a conference panel today about innovative technology and health care. Once I got over my stage fright I thoroughly enjoyed the discussion.  It was a privilege to speak alongside some very talented innovators. And the great audience participation meant I was able to crowd-source lots of new ideas.

I was speaking about our mHealth initiative in Mozambique. We have invested in a randomized control trial to establish whether certain technologies can positively impact identified health outcomes. The study is midway through so I was not able to share results. Instead I spoke about how we have come across an unintended consequence of innovation.

Tech-utopians* are bullish about the opportunities promised by rapidly accelerating access to technology, particularly mobile phones, in developing countries. And the statistics are compelling: according to the World Bank developing countries accounted for around one-quarter of the world’s 700m or so mobile phones in 2000. By the beginning of 2009 their share had grown to 75% of a total, which by then had risen to over 4 billion, with 600 million subscribers in Africa.

Our study in Mozambique is targeting 1,300 HIV positive pregnant women and antiretroviral patients (men and women) with a mobile technology aiming to increase their treatment adherence. I mentioned earlier that we are just halfway through the RCT  but, trying to avoid the pitfalls of pilotitis that have befallen mHealth interventions in many other countries, we are already planning for scale. And we are being transparent about the challenges we will face in achieving that scale.  What is clear, even at this early stage, is that equal inclusion of women will be a major barrier.

Pregnant women wait to see a midwife at a clinic in Mozambique

To be eligible to participate in the study patients must meet a number of criteria, including basic literacy and mobile phone ownership. During the enrolment phase we discovered that 29% women and just 7% men were not eligible because they did not own a mobile phone.  This tells us that, as this type of initiative goes to scale, women will not have equal access to interventions that have the potential to have considerable impact on their health. So my question to the audience at today’s conference was this: could a technology innovation, designed to improve health outcomes, create an unintended consequence that actually deepens existing inequalities between men and women?

In Mozambique a woman is 28% less likely to own a mobile phone than a man, a gap that increases significantly in rural areas. And worldwide the equivalent figure is 21%. (I was told recently that globally, taking all technology into account, men have double the access women do. A slightly dubious factoid whose origins I must delve in to).

Closing this gender gap would bring the benefits of mobile phones to an additional 300 million women and provide substantial revenue to the telecoms industry – $13 billion according to GSMA Association. Definitely a strong business case for a gender-orientated marketing strategy.

* I am often described as a tech-utopian. But I prefer to self-identify as a tech-optimist.


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