Technology for Health

Digital Exclusion: The opportunity, the onus and they way forward

Posted On
Monday, October 21, 2019

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#15yearsofimpact

Very often- sometimes in the course of a single day- you will hear these two almost contradictory statements: One about how many tech users there are in India (1.18 billion phones, 468 million of them smart), and the second to the tune of ‘Not everyone is as tech savvy as [you/me/us/them]’.

The gap between the two statements isn’t often explored: it’s the territory of people who are still more tuned in to community radio and street theatre than Netflix, and the Netflix folks may not even know they exist. Yet where do they fit in to the increasingly digital world we now occupy?

As a social sector worker and public health professional, the community radio community are my daily concern. Among my sector colleagues, there tends to be a dichotomous attitude to the use of technology in our work: either it is a tremendous opportunity, or it is more trouble than it’s worth. There are elements of truth in both positions, so they both merit exploration if we are to move forward.

The Opportunity

As the most ‘emerging’ of industries in the 21st century, tech is constantly transforming the world we live in- and not just for the Netflix society. Systems (from land records to medical records), communities (Whatsapp or Sharechat groups to digitally housed Communities of practice) and individuals (using fitness monitoring to agricultural updates) are changing to take advantage of the economies of scale and seamless information access that technology unprecedentedly allows. Yet for the 54% of those ‘offline’: mainly the poor and, among them, women, the lack of access to these advantages worsens the inequality of opportunity they already face. The 64% of 14–18 year olds in India who have never used the internet (73% in rural India) fall daily behind the 36% who have.

And it isn’t just opportunities for individuals: as industry reports point out, the ‘untapped potential’ of the Indian economy comes largely from those who are yet to fully participate in it. And even were one not trying to tap their e-wallets, the opportunity for reaching vast numbers of people with relevant messages (like vaccination reminders), nudging them to take action (think Change.org) or simply connecting them to resources they need (telephone consultations with distant doctors) could change the game for social sector professionals trying to make a positive impact, and governments looking to capitalize on a window of demographic dividend.

Image: Learning4impact

The Onus

If the opportunity is there for the taking, who are the takers? Government, startups, corporates, and the social sector are all willingly stepping into this space. The number of tech startups in the healthcare sector, for instance, has ballooned: (4,892, who have collectively raised $504 million). The government has over the last decade or more been promoting digitization of all sorts of processes and services, from salary receipts to public consultations.

The social sector have arguably been the slower adopters: which represents a missed opportunity of its own, since these are the people most habituated to listening to the communities they work with, and translating those felt needs into calls for transformation: the upcyclers of social change.

Why have NGOs been largely unable to make the shift? A group of experts across different sectors gathered at a forum called Catalysing Social Impact 2019 in Bangalore last week to try and answer this key question. Labelling their efforts as #Techtonic, they looked at the impact gap of technology uptake in the social sector, and tried to evolve solutions for it, which they have committed to test and share as a common resource over the coming seven months.

According to the group, technology use in the social sector suffers from three key stumbling blocks. The first is that the adoption of technology requires system changes, both within and beyond any one organisation. NGOs are often dependent actors with limited resources, who end up making the decision to adopt technology only on someone else’s instigation, such as a donor demanding digitized transparency or a vendor promising a silver bullet for inefficiency. The ‘oil’ of data may not be available in a usable form, and ensuring its (adequate) collection may take bandwidth that NGOs simply don’t have to hand.

The second, and related challenge, is a lack of internal capacity to understand why, whether, and how to adopt technology, and what to expect from it- leading to limited buy-in from managements and/or front-line implementers. This is even more challenging when it comes to technology at the cutting-edge of the tech sector itself, such as artificial intelligence and machine learning, which often have the most potential to change the game with persistent societal problems.

Finally, and as a result, NGOs can end up lagging behind the communities they serve in the adoption of technology, and even end up misdirecting their painstaking efforts: the medium undercuts the message. An NGO may pour resources into an app to engage youth in sexual and reproductive health messaging, roll it out with a poor ‘marketing strategy’ or ‘sales pitch’, and find to their horror that adolescents refuse to talk to ‘NGO aunties’ about their doubts at all.

The Way Forward

How do we emerge from this tangle?

One clear way forward is to build bridges between the technology and social sectors, such that the service providers are sensitized to the specificities of the sector, and the users to the possibilities and limitations of each product or service. In addition to managing the mismatch in expectations and experience between the two, a joint effort or appeal may make much more headway in changing the environment for better access to technology among the excluded.

But digital exclusion cannot be solved by addressing the issue of the translators and catalysts alone. What prevents communities at large, and some groups among them specifically, from capitalizing on the opportunities of tech has to be addressed: Gaps in accessibility, affordability, information, language, social norms (for instance, who in a family has/uses a phone), trust, appropriateness (the ‘need-solution fit’) and ease of use are only some of these. In doing so, the implementers (whether government, NGOs, corporates or others) not only need to listen to people’s voices, but also to learn from each others’ experiences- so that we aren’t all asking the people to keep repeating themselves.

Finally (and I may be overusing the rule of three), we might need to seek answers with patience. While the unrelenting pace of obsolescence in tech frightens those who adopt it for the sole purpose of being ‘cutting-edge’, it’s important to calmly and coherently seek evidence for taking calculated risks, with all stakeholders firmly on board. This is easier said than done for a social sector organisation, with punishing outcome targets, struggling communities and overburdened frontline workers to consider. But doing no harm means designing tech systems with enough care and evidence that we protect and promote the inclusion, rights and well-being of every person involved.

Rhea John is Learning Catalyst at Learning4impact.

Learning4impact is a platform that generates actionable insights for program and policy design for public health in India.

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