[Video ends]
[Mirja Sjöblom]
Hi everyone, and very welcome to this event. Welcome those of you who are here and those of you who are connecting with us and watching this on World Bank Live. Today we're going to talk about something important: delivering digital healthcare to 1.5 billion people. Now, that is a very big number, but behind that number there are human lives. A child treated on time or too late, a health worker that has the right equipment or not, and a family that falls into poverty because someone got sick or is protected because of health insurance. This is what we are here to talk about. My name is Mirja Sjöblom. I'm a senior economist here at the World Bank. I specialize in partnerships with the private sector. It's my honor to welcome you to this event and to be your host. Did any one of you use Google Maps to get here today? One person only? No? All of you? Yeah, that's what I thought! Google Maps is a very useful tool to get around in DC for those of you who have not discovered it yet. And what is very cool about this session is that we will meet one of the minds behind this invention. He is our special guest, and I'm very excited to bring him up on stage a little bit later in the session. Before we get into that conversation, let me take a moment to update you on the World Bank's health strategy. Health has always been central to our mission. This is because health is not— This is because health matters in its own right. It's about dignity and it's about well-being. We all know that. But in addition to that, people who are healthy, they are empowered and they are more productive, and this drives economic growth. Health drives economic growth. We also know that resilient health systems protect economic sectors and jobs. I think you all experienced that during the last pandemic. The health sector is also a job engine, especially for women. And about 70% of the health workforce is female. And this is not just any jobs. These are actually jobs that are formal, that are often skilled, and that are resilient jobs in an economic downturn. What are we doing differently now at the World Bank if this has always been central to our mission? In April 2024, during the Spring Meetings 2 years ago, this institution, for the first time in our history, made a bold commitment to health. This is to deliver quality, affordable healthcare services to 1.5 billion people by 2030. This is not incremental change. This is actually a different level of commitment to health by this institution. And to reach this target of 1.5 billion people in only 6 years, we have had to rethink, and we need to do things in a different way. We are now laser-focused on the most cost-effective way to reach more people faster, and that is by supporting governments and countries to build digitally connected primary healthcare systems. Why are we focusing on this? Because primary healthcare can tackle about 80% of the health needs in a person's life, and they are prevention focused. They actually reach people before their health problems get more severe and more expensive to treat. We have also recognized something fundamental that in order to achieve this target in only 6 years, we need all hands on deck. We need governments to step up, we need development partners to step up, and we also need the private sector. And this is why we are supporting countries to develop national health compacts. What are these compacts? They are country-led roadmaps for critical health reforms. These compacts align partners behind government visions and mobilize the private sector where it can make the biggest difference in the healthcare system. So far, about 16 countries have launched their compacts, and we expect that number to increase to 45 countries by the end of this year. This is a major effort. But most importantly, we are starting to see results of these efforts. And today I'm very pleased to announce that as of end of March this year, we have already reached 575 million people with health services. Yes, a round of applause for that.
[Applause]
[Mirja Sjöblom]
And all of us contributed. So let me say it again, 575 million people. That is 38% of the way to our target by 2030. I think it's real progress, but it's also a stark reminder that we have a lot to do in the next 4 years, right? How did we get there? We have been focusing on a new generation of World Bank Group projects, and these projects are finding new ways to deliver and reach people at scale. I wanted to give you two examples of these types of projects. The first one is Côte d'Ivoire in West Africa. Here, thanks to the World Bank Group support, they have rapidly transformed their healthcare system. Reforms expanded health insurance and digital systems, and investments upgraded clinics, and public and private providers have been contracted by the government to deliver care. And the results are impressive. In only 2 years, the enrollment in the national health insurance program has increased from 3 million to 20 million people who are now covered by health insurance.
