Countries with fewer resources could leapfrog richer ones in leveraging AI for health

The Gates Foundation and OpenAI announced Wednesday that they are pledging 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. This will see them working in 1,000 primary health care clinics by 2028. The first country is Rwanda, followed by Kenya, South Africa and Nigeria. Bill Gates joined Paula Ingabire, Rwanda’s Minister of Information and Communications Technology, and Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, for a conversation at the World Economic Forum, detailing new initiatives and, more broadly, what they think is the most promising role AI can play in delivering health care in low-resource settings. Experts said they believe that rapid adoption of AI in healthcare in low- and middle-income countries could eventually surpass its use in wealthy countries. Gates pointed out that AI is being used both vertically and horizontally in the medical field. This area includes AI-powered diagnostic tools and pregnancy ultrasounds to determine if a complicated birth requires a referral. However, the initiative focuses on horizontal applications, allowing patients to access free AI in their native language even when they are not in the facility, he said. Gates said countries like Rwanda have an opportunity for “a deep level of integration right from the start.” For example, after a patient speaks to an AI application, comes into the clinic, a summary of the information collected is passed to the doctor, a record is generated, and the patient leaves the medical facility, the patient can rely on the AI ​​application to ask follow-up questions. “I would say it’s even more important that AI is used on the delivery side,” Gates said, adding that this is especially important in countries that don’t have enough doctors and clinicians. “This year will be the first year we really see horizontal application.” The information collected will be integrated into the broader health care system, reducing the amount of paperwork that facilities complete. Paper-based records can be an imperfect way to identify patients and can waste busy clinicians’ time, he said. “We remove paperwork and organize resources so patients know what’s available and when to come in,” he says. Gates said his foundation has “three big scenarios” for AI. They are virtual tutors for education, virtual doctors for medicine, and virtual agricultural advisors. Rwanda’s Ingabire said technology plays a “very central role” in a nation’s development. “With limited natural resources, I think technology will become a natural reliance rather than an afterthought,” she said, adding that Horizon1000 will help support the country’s more than 60,000 community health workers. “Some of the administrative tasks that they’re working on can be done with the help of AI, so they’re focused on providing better, more targeted care,” Ingabire said. Last year, Rwanda also launched an AI scaling hub with the Gates Foundation. “Many countries have conducted pilots, but what will happen? How can we move away from them?” she asked. “We have selected a number of use cases that we can deploy and scale.” Sands praised both Rwanda’s high internet connectivity rate and the implementation of the government’s health goals. “Rwanda is really a beacon of what is possible,” he says. “I think one of the things that Rwanda has been able to do is prioritize very carefully.” Leapfrog The use of AI in healthcare could spread more quickly in low- and middle-income countries than in richer countries, experts say. That’s because the need is so great that many governments are embracing it. And while there is great resistance to advances in AI as people worry about losing their jobs in rich countries, there are places where the jobs never existed to begin with. For example, Sands said there are more than 1 million Sudanese refugees in Chad, and the Global Fund is working with governments to use AI-powered tuberculosis tests to enter refugee camps. “The problem wasn’t filling radiologists. We didn’t have radiologists,” he said. “If you want your screenings to be interpreted, you have no other choice.” He said the Global Fund has invested about $170 million in the past four years using AI-based TB testing, including on mobile devices. “In some ways, I think one of the reasons why this movement may start sooner in low- and middle-income countries is because people are less likely to say, ‘This is taking my job,'” Sands said. Sands said one area where he sees particular promise in using AI is to better understand patterns of malaria drug resistance across Africa. But Sands also pointed out the caveat that there are still many primary health care facilities without internet connectivity or electricity. “There are some fundamental things that need to be fixed,” he said. He added that the easy part is developing the AI ​​tools, and the hard part is training people to use them, so they don’t get poached by technology companies. And work needs to be driven by what is needed, not what is developed, he said. “The whole thing needs to be framed around the problem that needs a solution, rather than a bunch of tools that need to fix the problem,” Sands said. “There’s a bit of a situation where people are running around with a bunch of hammers looking for nails.” Partnership Opportunities With cuts in foreign aid and high debt burdens on African countries, the future of health care will require donors and governments to make difficult decisions about what to prioritize. “But I think the interesting thing about AI is that it allows us to change the equation a little bit and perhaps make a big jump in efficiency and effectiveness,” Sands said. “So, in a way, you get more benefits.” Rather than focusing on “cool tools,” it will be important to focus on where the sector can have the most impact, he said. And the global health sector is expected to secure more partnerships with philanthropy and technology companies. Gates said Horizon1000 partner OpenAI is a bit unique in that about a quarter of the company is owned by a foundation. “This roughly equates to the $200 billion in assets that the Gates Foundation plans to spend on research over the next 20 years,” he said. “You’re going to see more and more of them doing it on the philanthropic side, and this is one of the first ones,” Gates said. “They’re in the process of adding people on the foundation side,” he said, adding that they’re pleased that their strong global health commitment is their first purely philanthropic effort. He said the companies’ joint $50 million effort is “just the beginning.” “Technology giants, including OpenAI, want to dedicate some of their resources to helping the world at large. [understand] “What can AI do? And they will be partners in many of these things,” he said. “And the Gates Foundation will work to highlight the work of those people. His foundation funds an organization that ranks pharmaceutical companies by their generosity in global health efforts. Fortunately, people care about how they are judged.” “Maybe someday we’ll do something similar for AI companies — just to make sure the companies that are doing great work get the credit they deserve,” he said.