 My name is Matt Bonds. I'm a professor at Harvard Medical School and a founder of the non-governmental organization called PIVOT. We work in Madagascar. And I was wondering if we could ask people to take my badge. If you would like to come up close to here, that'd be great. No pressure. We're a worn that would be a much more enjoyable experience for everyone if we could see you. So today we're talking about health care in Africa, blending the old with the new. We have a lovely set of panelists. We have Patrick B.T. from Redbird, Diane Kane from Medic Mobile, and Jacob Zandu from Z Valley. I was asked, I'm also a panelist. I was also asked to be a moderator. We lost our moderator on short notice. I don't know if anyone saw that Dr. Agnes Ben-Gwaho was originally on the panel. And she's one of my heroes. And I assume an attraction for a lot of people. But she had a little bit of a travel situation. So unfortunately, she's not going to be here. So it's fine. I think everything I know about global health and health in Africa, I learned from her. So I think I can try to channel some of her energy. So I was asked to frame this conversation around broadly the landscape of health in Africa, which is kind of an impossible thing to do, as you can imagine. For one, Africa isn't a single population, obviously. It's not a country. And it's quite, it's famously heterogeneous. Some of you may know that there's more genetic diversity in Africa than the rest of the world combined. There's hundreds of individual languages, huge economic diversity, as well. And so it'd be kind of crazy for us to try to overly simplify what it means to do health care in Africa. But there are common problems across the continent that those of us who work in that space see in a lot of different countries. And so I thought I would just start by framing some of them as a way for introducing the rest of our panel. So I understand this is a pretty broad audience. So I'll do my best to start at the most basic level, I guess. So most of you know that around the turn of the millennium, we established the Millennium Development Goals with pretty ambitious targets of dropping under five mortality by 50%, dropping maternal mortality by 2 thirds, and along with a lot of other health-related and development related objectives. And at that time, the world was actually starting to feel pretty optimistic, although issues like HIV, the pandemic, were looming extremely heavily. And so there was a huge burst of goodwill, international will, the development assistance for health increased by seven times. Now there's about $32 billion in development assistance for health internationally. Most of that money is actually in Africa, Africa receives more than almost all other regions in the world combined for that. And so, and we saw progress. I don't know if people are tracking that, but life expectancy's increased by about 10 years in Africa since the turn of the millennium. HIV rates have decreased by 50% in terms of mortality. And almost every indicator that any of us care about, things like under five mortality, maternal mortality, coverage rates, immunization rates, all those are enjoying some level of a meaningful systematic progress as part of general economic development and investment in health. So that's the good news. The bad news is it ain't good enough. And we're not there yet. Almost no country's actually accomplished the millennium development goals. I believe that the country of Rwanda is the only one to achieve those millennium development goals. Coverage rates, the ability for children to get access to treatments of very simple illness like fever, diarrhea, pneumonia. Those are less than half for the country. Under five mortality is about across the continent, about 8%, which is significantly greater than any other region in the world. Internal mortality is 10 times what it is in most other parts of the world. So there are huge problems. And they're thorny problems. And some of these problems are starting to not go away at all. We see some level of resurgence of malaria. We see vaccination rates not improving in many parts of the continent. And so there's like all these, so even as we're seeing progress, we're like seeing real hard challenges. And maybe to just name a few that have get a lot of headlines, the Ebola outbreak on top of normal chronic issues is obviously a no-joke situation of very infectious disease that destabilizes entire governments. I work in Madagascar. Last year we had the biggest plague epidemic in 50 years. And we actually had the case of Pneumonic Plague, so that's spreading airborne, killed people within two days. Classic story of a global threat, invading population centers. And so the question that, the way that I think about these kinds of problems, and I believe some of the panelists share this view is, what's the deal there? Like why do we have these persistent problems and new kinds of problems? Plague, many of you probably know that plague is, plague is a medieval disease, but it's actually a very wimpy disease. It's a bacterial infection that actually responds to most antibiotics. Very few are actually resistant. It's almost 100% curable for almost nothing. And so we see in places like Madagascar, 20, 30, 40,000 children under five die even more common illness for things that are just as easily treatable. So those are the kinds of problems we'd like to solve. And so today I'd like to propose these kinds of questions of how do we actually, why do these problems persist? Why couldn't we accomplish the goals that we set even as the world was rallying resources around them? What does the modern world offer for a continent like Africa where technology, we have it at our fingertips. Lots of people have smart phones. They're actually in the hands of community health workers and actually individuals. We have access to data that we've never had before. And obviously