Low-resource nations may leapfrog wealthier ones in using AI for health

The Gates Foundation and OpenAI announced on Wednesday they’re committing up to $50 million in combined funding, technology, and technical support to advance the use of artificial intelligence in health systems across Africa through a new, country-led venture called Horizon1000. Through it, they will work in 1,000 primary health care clinics by 2028. The first country to launch is Rwanda — with Kenya, South Africa, and Nigeria to follow. Bill Gates joined Paula Ingabire, Rwanda’s minister of information and communications technology, and Peter Sands, the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, for a conversation at the World Economic Forum to elaborate on the new commitment and, more broadly, what they see as the most promising roles AI can play in delivering health care in low-resource settings. The experts said they believe that fast adoption of AI for health care in low- and middle-income countries could end up leapfrogging its use in wealthier countries. Gates noted that there are both vertical and horizontal uses of AI in health care. The vertical includes AI-powered diagnosis tools or a pregnancy ultrasound to determine whether a referral is needed for a complex delivery. But this initiative focuses on horizontal applications, he said, ensuring patients have access to free AI, in their own language, even when they’re not at the facility. Gates said in countries such as Rwanda, there’s an opportunity for “a deep level of integration right from the very beginning.” For example, a patient talks to an AI application, comes to the clinic, a summary of the information gathered is given to the doctor, a transcript is generated, and the AI application is available to the patient for follow-up questions once they leave the health facility. “I would say it's even more important that AI will be used on the delivery side,” Gates said, adding it’s especially important in countries where there aren’t enough doctors or clinicians. “This is the first year that we're really going to see horizontal application.” The collected information will be integrated into broader health systems — reducing the amount of paperwork filled out at facilities. Paper-based records can be an imperfect way of identifying patients, and consume the time of over-stretched clinicians, he said. “Taking away the paperwork that needs to be done, organizing the resources so the patient knows what's available, and when to come for their appointments,” he said. Gates said his foundation has “three big scenarios” for AI: virtual tutors for education, virtual doctors for health care, and virtual agricultural advisers. Rwanda’s Ingabire said technology plays a “very central role” in their development as a country. “With limited natural resources, I think technology becomes a natural go-to and not an afterthought,” she said, adding that Horizon1000 will help support the country’s over 60,000 community health workers. “Some of the administrative tasks that they've been working on, we can use AI to do that, so they're more focused on delivering better and targeted care,” Ingabire said. Last year, Rwanda also launched an AI scaling hub with the Gates Foundation. “Many countries have done pilots, but what happens? How do you move away from a pilot?” she asked. “We're picking a few, a handful of use cases, that we'll be able to deploy and scale.” Sands praised Rwanda on both its high internet connectivity rates and the government’s execution of healthcare goals. “Rwanda is really kind of a beacon of what can be done,” he said. “I think one of the things that Rwanda has been able to do is actually be very deliberate in its prioritization.” Leapfrogging The use of AI in health care may have a faster uptick in low- and middle-income countries than in wealthier ones, the experts said. That’s because the need is so great, and many governments are embracing it. And while there is often much resistance to the advancement of AI in wealthy countries — with people worried about losing their jobs — there are places where the jobs weren’t there in the first place. For example, Sands said there are over a million Sudanese refugees in Chad, and the Global Fund, with the government, has gone into refugee camps using AI-powered tuberculosis screenings. “The question is not replacing any radiologists — there were no radiologists,” he said. “If you want the screening to be interpreted, there is no alternative.” Global Fund has invested about $170 million over the last four years using AI-based TB screening, including mobile devices, he said. “In some ways, I think that one of the reasons this may well take off faster in low- and middle-income countries is because there won't be the resistance from people who say: This has taken my job,” Sands said. Sands said one area he sees particular promise for using AI is in better understanding patterns of malaria drug resistance across Africa. But Sands also noted points of caution — that there are still many primary health care facilities without internet connectivity or electricity. “We've got some fundamental things to fix,” he said. Additionally, he said the easier part is developing the AI tools, and the harder part is training people to use them — who won’t then be poached by technology companies. And he said the work needs to be driven by what’s needed, not what’s developed. “The whole thing has to be framed around problems needing solutions, as opposed to a whole bunch of tools needing a problem to fix,” Sands said. “There is a little bit of: People running around with a whole lot of hammers looking for nails.” Opportunities for partnership With foreign aid cuts and the heavy debt burden of African countries, the future of health care involves donors and governments making difficult decisions on what to prioritize. “But I think the thing that's exciting about AI is it allows us to kind of change the equation a bit and maybe get quantum leaps in efficiency and effectiveness,” Sands said. “That means we get, in a sense, more bang for the buck.” It will be important not focus on the “cool tools,” but on where the sector can have the greatest impact, he said. And there is promise for the global health sector to secure more partnerships with philanthropy and tech companies. Gates said that their partner on Horizon1000, OpenAI, is a bit unique in that about a quarter of the company is owned by a foundation. “It almost matches the $200 billion in assets that the Gates Foundation is going to be expending over the next 20 years as we finish our work,” he said. “You'll see more and more from them on the philanthropic side. This is one of the first initiatives,” Gates said. “They're staffing up the foundation side some.” He added that he was pleased that a strong global health commitment was their first purely philanthropic initiative. He called their joint $50 million commitment “just the beginning.” “The tech giants, including OpenAI, do want to devote some of their resources to helping the world, at large, [understand] what AI can do, and so they will be partners on a lot of these things,” he said. And the Gates Foundation will work to highlight the work of those who do. He said his foundation funds a group that ranks pharmaceutical companies on their generosity towards global health commitments. “Fortunately, people care how they get rated. We'll probably do that for the AI companies at some point — just so the ones that are doing a great job get the credit they deserve,” he said.