mDevelopment: Harnessing Mobile Technology for Global Economic Growth

Thursday, May 10, 2012

Ann Mei Chang, Alex Counts, and Scott C. Ratzan discuss innovative ways mobile technology can be leveraged to foster economic growth, empower women, improve public health, and alleviate poverty.

The Women and Technology Roundtable Series is made possible thanks to the generous support of ExxonMobil.

ISOBEL COLEMAN: Good afternoon. Good afternoon, everyone. We have a really terrific panel today, so we're going to get started a few minutes early to allow us maximum time for discussion. And before we start, we're going to hear from two fantastic women leaders and supporters of the work we've been doing here over the year -- years at the Council on Foreign Relations.

I'm Isobel Coleman. I'm a senior fellow here at CFR. And we have for many years now had a wonderful partnership with Exxon Mobil to focus on women and technology. And this meeting today, m- development for global economic growth, is part of that series.

And we've touched upon lots of different topics in the course of our working relationship with Exxon Mobil, and we've had everyone from Bob Zoellick talking about the central role of women in development to people speaking about microfinance and the role that women play and can play in economic growth.

And in recent years, we've focused a lot on the mobile sector, which has such enormous potential for really transformational change in so many different ways. And women, as we know, have lagged in terms of access to mobile technology. In fact, the Cherie Blair Foundation did a report last year quantifying that gap. And in some countries, women -- anywhere between 20 and almost 40 percent less access than men to mobile technology. But we know that when they do get access, it can really be a very transformational change.

So, we're going to hear more about that. But first I'd like to just introduce Suzanne McCarron, who's the head of the ExxonMobil Foundation, and then also Cherie Blair herself who's going to come up and make a few remarks about their new report, which is just out. And it is available for all of you, "Mobile Value-Added Services of Business Growth Opportunity for Women Entrepreneurs." So I hope you will take a copy of that with you.

And as you know, Cherie Blair, former first lady of the United Kingdom, a wonderful champion of women's rights and human rights for many years, but also has been the founder of the Cherie Blair Foundation in 2008, which is really focused on women's economic opportunities and this whole issue of access to mobile technologies.

So we're going to have a great discussion. Let me welcome Suzanne McCarron first. Thank you.


SUZANNE MCCARRON: Good afternoon, everyone.

Thank you, Isobel, for that kind introduction.

Before we dive in, I just want to spend a couple of minutes talking about why Exxon Mobil is sponsoring this series and why we're so interested in women's economic opportunity. A couple of you have already asked me, what does an oil company have to do with women's economic opportunities? So I'd like to talk a little bit about that.

You all know energy is found in some pretty challenging places sometimes. And we see political instability in some countries. We see huge infrastructure needs related to health, education, et cetera. And so if you think about our business model, what we're trying to do in these different countries around the world, we typically go in with a contract with a government to develop that country's natural resources. So to be successful at that, it's extremely important that we're considered to be a valued partner and that we are contributing to economic development.

Now, how we do that takes a variety of different forms. But it begins with how you structure your business in a country and, first and most importantly, is the provision of jobs to local citizens. And in some countries, you know -- for example, we're in Papua New Guinea right now -- we are having to do very large-scale training programs, just so that people can be qualified to apply for those positions and we are very much targeting young women there.

Second, though and very importantly, is the contribution you make to the local supply base. So that means using local suppliers, looking at women-owned companies where you can, but also very critically, in some cases, actually building the capacity of local companies so that they can actually compete for the large-scale contracts -- you know, billions of dollars of contracts in the energy sector.

We just had a great example in Nigeria where, for the first time, we had offshore platforms and all the technology that goes into that built by a Nigerian company.

We helped them do that.

So economic development generally is a fundamental value proposition that we offer governments and communities, and that brings me really to why we think investing in women is so important. And the reason is, quite frankly, a few years ago, we had folks like the Council on Foreign Relations, the U.N. Foundation and others come to us with the research. And the reseach essentially, as you know, shows that any additional income a woman is going to get, the reality is that she will probably take that, invest it in her family, and that's going to have these very significant multiplier benefits for her children and for the community. And so it's for that reason, in 2005, we launched what we call our Women's Economic Opportunity Initiative. We've invested about 53 million (dollars) so far, and I will tell you, of the 273 million (dollars) for the foundation, I mean, it is the fastest-growing program.

While the evidence is there on supporting women in terms of the multiplier impacts, et cetera, we do think there's more work to do on understanding and researching the different kinds of interventions in the Women's Economic Opportunity space to see what is most effective. We also think there's more to learn in terms of how to best structure interventions.

So we made the decision early on to put more of our budget into research so that we can understand what works best to inform not only our own spending going forward, but to serve as a resource for other funders in this area. This dialogue is very much a part of that building of understanding. And you're going to hear very shortly from Cherie Blair about a new research project on mobile phone value-added services that we are working on with them.

I think this is a classic example of building the knowledge base of interventions for women's economic opportunity.

Now, based on the initial findings, we are prepared to fund pilot projects in three different countries, in Nigeria, Indonesia and Egypt. And let me just say that we are so pleased to be here, to have this discussion to today, to look at this issue in much more depth.

I will leave it at that. And I will be very pleased now to hand the discussion over to Ms. Cherie Blair. Thank you very much. (Applause.)

CHERIE BLAIR: Well, thank you, Suzanne, for all you've said and for your personal commitment, and ExxonMobil of course, to this space. And thank you, Isobel, for having me back again here on the Council on Foreign Relations. I am so delighted that we are able to launch our new report and -- please -- they're going like hotcakes. Please grab yours now -- Mobile Services for Women Entrepreneurs.

Now more than ever, mobile technology is defining every aspect of our life: the way we communicate, how we conduct business, how we socialize, and actually, to a greater extent, what we are able to do. Now, I'm a working mother of four and a self-confessed techie. And I am absolutely convinced of the benefits that mobile technology has brought to my life. And I've also seen for myself the amazing affect it has on others, whether it's in developing and emerging markets, but in particular for women in those markets.

And we're going to hear a bit more in the discussion about that. In this ever-changing environment, mobile technology can be literally transformational to women who have that entrepreneurial flair, but they have the lack of tools and support to actually put that flair to work.