we're seeing broad based, slow, uncertain economic development. So I will hand it over to the group to start posing these questions. What's the future of healthcare and health access? In Africa, before I do that, I'll start by taking off my moderator framing hat and put it on my panelist hat. So I mentioned that I work with an organization called Pivot. I'm one of the founders. We believe that one of the major problems in all these things is that systems, health systems, geographically defined systems of hospitals, health centers, supply chains are broken. And so even the simplest of solutions, even anti-malarial drugs or antibiotics have trouble even when they work amazingly well, had trouble getting to the individuals who need them. And so we as an organization have created a model system at the level of a government district that works at hospitals, health centers and community health workers. And we build infrastructure, supply chains. At all levels of that system, we do the trainings and the human resource development. And then we in particular invest quite a lot in data so that we can understand whether we're seeing change, whether we're having impact, why that's happening and then identify programs that can scale across this country. So our problem we see as broken systems, our solution is a model system for healthcare in Madagascar. So with that, I'll hand it over to Jacob to introduce. Thank you very much. I'm Jacob Zano. I'm a race or nurse here at Kaiser Oakland. And I'm from Benin Republic, West Africa. I've been educating the system over there before I got here. And I like to start it with a phrase you just used earlier. So he's talking about health system and that's my passion because my approach of the health system growing in Benin, being in Benin every three months for the last decade also is completely different the way I say things is completely different. The World Health Organization have been saying the same thing and over and over. Health system, they are four key pillars. They are main pillars to a health system when at the country level. Number one, health infrastructures. It's basic. How do you convey that vaccine to the kids in my village, Hosi, if you don't have a small infrastructure over there? Health infrastructure, whether it's in public sector or in the private sector, you can check and see. We're talking about five beds per 10,000 population in Benin. Four beds per 10,000 population in Bukina Faso. Three beds per 10,000 population in Niger and so on and so on. So this is Soka. So I believe maybe there are some investors here. So you see there are room here to invest if you wanna put health facilities. That's number one. Human resources for health. Doctors, nurses, midwife. I've discovered something extraordinary here in the United States. They call them technician, EKG technician, cardiac echocardial technician. We don't have that in the French system. So if you want to invest and make money, why don't you put a school over there and train this because we need those. We have less than one doctor per 10,000 population. So that's the second pillar, human resources for health. Then talking about health information technology. Put some software. Electronic, we have email. Electronic healthcare record system that we can use. So whether it's in the public or a private sector, there room for investment. And then I'm telling you, Africa is the lens of opportunity. The lens of opportunity because you have the human resources that just waiting for training. If you can put right there, the schools, the institute to train them. And then you put the healthcare facilities. And then we have a system that can work because the problem that we have so far is to have a basic system that can convey basic healthcare services. We don't have that. And government, talking about government, I can speak to Benin. Five years ago, we were able to raise half a million dollars and put it to an in bed hospital in Benin. The government is changing the rules now in a way that help investors make money. So that is very attractive for investors because they are changing the rules. They are making it very, very attractive for investors to come and invest. So they are room for, you know, if you wanna make money, this is the time. This is the time because I think the investor that gonna position themselves right now will be the leaders of tomorrow, whether it's healthcare in West Africa or all over Africa. And especially French speaking Africa. It's very important because most of the funding that are going to Africa, I'm not saying that the English speaking countries don't need resources, we all as African need resources. But if you see the gap between the French speaking countries and English speaking countries, it's huge. So they are, I say, wherever there are needs, they are profit to be made. So the needs should be seen as the basket of opportunities. So whether it's in the private sector or in the public sector, I can speak to both because when you're in the private sector, you have to talk, you have to work with the government in regulation side so the government can see everything. And then there's opportunity to transfer skills that we have here that we don't have back home. So there are plenty of room over there where we can invest and make money and save lives. So that's gonna be my message as of now. Thank you. Let me just do one more follow-up question I'll go for. Just before we move on, can you just talk a little bit about the Z Valley model? So what we're trying to do technically is, I don't know how well you are aware of the Kaiser system. I work at Kaiser and I love Kaiser. I don't know, I'm passionate about Kaiser. So we put that 20 bed hospital, Kaiser step, Kaiser Oakland where I work and step in and equip that. So after five years, so what we see now, I'm like, okay, let's get this to, let's scale this up like seriously, serious