[Applause]
[Mirja Sjöblom]
Yes, that deserves a round of applause. And that is what scaling looks like. Another project that I wanted to bring to your attention is a project in the Pacific region. In this region, we see a lot of dispersed populations who live on small islands, and distance has always been one of the main barriers to access care. In this region, the World Bank Group support is benefiting 8 island nations. These countries have come together to develop a regional approach to transform their primary healthcare system. Remote communities are being linked to clinics, to specialists, and to hospitals through a regional telehealth network. I think this is really impressive because most people or most governments think only about what's happening within their national borders, but here we have a regional approach. It's really impressive. This approach is being co-financed by several partners, because to reach the scale that we want to see, we need to partner, and this requires strong partnership. Now let's turn to one of the biggest questions in healthcare today: artificial intelligence. I'm looking at your faces. I see Srini, he's smiling and he looks a little bit excited. Yes, some of you look excited. Some of you look a little scared. Maybe some people are a little nervous about losing their jobs. Yes, you can feel all of that. I feel it. But I'm very, very pleased that we're going to have our special guest to come up and enlighten us about how AI will transform healthcare in the future. This special guest is not just thinking about the future, but he is actually helping to build the future with AI. Ladies and gentlemen, are you ready? A big round of applause and welcome to Dr. Moustapha Cisse.
[Applause]
[Mirja Sjöblom]
Do you want to sit here?
[Moustapha Cisse]
Yeah.
[Mirja Sjöblom]
Moustapha Cisse, you are the founder and CEO of Kera Health Platform, which is a digital health innovator. That is based in Senegal, and it's also one of the companies that IFC has invested in. But this man is not only a CEO, he's also a professor in machine learning at the Africa Institute of Mathematical Sciences. And as I mentioned earlier, I think we are all grateful to you for bringing us here today. Many people here use Google Maps, because it was Moustapha's team at Google, and that was actually the first engineering site and AI research team in Africa that was in charge of building Google Maps. We're grateful that you're here, and we want to hear about where AI is going to take us into the future. My first question is that Kera operates in a context that is familiar to many countries. Health workers are scarce. Patients may live many hours away from health facilities. Could you give me a concrete example of how Kera is helping to close this gap?
[Moustapha Cisse]
Thank you very much. And thanks for the invitation. When I arrived here, I realized I did not have my badge. We had to run 200 meters or a bit more to a different building in order to get the badge, just because of the way this whole thing was orchestrated. And it actually very much reminded me of how beneficiaries go through the health systems because the fragmentation of the information routinely leads to the same type of situation. I come from Senegal, it's in West Africa, and it's a country of about 18 million people. I actually want to ask a question here, just to answer your question. As we are in the US today, organizations like the WHO, one of the metrics they use to quantify or to assess the quality of a health system is the number of medical doctors per 100,000 people. How many medical doctors do you think we have in Senegal and more generally in sub-Saharan Africa per 100,000 people? Any ideas? Someone can guess. Can you guess?
[Member of the audience]
20? 10? I don't know.
[Moustapha Cisse]
Someone says 300. She says 20.
[Mirja Sjöblom]
No, you said per 100,000.
[Moustapha Cisse]
Per 100,000.
[Mirja Sjöblom]
Ah, okay. No, listen to the audience instead.
