Real innovation can only happen from within

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I was recently invited to talk about innovation in healthcare in emerging markets at the Royal Society of Medicine’s Digital Orthopaedics event in London. Normally, I am very much the outsider talking tech to doctors, so I was delighted to see that my presentation was preceded by Dr Shafi Ahmad – the first surgeon to broadcast VR Surgery – and Dr Axel Sylvan, an orthopaedic doctor-turned-entrepreneur and cofounder of

My talk started with a photo of Mark Zuckerberg’s recent visit to Kenya to “learn about mobile money”. It seemed like a neat segue into my theme.

Traditionally, innovation in medical technology originated in developed markets, and was subsequently exported to developing markets. But I wanted to show how emerging markets themselves can be drivers of innovation.

In many such markets the gap between a fast growing population and limited healthcare infrastructure is vast and is today a key driver in homegrown medical innovation. No longer are such markets importers of innovation from the developed world’s myriad ‘Silicon Valleys’; nor are they merely recipients of overseas aid. Instead they represent the next big commercial opportunity.

The established approach of exporting to developing markets has typically been costly and ineffective. Technologies designed for the developed world failed to address challenges posed by the operating environment of less developed countries; think unpredictable power supplies, untrained personnel and environmental issues such as humidity and dirt. Maintenance costs originally envisaged for developed countries were simply not sustainable in this context. Astonishingly, an estimated 70 percent-plus of medical devices sit idle in hospitals in the developing world.

Daher at the London event. (Image via

Big manufacturers had a stab at solving this problem by stripping their devices of unnecessary features to make them cheaper and simpler. Known as ‘frugal innovation’, this was quickly proven sub-optimal too.

Real innovation, it seemed, could only happen from within, driven by changemakers with intimate knowledge of the challenges and available resources, of their home environments.

Tricky, of course, in the conventional medical device industry, but entirely achievable in the digital health space. Because the beauty of digital technology is that it removes many of the barriers to new med-tech roll-outs thanks to lower costs and accessibility. Medical technology that utilises, say, a mobile phone network is more accessible in countries where health facilities are difficult to reach.

A great example is Nigeria-based eHealth Africa, which developed an Android-based app to help caseworkers trace people who had had contact with Ebola patients. The result? Reporting times shrunk by 75 percent.

And in Rwanda TRACnet developed an IT system designed to collect and disseminate information related to treatment and care of HIV and AIDS patients. Practitioners submitted reports to a central database and received timely access to vital information through a solar-charged mobile phone.

In both cases the development of a system that factored in local considerations and used locally collected data was vital to success.

But pandemics are not the only drivers of innovation. Economic growth has led to a population explosion in emerging markets creating increased demand for healthcare services.

As more people move from rural to urban areas, lifestyles become more sedentary leading to skyrocketing figures for Non Communicable Diseases (NCDs). Eighty per cent of the world’s diabetic population are expected to live in low- to middle-income countries and 80 per cent of deaths related to NCDs will be generated by low- to middle-income countries.

Demand is huge, then, but what about supply? It lags on all levels. Nigeria has four doctors per 10,000 population and 16 nurses, compared to 28 and 98 respectively in the UK. Nigeria’s population is 174 million compared to the UK’s 64 million. Nigeria stretches over 923,768 square kilometres, almost three times larger than the UK.

From primary care units to radiology centres and labs, it will be very challenging to follow the conventional model of building infrastructure and services. The solution? We leapfrog healthcare through innovative models and services including telemedicine, teleradiology and primary care triage.

Take the remote training of radiologists. Ethiopia has one trained radiologist per million population. With a population of 94 million it needs more radiologists and the means to train the next generation. Importing talent is pricey; send your best people abroad to study and many simply won’t return. So how do you bridge the gap? Teleradiology can be a quick, short-term fix, while teletraining offers a compelling longer-term solution.

Moreover, an increase in adoption need not require giant bandwidth. Necessity is the mother of invention and existing bandwidth limitations are pushing innovators to optimise apps to work over 2G networks.

Increasing demand. Low supply. Growing incomes. High mobile phone adoption. All the indicators point to emerging economies’ potential as testbeds of innovation.

Who knows, before long Mr Zuckerberg could be making another trip to East Africa – this time for a masterclass in digital health.

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