investment where we have great hospital, we have a hospital. So when you have a hospital, then we will have institute to train. Kaiser also have, they train the EKG tech, they train the cardiac ecotech. So I want to build the next Kaiser system for Africa. That's what I want. And the system, it's a blend of for-profit and non-profit. I think the most, the infrastructure sides train more non-profit and then the operation side, it's mainly for-profit. So we can have a blend that will fit to kind of capture resources and put what we need to build a health system in West Africa, in all Africa starting from Benin and also more importantly, call in the government to show them the way to do things. I'll give you a simple example. In beginning next year, we're going with a team of OBGYN from Kaiser Oakland to start a diagnostic capability for women cancer. So diagnostic, basic diagnostic capability and then from there, the protocol for treatment. Then that, the structure we have right now in Benin, it's called polyclinic sentin, will be used as scent of excellence. Then we're calling the government and show them and then that can be replicated and scale at the national level. But I'm thinking bigger than that. Let's get investors together, build something nice and then have all the components since we already have the human resources here helping us at Kaiser from Kaiser Oakland. So that's what it is. So we'll go to Diane. So I'm Diana Kane. I'm the chief design officer at Medic Mobile. Medic Mobile is a nonprofit organization that builds open source software for community health systems. So we work with organizations like MATS, Pivot, as well as others that are building new models of community health delivery in the hardest to reach parts of the world. So our primary users of our software are community health workers. And if you're new to global health, a community health worker is oftentimes a volunteer, though in some models we're increasingly seeing payment and professionalization of them as a service. But they're often nominated by their communities in remote villages as oftentimes women who have demonstrated a commitment to their community and a passion for the health of their community. And they're given anywhere from two weeks to a year's worth of training depending on the infrastructure and the model that's in place. And they're delivering services door-to-door. So they're all the families and their vicinity. They're showing up at their house. They're seeing if there are any sick children. They are sometimes providing some over-the-counter medicines at the door, some basic diagnostics, again, depending on the support that's provided by the organization. An organization like Pivot is training and providing a very high level of service there. Many ministries of health also have community health worker programs again to varying degrees of service provided. Those health workers are also accompanying patients to primary care facilities and are really the linkage between the community and the health system, oftentimes the only linkage that a family ever receives. So the software that Medic Mobile designs and builds is designed to support and enhance what those community health workers are able to provide. So we have the ability for the health worker to register every family that they're caring for into an offline app that's on their phone. And so they're able to scroll through that list and see which families they visited recently and who they haven't. And they're able to receive reminders about children that need a follow-up after a clinic visit or need to be referred for their next round of immunizations. So it really keeps people from falling through the cracks and it also provides decision support and algorithms for those health workers to ensure that they're providing a consistent level of care across, again, different levels of training that's provided to them. So I've been with the organization coming up on seven years now we're about 10 years old and our staff, we're 100 people spread across the world San Francisco is by far our smallest office. We've got 40 some people in Nairobi now another 20 some in Kathmandu, other remote offices in Kampala and Dakar and then quite a large remote team of developers. So my background is in public health and sociology and anthropology and I lead the design team with a specific focus on designing with the health workers that we serve. So I bring in a lot of human-centered design principles and methodologies and I'm happy to share more about all of that too. Great, I have a quick follow-up question. So mobile technologies are extremely exciting in the world in general and in the health space in particular. There are a number of organizations that are emerging around getting community health workers mobile technologies to help support their work. Could you just say a few more words about what's different about Medic Mobile or the principles with which it operates? Yeah, sure. I think being open source is it's always been a really important core part of our mission and being nonprofit as well. So we have no user fees there's no contract fees, service agreement fees that would be a barrier to a Ministry of Health adopting these tools long-term. It's really part of our model to be working with organizations like Pivot and others to embed these tools and show that a new way of delivering care is possible and then to have governments pick that up. And so we're doing everything we can to eliminate the barriers to governments taking on a system like this and operating it long-term. I think also the commitment to designing with the user is an important differentiator for us. You know, we really, we see ourselves as walking hand in hand with users and understanding the processes that they go through on a daily basis and that drives our roadmap and our feature requests. So this isn't a kind of quick and one and done type of