For example, Lilian, who's one of the women entrepreneurs supported by my foundation in Kenya -- she used to keep the cash from her business under her bed. She didn't have a bank account, and she was under constant threat of course of losing that money to theft. Since taking part in our program, she now uses a mobile phone to transfer her funds into a savings account, and she can distribute her goods via her phone. So Lilian's story is an inspirational one about how the mobile phone has helped her really take her business to the next stage, and we want to understand how mobile value-added services can actually do that for other women and women-led businesses and increase their household income.

And that's why with the ExxonMobil Foundation and Booz & Co., we developed a project to research mobile value-added services for women entrepreneurs, but today, beyond that, as Suzanne has said, to actually then put our money where our mouth is and implement our findings on the ground and follow that through with an impact assessment on the results. So we have now completed the first phase, which is the report, "Mobile Value-Added Services: A Business Growth Opportunity for Women Entrepreneurs." But that's only the beginning.

The report is a culmination of research across three countries: Egypt, Indonesia and Nigeria. And we found that microentrepreneurs offer the biggest opportunity for adoption of mobile value-added services. They represent 98 percent of entrepreneurial activity in these three countries, and microenterprises account for 38 percent of GDP on average and include an estimated 32 million women across the three countries.

In our on-the-ground survey of over 300 women entrepreneurs, we found there were common business challenges across all sectors, including a lack of access to digital channels, affordable resources and marketplaces. One woman who was interviewed suggested she needed a service where she could advertise her business using SMS so that actually she could get in new customers and grow her business. On average, 94 percent of the respondents believed that addressing their most relevant business challenges would increase the value of their business, and 50 percent believed that would be in a significant way.

Elizabeth Tinunbu in Lagos, Nigeria, started a toy store business just to generate income for her family. But she was good, and demand for her products grew, and now she employs three other people. But Elizabeth wants to do more. She wants to expand her business, but she can't find proper distribution channels that allow for growth nor can she source for materials that she needs.

We believe that the mobile phone value-added services can actually provide information and business knowledge which Elizabeth needs to overcome these challenges. And the report demonstrates the enormous commercial potential that exists for mobile services to actually meet the needs of women entrepreneurs. The private sector is an integral part -- partner in our effort to promote women's financial independence, and actually this report shows how exciting this potential for partnership is.

So our challenge now is to implement and then test these solutions with mobile phone operators, with handset manufacturers and with other partners. And I hope that some of those partners could be here in this room today, that you will join with us in this initiative, and we would and do relish this opportunity to start this discussion on how we can take this report and make it really happen on the ground. Thank you.


COLEMAN: So I think that's a great way to jump into this topic. And we have three terrific panelists who, each in their own way, are playing a very important role in this space of mobile technology for development from the health angle, from a savings and finance angle, from an access angle, from all different -- to my immediate left is Alex Counts who had about a decade of experience in the microfinance world before founding the Grameen Foundation in 1997. And he's been the CEO of that organization, which he has built into a real powerhouse of global philanthropy around the world today.

And so thank you for being here, Alex. And as you know, Grameen is involved in many different aspects of this mobile issue.

Ann Mei Chang, who is the Franklin Fellow -- and I encourage all of you to learn about the Franklin Fellowship; it's really interesting, but it takes midcareer and more senior people out of industry and gives them a year at -- in government -- and Ann Mei Chang is spending a year with the State Department as an adviser for women and technology at the Office of Global Women's Issues at the State Department. And she's on leave from Google, where she was the senior engineering director for their emerging markets businesses, which, under her watch, she grew into a billion-dollar business. So thank you for being here.

And last we have Scott Ratzan, who is a vice president for global health at Johnson & Johnson, which is involved in, again, all interesting parts of this mobile technology for mHealth.

So thank you all for being here.

Actually, I thought, Ann Mei, we would start with you, and your work in the State Department is focused very much on this whole question of access. And as we've heard, there's an enormous opportunity for providing people with access to mobile technology for all sorts of productive activities. And yet, in some countries, the access for women is much lower than it is for men, and your focus has really, over the past year at the State Department, been looking at those issues. Maybe you could tell us a little bit about some of those access challenges and how you're thinking about resolving them.

ANN MEI CHANG: Absolutely.

You know, first of all, as we've heard from Cherie and others, ICT is absolutely a huge opportunity in the developing world. ICT has the ability to enable businesses to be far more productive and efficient, whether it's a small business or a large business. It has the ability to open new markets, whether local markets or markets abroad, and it has the ability to create new types of well-paying jobs in the IT sector. And not only from a pure economic standpoint, but ICT also opens up opportunities for education to access information and to inspire people to drive new innovations, which can really transform business models. So ICT is an absolutely essential and enormously powerful tool in this day and age.

The problem is that women are really being left behind. As been -- has been referenced, the Cherie Blair Foundation and the GSMA had a seminal report come out a couple years ago that showed a gender gap of 21 percent. Fewer women have access to mobile phones than men in low- and middle-income countries. The reality is, as bad as that is, when it comes to the Internet, which I believe is even a more powerful driver of economic growth and opportunity, it looks like the gender gap is probably twice as large, probably 40 percent. There's some data from the (ITU ?) from 2008, which is a little dated, but showing that in countries in Africa, men had twice as much access to the Internet as women did. And if you just look today at Facebook data -- and Facebook is the most popular application being used in many developing countries today -- in Africa, 40 percent fewer women are accessing Facebook than men, whereas in developed countries, the numbers are largely at parity.

So there's a huge gap there and --

COLEMAN (?): What are some of the reasons for that gap?

CHANG: Yeah, so if you look at the reasons for the gap, there's a number of them, and it depends on the country and on the situation of each individual.

One of the big drivers for the gap is affordability. When it comes to Internet in particular, Internet access is still extremely expensive in many countries, where it's considered a luxury good. And as a luxury good, women who have fewer financial resources and less control over the financial resources that they do have are not able to access it.

Cultural barriers are also significant, especially in Muslim countries, where there's an association, both with mobile and with the Internet, with the idea of promiscuity. You know, husbands or brothers or fathers are concerned that if the women and girls in their lives have access to mobile phones or the Internet, that they will become promiscuous. And so they don't want them to have access, even though there's a lot of other benefits. So there's a lot of fear around that.