[Moustapha Cisse]
Okay. She says 1,000. She is a very optimistic person. Just to give you raw numbers, the average in OECD countries is over 200. If you are in very well-off countries like France or Switzerland or Italy, they'll have over 300 medical doctors per 100,000 people. In Senegal, we have between 7 and 10, depending on the sources, between 7 and 10 medical doctors per 100,000 people. Now, this is already orders of magnitude smaller than where we should be, but it's not the worst part of the story because it's a ratio, and if you want to improve a ratio, you have to make the numerator grow faster than the denominator. If you remember from high school or even before, right? The numerator here is the number of medical doctors, and the denominator is the population size. The problem we have in all sub-Saharan Africa, maybe about South Africa, is that this denominator, the population, is growing much, much faster than the denominator. Today we have a bit less than 1.5 billion people living on the continent. In 20 to 25 years, that number will reach 2.5 billion. In some countries, actually, it's just literally going to double or grow faster than that. At the same time, the number of medical doctors, and you can extend it to healthcare practitioners, is decreasing even in some places. I was reading an article that was explaining that you have more Nigerian doctors in the UK than in Lagos, and Lagos has over 20 million people living there. If we are already in a very bad situation with around 7 medical doctors per 100,000 people, and in 20 years, given that same ratio, we will be even worse, what can we do today in order to change the situation? The simplest answer could be “let's train more doctors.” Well, we can't. We don't have the education infrastructure, and there are time constraints for doing this. The other situation is let's slow down population growth. We already know we can't as well. And this is where opportunities like artificial intelligence bring exceptionally timely tools to cater to this problem. Why? Because from the numerator side of things, we can build systems that make the medical doctors and the healthcare practitioners and the whole system much more efficient. If they are serving today, I don't know, 30 patients per day, maybe tomorrow they will be able to serve hundreds while increasing the quality of care. But at the same time, we can make the denominator grow much less fast because if we manage to keep people healthy, if we deliver them the right information, if they diagnose on time, if they are more proactive about their healthcare, then the ratio, the denominator of the ratio, matters much less. Because people have to take care of their healthcare before they get sick. AI allows us today to do all of those things. And that's the kind of systems that we are building at Kera Health Platforms to make quality healthcare universally accessible and to orchestrate the care journey better.
[Mirja Sjöblom]
Great. Thank you so much. That's very inspiring. I want to hear a little bit about, because you started Kera in Senegal, I want to hear about the enabling environments. What do you see are some of the conditions that can make or break an innovation like Kera?
[Moustapha Cisse]
What is true for Senegal is true for most of the WAEMU zone. For those of you who are not familiar with it, the WAEMU zone is a group of 8 countries in West Africa with a total population of around 140 million people, same regulatory framework, same currency, same language, and very similar policies as far as innovation is concerned. We started a couple of years ago, we put a product on the market, and it grew extremely fast. Why? Because we are solving a problem that's real. We are solving something people are willing to pay for because it materially improves their lives. It's actually as simple as that. I personally have, for a very long time, believed that technology cannot be detached from the environment in which it is created and from the needs of the population it is meant to serve. To answer your question, it always boils down to which problem you are trying to solve and who is ready to pay for that problem. Yes, the ecosystem, the regulatory frameworks, the incentives that governments and public policy put in place in order to enable and encourage that kind of innovation is extremely important. But the most important aspect of that whole ecosystem is the population you're solving for, whether they are ready to pay for it, whether the market exists for the innovation that you're building. Now, once that's the case, you have many incumbents that have been around for a long time that have benefited from a certain regulatory framework, and I have to admit that our governments could do much more in terms of enabling these technologies by just streamlining and making the regulatory frameworks much simpler and putting in place the incentives, whether it's tax incentives or legal or all of those things. I know there are many organizations like the World Bank and IFC helping with that, but I would be— and this is true for most startups across West Africa— it could make our lives much easier and therefore, focus our time much more on solving for the customers if all of these roadblocks that are unnecessary from a regulatory perspective, from a financial perspective, etc., were lifted by governments.
[Mirja Sjöblom]
That's very interesting. I'm just curious, are you collaborating with the government in Senegal? Or discussing with them?
[Moustapha Cisse]
Well, yes. I mean, I give my— I write. I give my opinion about certain things. And I have to say, to their credit, that they are extremely proactive about this recently. Things are moving. But it has to move much faster. And it has to move at the same pace as the innovation. I understand it's very demanding to say to a government, you have to move at the pace of innovation, because the very definition of a government is to be slow. But it has to be faster than it is right now. And not just in Senegal, by the way. This is true for most countries in West Africa.
[Mirja Sjöblom]
If we like hone in more on that question, because I think it's really important, and there I'm sure there are many people in the audience who might come from government. Is there anything that, from your experience working in Senegal, but also, across the region, what do you think is the single most important thing that a government can do or stop doing to allow companies like Kera to scale?