engagement. We're not a typical technical consulting company that will come in and design and deliver a solution. We really work with organizations for the long-term and are continuing to evolve the toolkit alongside them. Yeah, it's a tech company that's driven by social scientists and socially-minded folks. Okay, great, thanks. Patrick. Hi everyone, I am Patrick. I am one third of Redbird, which is a for-profit Ghanaian startup in digital health. At Redbird, what we do is we are a lab in a box solution for convenient healthcare via pharmacies. So we see a complete lack of convenient options for the most basic screening or monitoring information you might want to get. Right now in Ghana, where we are headquartered, we have diabetes exploding, growing at almost four times the rate it's growing in the US. And that's a very different need on a patient side. You need to therefore be monitoring your health over time. And right now your only real option if you wanna get a checkup is to go into a hospital and wait in line with everyone else and spend about half your day. Now that's not gonna happen. And so what we're trying to do is create a network of convenient places where people can get these health checkups. And we do it by leveraging existing pharmacies and providing them with a two-part solution. One is the rapid diagnostic technology to perform these tests. This is already existing approved diagnostic technology. And the other is our health monitoring software to help them track patients so patients can get their results over time and not just one-off results so they can transform into managing their health. We sometimes get asked why we focus on emerging markets because we're actually a US-incorporated company although we work mainly in Ghana. And it's two main reasons. And I think that is important for the investor side of this discussion. It's growth and opportunity. There's huge growth happening in the population that we serve. And obviously on the disease side when we look to the future, chronic disease is exploding. It is going to be the future of disease all over the world. But in addition to that, we also have the fastest growing middle class. And so we have a lot of opportunity of people that are coming into being able to pay for better healthcare, being able to pay for better education and things like this. Now, we also see huge opportunity. We have a greenfield space. And I think this is a leapfrog opportunity if you will in that disease is becoming much like the rest of the world but we're not burdened by existing infrastructure that was developed in a pre-digital age. So we can look at how can we develop a healthcare system that fully utilizes digital technology and creates something that's much better than anything we have anywhere else. And that's really what we're trying to do at Redbird is create this network of convenient health points that has digital technology as a backbone so that we can create a system that is unlike anything you see in the world, much better, much more convenient for patients but also now can do much more because we don't have all of these entrenched interests that we have to fight against. And so that's what really gets us excited. And to me, it's not a question of why would you invest in emerging market healthcare? It's why would you invest anywhere else? This is the place where you can create something unique. Thanks. Thanks. I have a couple of follow-up questions. So in case it's not abundantly clear, Medic Mobile and Pivot are non-governmental organizations. If you give us money, we're not going to give it back. We probably won't give it back. So, and we operate, our consumers are the extreme poor. And Redbird and Z Valley are going in the for-profit space and if you give them money, they're hoping to give it back to you. So we're in completely different markets but one thing that's in different kinds of problems but one thing that is conspicuously similar and given how widely different our markets are, I would say that we're all totally obsessed with data. And we see that as not the end goal but a really powerful tool and we collect data in different ways and we are constantly envisioning a future for how that data becomes our friend really fast and helps us make decisions at the individual caregiver level, on up to the systems and supply chains and strategy level. And so I just have a question for Redbird. So just to summarize what you're describing as lab in a box where you have all the diagnostic tools at a private pharmacy, those treatments tend not to be overly expensive and then you have software that help people monitor their health, make decisions and you're forming a big network of information. And I'm just like, if you were to dream a little bit but not too much, like predict aspirationally in five years, how is that data actually being used to solve these problems? A great question and something we think a lot about and I think what we focus on at Redbird with our strategy is we see this big term vision that we want to get to where all the potential that you can get from data. And this is our way, our lab in a box is one of the ways that you start creating the groundwork for that because you have to develop that network so that you're generating the data to where it gets useful. And when I look into the future and envision a place where we have been successful and we're getting a real time database of not just disease prevalence, not just how people are managing their disease on a test side, but also potentially how people are trying to improve their health, your exercise regimen, things like this, everything that's involved in health because health is actually holistic. What I see then is a potential to use all of that information in a way that informs care and starts evolving how care is done. We don't wanna go in and say we should be completely changing how care is being done now. We wanna