COLEMAN: Yeah, and I've seen some studies that show that when asked why they don't have mobile phones, something like 74 percent of married women say, because my husband doesn't want me to. Is that right?

CHANG: Absolutely, yeah. Yeah, and there's many other barriers. I think there's lack of technical literacy and familiarity with the technology and the opportunities it can provide. There's lack of just literacy in general. Women's literacy rates are lower. It makes it much harder for them to take advantage of the Internet.

COLEMAN: Alex, Grameen -- I think of Grameen 1.0 is being microfinance and Grameen 2.0 as being the telephone ladies.


COLEMAN: In my mind, that's how I think of Grameen. Grameen has played a very central role in expanding access to women of -- for mobile technology and creating a business around it too. Could you tell us a little bit about the history there and how -- the role that Grameen has played and how you're thinking about this technology moving forward?

COUNTS: Sure. Well, first of all, it'd be appropriate to start this meeting to ask of all of you to please turn your cellphones on -- (laughter) -- as many, many people are doing around the world.

Grameen -- so Grameen Foundation was started 15 years ago. It was started right at the time where Grameenphone was being launched in Bangladesh. Grameen was joined with Telenor from Norway, and that turned out to be -- many of the people involved in it thought it was going to be a tiny little company with -- serving a very small elite at the top of Bangladesh and maybe a few village women having a payphone. It turned out to the biggest employer; the biggest taxpayer; the biggest, most profitable country in the history of Bangladesh. And we, seeing that, Grameen Foundation -- we partnered with McCaw, one of the innovators in mobile phones here in the U.S., to start something called Grameen Technology Center in 2001.

So we've been at this for 11 years trying to leverage mobile phones as a tool for empowerment of the poor and poor women and we've learned a lot. And if I had to summarize it in a couple of -- a couple of ideas, one is that the mobile phone is no silver -- kind of silver bullet, and -- but it does potentially change the economics around bringing information the last mile to the poor in some domains that really matter to them, that'll help them make better decisions. Decisions around their health, business, searching for jobs, agriculture -- the list goes on. We've tried to work in -- through these areas that I'll talk about.

It also creates an opportunity to capture information about the poor in that last mile so that policymakers and businesses, that want to do business with the poor, can actually have timely information about who's growing what, who needs what, what -- where are the health crises that need to be solved, the epidemics outbreaking. And so both that knowledge and that information delivery and capture is made much, much more economical when you have affordable phones in people's hands.

And we also see that the job of doing that intermediation at the grass-roots level, with the phone capturing and delivering information, can be done by poor people and poor women as a business, without any kind of ongoing support, long-term support from either government or the aid industry, right? This can be a -- the business can be done -- can be done with -- as information brokers at the village level. And we've seen that. We have experience with that.

But this isn't going to happen automatically. There are literacy issues. There are discoverability issues that go on. It really takes people sitting down, writing applications, figuring out what can be done on very basic phones, which people have. It takes developing partnerships, as we've seen in the mobile financial services between banks and technology providers. This isn't going to happen without a conscious effort, but the potential is huge.

COLEMAN: And you've been actually realizing that potential in various places around the world. I know you've got a very successful program in Indonesia, and Indonesia maybe is a little unique in that it's got such concentrated population and very, very high cellphone penetration. I think it's over 80 percent. But you've got a whole microfranchising system there. Maybe tell us a little bit about that.

COUNTS: Sure. Well, we -- the village phone operator, the -- who you mentioned -- we first brought that to Uganda and brought 80,000 women as pay-phone operators, and that -- then take its own course. We've brought that to Indonesia, and we began to set up women as a phone operator. But that business model started to collapse because everyone was getting their own phone.

So the shared-access model -- so what we said is, let's develop some -- let's, rather than fight against the tide, we partner with a new organization that was set up specifically for this purpose, Indonesian organization, and we said, what application for them can really work quickly to get them some cash flow, women entrepreneurs, of which 64 percent, when they were earning under a dollar a day when they started at this business -- and we said that the killer app we found was actually airtime resales, right?

So sitting in the village, a lot of Indonesians want to buy airtime in increments of as little as 10 cents, and they want to do it close to their home. They don't have to walk into town for it.

So we set up now 10,000 women who are basically doing that. They have an application in their phone. They can -- someone gives them 10 cents, they give them 10 cents (sic), and they get a commission.

What we've found is within three months those women, on average, were able to double their income, earning about $1.10 per day in the commissions on airtime sales. So that's having an immediate benefit on the -- on those women.

And what we're now rolling out, given that that's the subsidy -- you know, again, it's working as a business now -- is to roll out -- we're -- a new application there, these same 10,000 women and growing, who are -- kind of a kind job matching through the phone, where they earn a commission if someone is placed in a job. And also there's a kind of a modified eBay-type thing which has been developed for the Indonesian market that'll be accessible on these phones, and also a mobile survey tool, so if companies and government and other -- want to -- want to get a quick survey in a certain part of the area -- and we're not nationwide yet -- about whether -- what -- people's opinions or what people are growing or their -- kind of trends in terms of births and deaths, we can actually contract that out to these women, they can upload that information on their phone into a central database, instantaneously, when they do the survey, and get paid for it.

But again, we start off with something very simple but profitable, but now we're moving -- and we've -- the company that we helped set up that is running this, with us in the background, is now attracting venture capital investment from the U.S.

COLEMAN: Scott, mHealth has enormous buzz and a lot of hope for really being a vector to change health outcomes in developing countries.

J&J has been involved with MAMA, the Mobile -- what is it -- Mobile Alliance for Maternal Action, which I know is a public-private partnership with the U.S. government. Can you tell us a little bit about that and how it's playing out?

SCOTT RATZAN: Sure. And thank you, Isobel, and thanks for all of you for coming today and having this great focus. I think it's great to hear women in technology with not only the empowerment that Cherie had mentioned, but really to address this digital divide and the mobile divide that we're seeing.

So I would say at Johnson & Johnson, we're really proud to be able to reach people, what we say, caring for the world 1 percent at a time. And one way that we've been looking at this is the use of mobile phones. And before I joined Johnson & Johnson -- I say this 10 years ago -- I was with the U.S. government at USAID. And we used to say that less than half the world's population had ever made a phone call -- not had ever owned a phone, had ever made a phone call.