[Moustapha Cisse]
It's interesting that you ask the question by saying what the government can do and what the government can stop doing. I was giving a talk recently about regulatory frameworks with respect to innovation in West Africa. And because sometimes I mean, I have helped many governments shape their regulatory framework in there. One of the biggest mistakes I see governments make is to copy frameworks that come from elsewhere, just basically lift it and drop it in there and hope that it works. And I can give you a precise example, which is GDPR. Many governments in West Africa currently are just copying the GDPR and making it the default regulatory framework for all things data privacy. At the same time, in Europe, and I can give you the example of Mario Draghi, who put out a report saying that it costs around 10% of their revenue to startups and companies to be compliant with this regulatory framework. If they are competing in a global market with companies based here in the US, for example, you already have 10% of that revenue that translates directly in the cost structure that whatever good they're building. They can't be competitive. And we're talking about European startups, right? Now think about it from the perspective of an African startup. At my company, because we are handling healthcare data and we have the means to do so, we are certified. We are ISO 27001 and 017 and 018 certified. We're GDPR compliant as well because we have the ambition to expand in Europe. But if I tell you how much it's costing us today, over 90% of the startups operating in the ecosystem will not be able to cover that cost while remaining competitive in the market. This is one single decision that a government makes with the good intention of doing right by their people, meaning protecting them from a regulatory perspective. And if you read the law, it makes a lot of sense. But context matters a great deal. Lifting a framework designed for a specific environment and putting it in a new environment creates unnecessary roadblocks and stifles innovation. And that's happening in many countries in West Africa.
[Mirja Sjöblom]
Thank you. That's very clear. It makes me think about the importance of consulting with the people who operate in the market when you design regulation. I hope there is some kind of consultations going on in Senegal and in many other places. I want to come back a little bit. You mentioned it a bit when you answered the first question, but if we look ahead and if you think about AI-enabled health system in emerging markets, what could they look like, let's say, 20 years from now? Maybe it's too long because innovations are moving so fast, but in the future, what do you see?
[Moustapha Cisse]
Well… In Africa, we have for— This is one of those very rare times in history where the situation is providing us with the opportunity to build for something that we are uniquely positioned to build because of the type of problems that we have, but because also the environment forces us to build that very thing because nothing else would be impactful. I'm 40 years old. In Senegal, I'm older than between 75 and 80% of the population, so, I'm extremely old in Senegal. Here in the U.S., I'm very young.
[Mirja Sjöblom]
Yes.
[Moustapha Cisse]
What does that mean? From a technology perspective, if you're designing solutions in healthcare, prevention is paramount in that area of the globe, while here, if you have a more aging population, then everything around acute care, inpatient and all that will be extremely important. But because it's the fastest growing population on Earth, if you build for that population and not just copy whatever is being done elsewhere, if you build to cater specifically for that population, in 20 years’ time, whatever you're building will be serving the largest population on Earth. It's a huge opportunity. And our bet at Kera is that a more proactive, more preventative, and more personalized health systems, which all can be enabled by AI today, can help us get there in the next 20 years. Granted, 20 years is a lot, but we have to start from somewhere, and whatever we're building today will be extremely impactful in the 20 years to come. And the goal really is not to build just to serve populations in Africa, because when you build for what we call the bottom of the pyramid— I don't like that analogy, by the way— But when we build for the bottom of the pyramid, whatever you are building can be very easily transferred anywhere else on Earth. The converse is not necessarily true. That's the opportunity I see.
[Mirja Sjöblom]
Yes. Thank you very much. I think this has been a wonderful conversation, and I want to thank you for your insights.
[Moustapha Cisse]
Thank you very much.
[Mirja Sjöblom]
And for coming here and your leadership your optimism. I think we need more optimism in the world and you are bringing it to the World Bank today.
[Moustapha Cisse]
Thanks a lot.
[Mirja Sjöblom]
We are very happy. And I also want to thank the audience. Thank you, audience. Thanks for joining us and for helping us to come together, envision a future where more people will receive better care and where we hope that technology will serve the people's needs. Thank you for coming here, and a big round of applause.
[Applause]