learn through the data that we generate and start getting to a point where the data that you're generating on a daily basis is informing the health policy decisions that are being decided and how we shift how things are viewed on a safety and regulatory standpoint to where you get in a point where you're constantly, you're creating this flywheel of constant learning and evolution on how healthcare is provided, what's viewed as safe and what's viewed as best practice. And that's where I think we wanna get when we think of how can you take a seemingly small step of starting to collect data and network that between everyone and create real incredible systems change. Oh, I'd like to follow that exact question with Diana. So the medical mobile technology is it's basically decision support. It's the decision support in a sense is data driven in the sense that it's based on evidence and WHO guidelines, et cetera of how healthcare workers are supposed to respond to a particular set of diagnostic signals. And we're all still in the space of when do the data start fundamentally changing the way we do our work. And I'm curious what you think the answer is for medic in terms of how the data are gonna be used in the coming years to improve and scale and be used in real time, yeah. Yeah, for sure. So I'll start with how it's being used already right now, which is, and to make the distinction between mobile technology being used as a data collection tool and data as a byproduct of all of these other work support tools. And so that's really how we see data first and foremost, which I think is an important statement is that often people come looking to go into remote communities to just extract data. And that's a very short term type of intervention. So rather we're embedding our tools into the way health workers are working and using the data that naturally comes from that, that's naturally comes from being in service to the health workers to better understand the situations of the communities that they're serving. So already we're making use of the data that's being collected to inform supervision dashboards and Ministry of Health impact indicators that enables primary care district level managers in health systems to make faster and more informed decisions about the communities that they're serving. So this is not only about designing technology tools, it's actually redesigning entire systems who just never before had response systems in place because they've never had access to data so quickly. A paper data system, you'd be lucky if you knew about an outbreak three months after it started and we're able to do much more real time outbreak surveillance and response systems that have actually redefined even power dynamics and roles within healthcare systems. So, you know, medic has been a partner in reimagining what those systems and who needs to be in place in order to do that. It's also increasing the ability for supervisors to better manage these cadres of community health workers and nurses at primary care facilities because you're able to see who's delivering care, you know, for what diagnoses and which health workers have higher levels of burden in certain communities and how we can better resource the distribution of health workers across communities. So that's already happening now. And then we're already really hands on and deepen the process of starting to build data algorithms and predictive algorithms to better identify which children are more likely to have malaria based on, you know, various aspects around where they live, around their, the wealth quintile of their family. So we're building models in that in the very near future are going to be informing the types of suggestions we make to community health workers so that they can better manage their day and serve the communities, targeting the families that are most likely to be in need. Right. Sorry, can I piggyback on that a little bit? Just, I really like some of the stuff you said and one of the things that I heard a while ago that has always stuck with me was, and I didn't realize this, but hurricanes, we all think of them as, you know, something you see coming. That's a somewhat recent development. And the reason that we can track hurricanes and we know, you know, the strength in all this and we actually know kind of where they're forming from the very start of when they form is because we've invested a lot in weather and distributed sensors all around the world that's constantly monitoring and analyzing. And it's a very similar concept that you can start thinking about when you get into better data collection and also distributed diagnostics of why are pandemics something that surprised us. You know, we should be able to tell just like hurricanes from the very start before something even takes off and therefore be able to address it. And I think that's, you know, part of what you were talking about there, which becomes very powerful in the concept that within our lifetime, pandemics are viewed as something that should not be catching us by surprise. Maybe they still happen, but at a much different scale, really I think is an incredible potential on this side. Yeah, speaking about e-health, my approach is kind of will be a little different because, you know, forgive me when I already see things a little bit from my cultural African, you know, point of view. I see my friend's approach as more likely from like companies, you know, coming to address some health issues and gathering data and so I was like, okay, this is extraordinary. This is great what's happening because we have a huge problem in healthcare. They're tackling different aspects of the problem. How can we do it at a national level? How can, I was talking earlier about putting in place, for example, Kaiser approach, but in hospital everything is run on software. Why can't we, for example, develop a national software because the argument