And here we are 10 years later, and we have more phones and more devices in this room than we have wristwatches. We have more people who are probably more addicted to their phone, if I can say, or their mobile device than anything else. So how do we come up with the affinity that gives women the opportunity, in many cases, to make the best decisions during their most precious time, during pregnancy and childbirth?

So we spoke with the U.S. State Department, basically through the work of -- following the great work of mWomen, to launch MAMA, the Mobile Alliance for Maternal Action, about a year ago with Secretary Clinton and our CEO at Johnson & Johnson, with the U.N. Foundation's Mobile Health Alliance, tying into some of these broader efforts of the Every Woman Every Child work from the U.N. secretary-general's office. But here everybody has been talking about mobile phones, but how can we actually demonstrate the value?

And what we've designed thus far is the opportunity for women -- currently in Bangladesh, next month in South Africa, following this year in India, with our goal to reach 120 million women over the next six years, with information at the time that they can use.

So they're getting, in some cases, an SMS message.

In other cases we're finding -- with literacy levels in Bangladesh, for example -- that we need to use a voice recognition, a voice that's not only in local languages but local voices, literacy level, the amount of time. And we're finding some good data thus far of the early opportunities and stickiness that women are using this as sometimes their only source of health information. And in many cases, we're looking at how this is empowering women to seek health care from providers, other times to make decisions themselves, and other times to work amongst the community.

At the same time, we're building on what we learned from the U.S. experience that we had with text4baby, which was launched with the Office of Science and Technology Policy, the White House, with Health Mothers, Healthy Babies, which is another 700-plus partnership coalition. And just this month World Health Organization's bulletin mentions it as one of the largest efforts, but yet the point in the article says that it's not fully evaluated.

However, we're finding some very good data that is showing that women are going for their flu vaccinations -- very important here in the United States during pregnancy. And we also have launched it in Russia, again with both governments as well, with the idea -- as 40 percent of pregnant women smoke in Russia, so there's some smoking cessation pieces there.

So in all cases we're trying to identify a public health issue and figure out ways where the mobile health environment can help people and build a long-term health literacy.

COLEMAN: So it -- clearly it's very easy to understand how it can help on the demand side. But what, if anything, can it do on the supply side?

RATZAN: Well, as we heard earlier, Alex and others have been talking about what it works -- how it works with community health workers and sentinel sites. And lots of people are doing work in that area.

We're working with both -- through the work of this United Nations' Innovation Working Group and others to try to get this information in a way that people can use on a broad scale. So our linkage with the United Nations Foundation has given this information, these text messages -- free of charge, open access -- that people can use and adapt. And right now 22 countries, from Afghanistan to Zambia, have started to use this to create the messages, to create the algorithms, to make this such a good global public good.

And I would say everything that we do at Johnson & Johnson, we do in partnership. And each of these cases is with governments; it's with nongovernmental organizations-- and so people on the ground that understand the consumer or the patient or the woman or the male partner that gets the information at the right time. So we're trying to work on all parts of the supply chain as you ask.

COLEMAN: So if I get a -- if I'm a pregnant woman in Bangladesh and I get a text message saying, you need a tetanus shot -- or to deliver the baby, you need a tetanus shot, is there a way to connect it to a provider of tetanus shots?

RATZAN: Well, it's a great question, and I don't know the exact answer in Bangladesh with supply chains or vaccines. But I can say in the United States what we've been very fortunate to do -- with the help also, shall I say, of the CTIA, which is the wireless association as well as a whole variety of groups -- that we can connect people with their local WIC or the local provider. And HRSA, the Health Resource Service Administration (sic), has a full-scale large evaluation of this project. CMS also has signed on to get women and children enrolled in health insurance that they're eligible for.

And all this as we've worked through the technology -- the technology issues are not the issues. Frankly, the issues are, how do we make certain that women get access to the information so they do the 511, 311, and get it from their state or local or county health department or local clinic or a local provider? Because all of these safety net mechanisms are in place in this country. People just aren't using them enough.

COLEMAN: Ann Mei, you have written about the potential of ICT to help women around the world -- in this country, but also in developing countries -- create jobs. Can you talk a little bit about that?

CHANG: Yeah, I think that, you know, ICT around the world is one of the fastest-growing fields and one of the most lucrative fields. There's an interesting study that came out as part of the World Bank Women in Development report this year that showed that although there is certainly a wage gap between men and women who work in the same job, the bigger factor in the wage gap between men and women is the sectors that women choose to go into. Women end up choosing education, health care and so forth and not higher-paying fields such as in ICT.

And I think that what's really interesting is in the developing world, the ICT sector is just forming today. And so we have an opportunity to really reshape the image of the ICT sector to be gender neutral and not to be a male-dominated field. There's a lot of characteristics about the ICT sector that are actually quite suited to women's lives. The fact that you can have a flexible location for doing your work, you can have flexible hours often for doing your work really suits a lot of women's constraints where they may need to be at the home and have duties at the home at the same time. And so I think it's a match that is ideal and that we should really pursue.

One really innovative approach to this at the bottom of the pyramid has been this idea of digital microwork. So this is the idea of taking from large multinational companies the huge pile of digital microwork that they are now building up -- this is things like data entry, image tagging, things like that -- that don't require a deep level of education but require a lot of manual labor. And there's an opportunity to parse out that work, essentially, to women in the developing world.

Samasource has been one leader in this regard.

And this -- Secretary Clinton just rewarded (sic) the Secretary's Innovation Award to Samasource for the work that they're doing in Kenya.

And the results have been very, very promising. Women who were making less than $2 a day have been able to double or triple their incomes by doing this digital microwork. And that's not the end of it. Once they start doing this work, having much more familiarity with technology and having -- becoming much more skilled in using technology, there's a lot more opportunities that open up for them beyond that.

COLEMAN: Alex, you mentioned data collection as a really important component now of the spread of mobile technology. Can you speak a little bit more about that? Because it is intriguing to think that now you can get real-time data back on not only goods and services and surveys but also on poverty alleviation -- what works and what doesn't. And I think we know from a lot of studies that a lot of stuff we thinks works really doesn't, or works in different ways than we think it does. So what are you finding?

COUNTS: Yeah, I think there's an enormous ability both to test with what works and also to provide data, as I mentioned earlier, to government agencies and companies that want to do better by the poor but just don't have the -- don't have the information. And in fact, an IFC report that came out about one of the biggest barrier (sic) to the bottom- of-the-pyramid thesis in doing business with the poor, incorporating in value change is lack of information about the poor -- current, actionable information.

And so we just -- I'll tell you a little story. When we in Uganda began to go from village phone operators to what we now call community knowledge workers, working with Google and MTN and others, what we did is, we developed -- we figured out the thousand questions that Ugandan farmers most ask and then we got experts to vet what the right answers were and put it into a database you could get from not -- a nonsmartphone, a feature phone.

And that's its own story, but we said, are we going to the charge the farmers for this? What's the business model around it? So we said, well, we'll just start doing it and see.

And we -- when we were -- when we were providing this information and when we -- first time we ever would talk to a farmer -- now it's 68,000 and counting -- we would do a little intake survey about just basic things about their farm and their family and this tool, this -- we call the Progress Out of Poverty Index, which is a very simple but sophisticated tool of measuring movements around, to and above the poverty line.

And what realized very quickly was -- is that information and the ability -- and the -- and the capacity, with resurveys, to build on it, there were a lot of organizations -- commercial, governmental, international -- in Uganda that were willing to pay us for it, and we could pay the enumerators, the community knowledge workers.

Just one example: A brewery in Kampala wanted to know -- they wanted to build in small-scale subsistent barley growers into their value chain, but they didn't know where they were, who was producing, who was having a good yield. Well, we were able to produce that to them at a fraction of what they'd ever paid for that information, and often they wouldn't have the information.

So that -- and we've actually, two years into this program, have earned more than a million dollars in income, which then we, as Grameen -- (inaudible) -- Foundation, share with the community knowledge workers and has made for a sustainable business model. And that agricultural extension can be provided for free, as long as that continues. And a lot of these are now monthly surveys they do, so it's not a one-shot type of thing, people hiring us out for that.

So there's enormous potential there in employing lots of poor people to get data to and from other poor people, and to do it as a business.

The other thing we're doing in Ghana -- and it goes to this mHealth thing I'll just mention briefly -- we have a mobile midwife program, which, just like you were saying, you register 14,000 mothers to get reminders about things that they should be doing as they get -- you know, prepare to give birth.

Interestingly, there are a lot of mothers who get a single message and can opt-in for secondary and tertiary messages -- more than half do.

But what's interesting about that, is that, again, that the intake of these women using a phone and using a menu that's on the Ghana health service nurse's phone -- they basically upload information about the women right in the field into a central database that can be used by any authorized user in the government up and down, including some future clinic that woman may visit. So through the use of mobile phones, for under a hundred dollars, we're creating medical records -- digital medical records for the poor women of Ghana that will probably be farther along than we are in the United States within a few months.

And so there are real issues -- I mean, you talk about the supply side -- but there's a lot of resources out there in the communities that -- they're not what they should be, but people don't get at them; or you show up at a health clinic different from what -- that doesn't have the service because no one told you that you should go to this one; or you go to a different one, but they don't have your medical record and you can't explain your medical history. Well, if it's all in a central database uploaded on the site by a Ghana health service nurse, that's exciting.

And one other little piece I just read preparing for this is that the Ghana health service nurses that we work with usually spend four days a month writing reports about everything they've done in the month, which I'm sure no one ever reads. Right now, the intake and the work they do on their phone in the field means that those reports do not need to be written at all. Those reports happen automatically.

And so that -- the savings of time of that and the fact that they're all accessible by any authorized user in the whole Ghana health service, that's -- that information, again, they're -- and I think that access to that information will drive -- and the analysis that can be done by policymakers -- and there's a real accountability for health outcomes that wouldn't necessarily have if you didn't have that real-time data -- I think that'll help drive, supply better information about what's actually happening.

COLEMAN: And Scott, J&J has been interested in noncommunicable diseases also --

RATZAN: Mmm hmm. (Affirmative.)

COLEMAN: -- and I would imagine that these type of data collection would be very useful for that.

RATZAN: Well, it's good to hear that. And frankly, I think we all are interested in noncommunicable diseases by virtue of the fact that the United Nations got together last year -- only twice in the history on health issues: One, it was on HIV/AIDS, and last year it was on noncommunicable diseases.

And as the world has an aging population, as we've been able to have, frankly, some successes in infectious disease, we're seeing noncommunicable diseases -- those that are -- the diabetes, the chronic obstructive pulmonary diseases, those related to cancers and other cardiovascular diseases -- being 75 percent of avoidable or preventable deaths.

So the industry was invited to participate in an innovative way during the United Nations meeting. In Johnson & Johnson (rows ?)-- that we were, one, representing industry at the U.N. piece, but also said, what can we do that would be a little bit different and how can we harness the power of the new technologies? And as such, we came up with this idea of a digital health scorecard, or something we're calling Score My Health, that we've both spoken there and will be speaking later this month at the World Health Assembly, which basically, through a very small algorithm of do you know your blood sugar; your cholesterol; yes or no on smoking; your blood pressure; simple computation on BMI; and if you have had the appropriate screening for cancer; and for giving your immunization.

So you take that, you tailor it, and I bet everyone in the room doesn't know all their numbers and doesn't know their score, which means, one, here's some preventative services you can garner or, two, you can gauge what you need to discuss with your physician or health care provider or family member. Very simple tool; could be done on, you know, anything from the electronic end. But the ideas behind this are, how can we then help people get information that's proven?

So if you -- the simplest thing is if you answer, yes, I smoke, the National Cancer Institute had -- has one of the great "quick text now," with a proven algorithm that's being used to help people stop smoking. You can easily get that through a low-cost intervention, make some -- make some headway.

So we think there's a lot of hope and promise by using these technologies that are consumer-facing, that are helping people at the time of need and helping build an overall focus on health and well- being. And that's where I think the NCD space fits right now.

COLEMAN: Open to your questions now. If you would, raise your hand and get my attention. And then there are microphones, if you could just wait for the microphone and stand and introduce yourself and ask a succinct question -- that would be great.

We'll start with Binta.

QUESTIONER: Hi, good afternoon, Binta Brown, Kirkland & Ellis.

Hi, Alex.

COUNTS: Hey there.

QUESTIONER: We served on a board together.