that, oh, it's gonna be too expensive, it's gonna be too complicated, it's not possible. That argument doesn't stand anymore. So how can we do, we put in plus an EMR, a national EMR and have the government in a public private partnership get on board and do something like that. That would be amazing. That would be amazing because we can factor all these small experiment that are done because it is important to have the systemic view of it so that we don't replicate a failed approach like the Haiti approach where you have the entire country run by different for-profit, non-profit organization and we all know that we're in the public health sector. So I still strongly believe in the role of government even though we need to help them, we need to accompany them as a company in the public-private relation to show them the right way to do things because everything we're doing here, data is key. Data is it all? Is it gonna come to data? And then 10, 15 years from now, it's gonna be like, okay, wait a minute, okay, whatever data you're collecting from my country, how are you monetizing that? Okay, you see? So smart investors from now that get into PPP, public-private partnership with our government can be advised enough to position themselves as the like, it's so crap, right? Bring meaning to money. So that's exactly my point of view. Like one follow-up on this theme. So one of PIVIT's core businesses is collecting and analyzing data to help us do a better job of what we do and increasingly, that those data are telling a story that we weren't aware of when we started the organization. So we work in a district health system with 200,000 people and we do the infrastructure and human resource support and supply chains stuff. We have a system where we partner with the government to actually eliminate user fees to the extreme poor, which is almost the entire population in this particular district. And even then, even then, there's a really fast drop-off of people who are able to access health centers based on geographic proximity. So folks who live within half a kilometer from a health center comes about three times per year. Folks who live five kilometers from a health center once every two years. Not good enough in a population where one out of seven children die before they're five years old from common illness. So it's kind of a, that's a mystery, right? Why do people whose children have a fatal illness take such a long time or not get care or even when it's five kilometers of a way? And then the question is what can you do about it? And the solution to that, one solution to that is taking things to the community level, community health workers. And the tradition in community health workers in the world is pretty narrowly defined, which is mostly around treating children who are under five for malaria, diarrhea, pneumonia, and some maternal health programs. That's generally the platform. There's some other programs that are done. And so the question that we can start answering now that I do not feel like we had the capability of answering very well, not that long ago, is well, how much more can the community health workers can do? Can you give them a lab in a box so that they can do good diagnostics and reasonable treatment that they're offered tools? Often they're not particularly well educated. They're literate, but they're not professional clinicians. And can modern technology give them the tools to expand the quality of services, the quality and quality of service that they can do in remote areas? So seven year olds aren't dying of malaria. And can the data through these kinds of technologies evaluate whether that's actually working, whether they're getting better care than they would have otherwise? So to me, it does seem like there's a lot of talk about these potential revolutions and in health and digital health. And I haven't seen it to my satisfaction yet, but in terms of like really showing much better care, but it does feel like for the first time that that is actually around the corner, I would say. Yeah. Yeah, and same principles you're doing. Yes, so questions. Yeah. Can you say the name of the organization company? Hi, Alice Lu with, should I stand up, with Empowering Frontline Health Workers. And I wanted to respond to actually several things. I know we, I'll try and keep it short because I want others to speak. So for Jacob's news comments, I totally agree with you. One of the things that we're, that we're approaching it is, our initiative is a private partnership with donor funds, private sector. Primarily our donor funds are from USAID, but we are working closely with the governments to try and support government ownership of the open source health worker training platform that we've implemented and empowering their partners to implement. And I think to get to your point about really looking at the issue systemically, there is a lot of work going on in the global digital health space, if anyone is not as familiar with it, in terms of developing national e-health strategies, national e-health architectures, establishing interoperability standards. So going forward when you think of blending old with the new, I think we'll have this ecosystem that's always gonna be a mix of public and private. But as long as we have these architectures and interoperability standards in place, everyone can do what they think is the right approach for them, but play together so that the data can be exchanged and ultimately at the national level, the governments will have the data they need to make policy decisions, resource allocation decisions and so forth. One other thing I wanted to add is maybe just stretch beyond where we are because I've been in this space for a long time. So I know that we're not gonna stay with paper and pen, we are definitely gonna keep marching forward with digital health, it's going to have the impact, even if maybe there's still some questions about it. I'm thinking about, have we combined this discussion with climate change? And I think of the opportunities to look at climate change data and kind of predict the pandemics or the impacts to health. If we're seeing drought in an area, there's gonna be hunger, it's gonna be malnutrition. And we see the terrible hurricanes or floods, we're gonna see disease coming out of the dirty water that's flowing through. So I'm just wondering if anyone's really kind of looking a little bit further out. I can respond to that. So we are, we're starting, I have like a couple of different trainings and one of them is as an economist but the other is as an ecologist, a disease ecologist. And so what we're doing right now with our data systems is we are, we've mapped our entire district and we know every footpath in the whole district, we've partnered with OpenStreetMap actually to identify the exact walking time it takes to get from one place to another. And so we are going big on geographic information systems so that we know who's getting care, who's not getting care, where they are. And we are right this very moment overlaying that with environmental data, satellite imagery on land use and seasonal climate change, not long-term climate change but weather patterns. And we're using those data to both model the dynamics of malaria. So that's like classic epidemiological modeling is like in some ways it's kind of straightforward to do which are obviously happening seasonally and in places like Madagascar and also model the role of those geographic phenomena, these environmental phenomena on people's access. So what happens is cyclone seasons where the rivers are going up and down. And so the reason why we're doing that is because malaria is a big problem but it's also because we've run into stock outs and we get really upset with ourselves that malaria is surprising us sometimes because it might just come a little bit earlier one year. We do see increasing like cyclone issues and weather patterns that are a little uncommon where we work in Madagascar. And so we are, we're actually going aggressively at that to use the most information that we could possibly have to get exactly when the malaria is hitting so we can anticipate what our stockets are. And so we're hoping to put that into our dashboard. We haven't done it yet but in the next like year and a half or so. That's okay. Hi, my name is Ronnie Dutt and I'd like to speak to the gentleman who was speaking about Africa and the work in collaboration with governments. I think that to strengthen the capacity at the government level is critical to scale and to genuinely improve the overall condition of healthcare in those countries. When I was at Jepago, I was capturing data from 40 different countries across 100 projects and what we don't wanna do is build parallel systems. So we need definitely public-private partnership and you definitely need governments to be willing to scale up and use the newer technologies that are available. So I would really like to hear from more people in the audience about that sort of collaboration because I think that having great pilot projects is excellent but until it scales within a country, you're not gonna see the impact. So it would be, I don't know if they're investors or funders but I think that is the way to proceed in the future. Of course, there are dangers with the government as they monitor then manage the information. So we, and so there is a critical need to have the voice of the NGO community also in the space. But... I'll comment that for what it's worth. We work exclusively with the government. So we work in the government ministry of health hospital, health centers, even the community health workers are technically part of the ministry of health and the information systems that I'm talking about right now are actually government information systems. Did you guys wanna... I can speak briefly to that as well. We have national level government strategies with both Kenya and Nepal and signed agreements with both countries and both of those healthcare systems are decentralized and so it involves us going door to door, district to district, creating relationships with those district health officials which we're doing in both countries. We're close to a dozen in Nepal and are making really good progress in Kenya including having one district who has stepped up to be the model district for the rest of the country and are taking amazing leadership and pride in being the first district to really go digital and design with us as a model building partner. And so that's really exciting. We have a few other countries that are active conversations right now and are in the works but that's definitely where we see our long-term strategy as well and the importance of that being open source and integrated with actually many of the other systems governments are using which are open source. So things like DHIS2 and OpenMRS, other types of national level monitoring systems that we're actively integrating with. Am I getting a signal that we're out of time? Is that what that signal is? Can we take one more question? Okay. My name's Livingstone, I'm from Kampale, Uganda. Let me comment about healthcare from the marketplace angle because I think we might be solving problems but if the marketplace itself is not functioning, we have a problem on our hands and this is what we've seen. We built a micro pension scheme, started on boarding by the time we crossed a thousand members, they were demanding health. So we wanted to provide them healthcare insurance but then it was impossible to provide so because they are making smaller contributions but they have to buy healthcare insurance in bits of policies for one year. And the reason that insurance companies want their money in advance, so you can't insure people that way. So what we found out is that there is quite a disconnect