So here's my question: We've heard about it in terms of health, a little bit in terms of business opportunities. One of the things I'm particularly interested in is the impact mobile telephony and access can have on rule of law.

One of the things I'm particularly interested in is the impact mobile telephony and access can have on rule of law. It's a different kind of access to information, right?

There are some jurisdictions where governments are passing laws that are helpful to the populations, particularly women who live in those countries, but they have absolutely no sense of what their rights are. So if we could have a conversation around that.

CHANG: I'm not an expert in this space, but I do know that there's a lot of work being to -- and there's a lot of successes that we've seen with leveraging mobile phones to enforce rule of law.

One has been in monitoring elections. And I don't remember what country this was in, but -- was it Kenya where they took the mobile phones to, like, report immediately the election results from each precinct as the ballots were counted? And they discovered that the -- that the places where they did that, they actually -- there was much, much less discrepancy in terms of, you know, voter fraud because it was very timely, so there wasn't time for people to sort of mess with the numbers. So that's one great opportunity.

There's also the Open Government Initiative through the U.S. State Department that when many governments have come together and made commitments to open up more and more data to citizens, so that citizens can understand what's happening with government, which laws are being considered and so forth. And that type of transparency, I think, is something that is new and is -- has huge potential to really reinforce democracy.

COUNTS: Please --


COUNTS: The forerunner of what we're doing now that didn't pan out because the economics of it but it shows possibilities is something we call the village computing program. And what was interesting -- the e-governance possibilities there that I think -- again, on the phone -- we had a case in southern India where a -- what we call the district collector, I think, the most senior civil servant was really clean, good government type, but he had difficulty knowing what corruption was going on under him.

And so we set up a number of things, just simple emails that went directly to him from people from our kiosks if they were being bribe solicited -- could be anonymous, could not be -- forms that could be downloaded that previously had to be done for -- and printed out right there that would be done all sorts of bribes and run around and so forth. And so I think there's a lot of possibility there.

When Grameenphone also was launched in Bangladesh originally, the village phone operator, who was again at that time a community phone operator, got a list of phone numbers with the phone. And first one was office of the prime minister, office of the minister of justice, you know, the local -- and basically -- you know, and they were just told, you know, you should feel free to use these numbers.

And there were -- there were a lot of cases -- no one studied it comprehensively -- where just the knowledge that that was there -- and I wouldn't have wanted to be the -- switchboard operator at the prime minister's office when they rolled this out, but where people said, you know, the local government was not providing the service. And people said, well, I'm going to call through the village phone operator. I'm going to start calling government officials until someone kind of calls you to account for it. And you'd be surprised; there were quite a number of cases where people then delivered the service.

COLEMAN: Maybe that's where Bloomberg got the idea. (Laughter.)


QUESTIONER: Thanks, Isobel. My name is Craig Charney. I run a firm, Charney Research, that does polling and market research in emerging markets. And I want to just ask you to speak a little bit more about the issues relating to the gender gap here.

We've done work in parts of Pakistan, for example, that shows that in many households women are not even allowed to listen to the radio, let alone use telephones, because in your conversations, particularly Ms. Chang, about women, you've talked about them so far as though they are individuals, whereas in fact almost always they are in households.

And likewise, the other question I would ask is in relation to literacy, where the doubled male rate of access to the Internet would also appear to mirror almost exactly the male and female literacy statistics in places like Pakistan. So I'm wondering what is being done or what are you trying to do, if anything, to improve women's access to technology and their ability to use it.

CHANG: Yeah, thanks. It's an excellent question. Unfortunately, there's no easy solutions for many of these things. I know many, many people are working on literacy. But the reality is -- let me just take sort of each of the different components to this. In the realm of literacy -- there's many, many people working on literacy around the world. It's a huge problem and a huge challenge, and I think we're starting to make some headway there.

The reality, though, is that in the developing world, there are far more women who are literate than are actually getting on mobile phones. So we're not -- we're not hitting the -- we're not hitting the literacy barrier yet. In Africa, it's -- for example, for Internet access, it's less than 10 percent of people who have access. There's a far greater number of women who are literate than that.

So I don't think that's the barrier we're hitting yet. It will be a barrier we hit as we get broader penetration.

When it comes to cultural issues, I absolutely agree. It's a family system. Cultural issues are very, very hard to get beyond. There's some -- the cultural issues come to play in a number of ways. So, one is just in terms of women purchasing a phone. Often it can be uncomfortable for a woman to go to purchase a phone from a store where a man is there, or she's unable to travel by herself, or whatever.

So there's been some innovative programs coming out such as in Qatar with Vodafone, having women actually go door to door or have sort of, like, Tupperware-like parties essentially. They have these brand new kind of red suitcases that they bring to within the household where women can come together in the safety of the home with other women, be able to learn about and purchase mobile phones.

So things like that are making it a little easier for women to actually obtain the phone, but there's still the issue of the culture within the household, and that's a much harder one to shift. I know there's lots of people working on that kind of thing, and part of it is actually showing the value that you get from the phone, right? So it's hard to change the sort of negative barriers without sort of creating much more positive reasons.

So, if it means women can, you know, get on the Internet, they can bring income into the home, that may be something that helps, or if it means that they can be more effective in kind of managing the household. So, I think that that positive side of things is also very important.

The other piece I talked about is affordability, which I think is also a barrier. And that's one I am actively working on at the State Department, and working across the public sector, private sector and civil society to look at ways that we can help, because many of the issues around affordability are really due to market failures, where there isn't sufficient competition through the whole value chain, or where the cost structure of the industry is just too high because of luxury taxes or lack of shared infrastructure and so forth.

So, those are areas where we actually can work with regulators and foreign governments and the private sector to try to shift how some of these services are being delivered and how the markets are working, so that prices drop precipitously. And I think if prices drop precipitously, as we've seen with mobile phones, I think access to the Internet will also -- the gender gap will also start equalizing.

COLEMAN: I just want to add, there was an interesting statistic, which I think was from the Cherie Blair Foundation report last year, that showed that women who own mobile phones in developing countries and many emerging markets, they spend less on their phone than do men, which you may think makes them a less attractive customer, but they have much greater retention rates. Their loyalty rates are much higher.

So, over the lifetime value of the customer, they're a much more valuable customer than men. And when that research is presented to mobile companies, then they get -- a light bulb goes off: Oh, we need to really focus on women as a segment.

And to your point, Ann Mei, there are examples, like Roshan in Afghanistan had a whole marketing program to women that failed because men were very suspicious, and ultimately they're the gatekeepers. Then they switched it and they marketed the cell phone to men for the women, very much playing up the angle of what's the benefit? You know, you can keep tabs on where they are. (Laughter.)

You can -- but, very seriously, the life-saving potential of it, you know, that women who are -- you know, have a security risk, or in childbirth, a medical emergency, any of these types of things. And they saw their penetration rates go way, way up. So, they're not insurmountable challenges, although they're very much there.

Do we have another question? Barbara.

QUESTIONER: I'm Barbara Crossette from The Nation.

Can you factor in the energy problems in some places, because particularly in rural areas where -- or even in cities in some places -- I don't know; what is it in Liberia, 1 percent of the people have electricity? And we've all see in developing countries people -- schools plugging their computers into car batteries, which they run on kerosene.

I don't know what you're finding and whether that can be part of your outreach, particularly when you start coming down to the lower income groups.

COUNTS: Could I --


COUNTS: I mean, one of the interesting things that -- when we started setting up these community knowledge workers in Uganda is the charging solution for the phone and what was that. And as part of the package -- they get a loan to buy the phone and some different materials -- is the charging solution. We're now going completely for solar charging solutions.

And it turns out that they can earn almost as much from charging other people's cell phones using their charging solution if they've kind of upgraded a little bit than they can from the -- you know, being an information broker. And so there's, you know, a real powerful, you know, possibility there to -- again, if you make the right investment.

And we went through a lot of different solar charging solutions that didn't work. There are many more that don't, or aren't that robust in a rural environment, but there are a few that do, and they're getting better. So I think that's a big part of it.

The other part -- and, you know, a success story that's come a little bit outside of here but a spin-off company of Grameen Bank called Grameen Shakti -- and I'm sad to say that all the Grameen companies in Bangladesh are under threat of a government take-over, that we're dealing with right now.

But this Grameen Shakti, leveraging the possibility of the network of Grameen Bank, have got to the point where they're able to finance and sell solar panels, a thousand a day, home installations throughout rural Bangladesh. A thousand yesterday, a thousand today, a thousand tomorrow.

You know, and what's really interesting about that is that there is a financing part of that that -- but a big part of it is in the information, that it's available, that it's affordable, that it works. And that's -- Grameen was able to kind of lap the competition there because it had a field force of loan officers.

But I think that the mobile phone and the ability to provide trusted information from a trusted source about, you know, clean energy and renewable energy options to the poor -- maybe not all through SMS, but through voice -- you know, this has the potential to really energize the uptake of clean energy, especially as the prices continue to come down.

COLEMAN: Alex, can I ask you about savings, because we often think of mobile phones as providing access to money and money transfer and things like this, but we don't talk so much about savings, and I know that that's potentially an even bigger opportunity than certainly credit, from a development perspective.

COUNTS: Well, I mean, the research is now telling us that microcredit, combined with microsavings and other things like insurance are much more powerful.

And so, right, the mobile financial services up until now has mainly been about payments, and that's a big deal but it doesn't really get at financial products that would particularly allow someone to go from a cash-based economy to where they can put money away and maneuver it without waiting in lines and paying bribes and all the things -- ultimately then people just leave it under their mattress, and that has all sorts of problems, you can understand.

So we undertook a three-country big microsavings program with the Gates Foundation, and Ethiopia and Philippines went as planned, but India was a big risk because India has been rightly criticized in microfinance for emphasizing credit much, much more than savings. And the excuse always was the government made it very hard to collect microsavings.

True, but we came up with -- and this is where the partnerships and use of technology to take advantage of things that are possible but not necessarily really happening -- is we joined with one of the most respected, though not one of the largest MFIs, in the India cash- poor, the biggest private bank in India, a technology company called ECO (ph), and we put something together which hadn't really been done before, which was to say, allowing the poor to voluntarily save, give the money at the field level to a loan officer.

And then it's transferred right there on the spot through their cell phone to the -- into a bank account that then they can access through, you know, anyone's cell phone. It turns out the women -- actually, the technology was not a big issue. The big issue, it turns out, was they were too willing to give their PIN numbers to other people. (Laughter.) But, actually, the technology, they were very quick to adopt.

Anyway, we launched this. It took us two years to get partnerships, a lot of sweat and tears and maybe even a little blood, but we got it together. And I'm pleased to say that there is now 60,000 bank accounts that have been opened in eight months. The average balance has gone from $3.50 to $7 over that time. And a few weeks ago we had one day where there were 614 new accounts opened by this one just medium-sized MFI in a very, very poor part of India.

And this is -- you know, this is just one case, but we're going back to Uganda, which is kind of our -- where we've had the most success and track record and relationships. We have just launched with CIGAP two months ago something called the Mobile Financial Services Incubator, that is trying to take the technologies, especially around payments that are already being used, and to transform them into useful financial products for poor people.

And watch this space. We don't have much to report in 60 days, but we think there's a huge potential there, and again I think that -- but we're only at the very forefront of realizing it.

QUESTIONER: Anish Melwani from McKinsey.

You just pointed out this point around, you know, one of the issues when people give away their PIN numbers too easily. What are some other pitfalls that you've found? What new types of abuse or crime or other things, you know, are the sort of downside of this technology being rolled out? Have we seen any of that come through yet?

COUNTS: None. (Laughter.)

QUESTIONER: It's perfect?

COUNTS: Yes, everything is perfect.

I think we have yet to work out -- probably our colleagues have, but I think we've yet to really figure out, and we need to soon, some of the privacy issues as we collect data, and also even just the issue of, you know, who gets to use the information when you're providing information to a poor person? If they're asking about X, there is someone that may want that -- just coming up with the ethical norms about how that information is shared or not shared.

We've been compliant in the countries we've been in with kind of the laws around privacy and consumer protection, but in some countries they're very kind of basic to nonexistent. And so we think that those should be raised, and, again, I don't think we're far enough along in that.

And so we're kind of feeling our way, being compliant with all the laws -- my general counsel, wherever she is -- but I think those standards need to be raised, and quickly.