between the healthcare facilities and the companies providing health insurance and then the consumers themselves. So if we're going to be able to serve our clients and open up the healthcare market and collect it, we need to build connections between healthcare, consumers and the insurance company that are providing it. Thereby we can be able to kind of re-engineer, reconnect the dots in between. So we think that if people continue to pay from cash out, cash in pocket and they go to hospital, they don't buy the folder doses because they don't have cash, they never planned for that, that's a huge problem. If we depend on the governments, the government of Uganda is budgeting $2 per person per year. That is not gonna work to be able to fix the problem. So I think we need to focus a lot of our efforts if we're gonna serve healthcare on the marketplace. I think that's my comment. While we're doing the mic, I'll just say thank you for your comment and I agree. I think the exciting thing about healthcare is there are so many players and so a lot of different ways you can try to solve things. Also can become a headache sometimes, trying to figure it all out, but it's great. Hi, my name is Malia and I'm with Digital Medic, which is a group out of Stanford University. We're also trying to use human-centered design and my question is around where do you see the greatest need for real education expertise? Meaning we've created some educational materials for different types of learners in different parts of the world and on different topic areas, including maternal and child health, mostly in that area in South Africa. So where do you see the greatest need? I'll say kind of where my focus is and for me, we do think a lot about chronic disease because chronic disease is exploding, but also it's something that requires behavior change and behavior change is the only way that you can effectively manage your disease and also avoid a lot of the bad outcomes or the disease altogether if you do the behavior change early enough. And so for me, behavior change requires so many things. Where we start, of course, is with helping people manage their health, but that doesn't create it in itself. Even if you know what your blood sugar level is, you need to create these feedback loops of awareness, of understanding of what you're doing and understanding of how that's actually affecting your health because oftentimes how you feel and the actual outcome you have aren't as closely aligned as you would like. And so to me, that is an area that will just increase in importance and education around prevalence, but also how to change your lifestyle, if needed, is a key area. Okay, can I add very, very quick, thank you for what you're doing because you're tapping into my passion right now because what you're speaking to in terms of education, I often say in Africa, in most of our country, we don't have health system. That's my personal point of view. We have disease management system because speaking to health, it's basic. We're not gonna reinvent the wheel. Tell me what you're eating. I can tell you your health status in the next couple of years. Okay, so we can put in place a health system if we want to. So we've been speaking about disease management system. Everything I've been saying, system, this and that, is a disease management system. But talking about health system, why can't we just put educational materials clear in the entire educational system from the kid from pre-K before end of elementary school where the kids know what is a real healthy plate? Let's put those material in place. And then if we teach our kid like that before they finish elementary school, we can, that generation of kids, we can assure that we can reduce like most of those diseases for, I don't know, 50 or 40%. We can do something extraordinary just by teaching what are the fundamental for health. Just starting from pre-K before the kids end school. But are we doing that? No, we are heavily on vertical diseases, funding, where we fight malaria by looking at how much we spend on buying Artemisinin or buying MosquitoNet, while you go to Benin and you work around the country, you know, all the drainage, the sewage drainage for water, everything is open. Like everything, like when it rains, the drainage is completely open all over the country. Talking about Mosquito programs, we invest in billions and we don't talk about that. But we're buying MosquitoNet, okay? We're buying Artemisinin. We have disease management system. So if you're interested in putting in place in Africa, real health system, let's talk. And then I have ideas. Plant-based tall foods. That's what you're going to. I had to say that. I'll just add to that. I think Matt mentioned this earlier in terms of community health worker programs are often focused on a really basic set of maternal and child health services. And that's very quickly changing right now. So we're experimenting with HIV self-tests which are rolling out in Kenya at the moment. Seeing increasing number of family planning services, including injectables being delivered at the home. Malaria rapid diagnostic tests haven't happened for a long time at the home, but we're putting into place more tools within our tools to help diagnose that more accurately and even take snapshots of those tests so that supervisors can be double checking them later. So there's, I think, a lot of opportunity for the task shifting that's happening to the community level where we could be enhancing community health worker training and reinforcement because those consistent in-person trainings are really expensive and they're hard to coordinate. So the more reinforcement we can do over devices they're using all the time is a big win there. Well thanks. Thanks everyone for joining us. It's a big room and it's actually a nice group. So thanks for your questions and thanks to the panelists. Thank you.