CHANG: Yeah, I don't know of any specific major breaches yet, but I think that they will come. It's only a matter of time. I think there just hasn't been enough money put in the system yet and enough, you know, time that that's happened yet. But I think it will come and I think it's something we all have to be very careful about.

One thing along those lines, though, is that one of the things we heard from women is that when it comes to mobile savings, that it's actually very important to them to have multiple accounts, because if they have a single account, they often can get pressured by their husband to say, hey, how much money do you have in your account? Show me. Give it to me, because I'm going to use it for whatever.

And so, one of the things that's really important to empower women is to enable them to have multiple accounts so they can just kind of squirrel away money that no one else knows about, to be able to save up for their kids' education or for a health care need or otherwise.

RATZAN: And if I could just say, in reflecting on all of these, is there's no one-size-fits-all, and we have to figure out the best way to use the mobile environment to empower women and to make appropriate health decisions.

And thinking on the question of energy, I don't know if anybody here had seen the front-page article on Nigeria and population in the New York Times a few weeks ago, but I have the picture in my mobile health slide set when I give lectures that has a picture of a baby being born with lights, and the lights are from a mobile device.

So, is that a misuse of a mobile device? I think we're just at the beginning on scratching the surface and the diffusion curve of how these devices are going to be used. And we're talking about feature phones or SMS's as being, frankly, 1.0. There's so much more that's going to happen, and I think it's up to our imagination to hope the ethical norms are there.

The other question on standards, whether it's the ITU, European Commission, U.S. groups, whatever groups are appropriate, that the market drives the innovation, and at the same time put the ethical safeguards in place that will help make the difference in the right way. So, hopefully that's helpful.

COLEMAN: Michael?

QUESTIONER: Thank you. Mike Hodin, an adjunct fellow at the council.

So, I'm persuaded that this has been a huge success, and congratulations even though there's tons to do. But with that, I guess my question is, what about the children? It would seem to me that, you know, even though there's tons to do with women, the mothers, the opportunity to use this technology with the children, one thinks of health, prevention and wellness.

If you could begin using that to help get some thinking for a 10- year-old or a 12-year-old, maybe even a 6-year-old -- financial -- thinking about financial in some sense. So, I guess the question is, is it too early to sort of extend this a little bit?

RATZAN: I'll take that first. That's speaking for my two kids that use their mobile devices for gaming more than anything else. And the evidence does suggest that gaming obviously has a big potential upside, and teaching people not only about computation and literacy and numeracy and so forth, but also some health issues.

The second piece I would say is the first evidence base for those in the health field that want to see evidence that these text messages work. Last week's Journal of the American Medical Association had 5- to-18-year-olds in text messages in vaccinations, and there was a difference that was made from a randomized clinical trial, making their peer-reviewed journal that showed that these text messages helped people get vaccinations.

That's a big deal in this country. Other countries around the world, where we know we have a proven intervention that doesn't have the uptake for both communication and, in some cases, supply chain issues.

And then, thirdly, I think that the whole technology in schools -- and Ann Mei would know better than I, and others, that we're seeing these devices -- and we're talking mobile -- we're all talking about phones. We're really talking about communication devices here and how are those going to be used, and how can we create the affinity and the knowledge and skills?

So my bet is, is that that's the next generation of real users. I can certainly learn more from my kids. The first app they put on my phone was the flashlight, on my iPhone. And I probably use that more than some of these other real sophisticated ones that people are trying to sell.

COLEMAN: So do I. So do I. And they put it on mine too.

RATZAN: So there's a lot to be said for some simplicity. So I think right now let's get the simplicity right. Let's create the core competencies that help kids do better in school. We see where we're falling in science and health literacy, and some people blame that on technologies being gaming for gaming's sake, or blaming it for other parts of society. If we can harness it in the right way we'll make a huge difference.

CHANG: Yeah, I agree that there's phenomenal opportunity for technology, especially for education for kids, where there's just not enough trained teachers out there to be able to teach kids effectively, and technology and mobile technology, things such as the Aakash tablet in India, this $35 tablet there, working on -- although I hear there are some challenges there right now -- you know, have enormous opportunity to transform the way we deliver education, and to get education out to people who haven't been receiving good education today.

At the same time, I do think it's also a little early that -- the promise is there but the promises may be more like five or 10 years from now, the penetration of access to Internet and access to mobile devices, it's not quite there yet, such that I think what we're seeing a lot is that there's a lot of people rushing out there because there's such great opportunity, whether in the health space or education space or otherwise, but they're running into a lot of roadblocks because the infrastructure isn't there yet because the penetration of devices isn't there yet, that the costs are still a little too high.

And so, the ecosystem is coming together and coming together quickly, and I think there's lots of opportunity to innovate today for the tomorrow that will come in five years or so, where the technology is widespread enough that it will revolutionize how things are done.

COLEMAN: We have -- go ahead.

COUNTS: Just real quickly, I think that -- you know, I have four nephews under 7 years old and in this country how often they get sick is amazing to me. But I think that the -- by equipping frontline health workers with cell phones, and they use it in some of these basic ways I was mentioning, but think of -- there's sensor technologies that are getting cheaper, the ability for paraprofessionals to treat children in the field, and telemedicine, and laying the groundwork in infrastructure for that is a huge upside.

And just to add to some of the others, the pitfall -- I thought of one -- there are a lot of mobile health programs out there, and some of them are very good, some not so good, but they're all using totally noncompatible technology platforms. And so, the Gates Foundation is trying -- working with us to take what we've done in Ghana, where they think we've got the technology pretty right, combine us with a couple of other ones that are good, and to come up with a common platform where these things can communicate and not all be so stovepiped, but we're not there yet.

COLEMAN: Well, I know that in the payment sphere you've had the same thing. You've had these proprietary systems. But now this next generation in the payments -- you know, Visa has just bought Fundamo in Africa, and you've seen this interoperative system emerging, which is really going to take it to the next level.

You know, unfortunately we're out of time. I wish we could have a few more questions here, but we do have to end right at 2:00. This has been fascinating. I want to thank our panelists very much and also thank -- (applause) -- thank Cherie Blair and the Cherie Blair Foundation, and in particular Suzanne McCarron, ExxonMobil Foundation. So, thank you. (Applause.)







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