A week ago Bill Gates published a story on his personal blog site : ๐๐น๐ฑ๐ข๐ฏ๐ฅ๐ช๐ฏ๐จ ๐ข๐ค๐ค๐ฆ๐ด๐ด ๐ต๐ฐ ๐ฉ๐ฆ๐ข๐ญ๐ต๐ฉ ๐ค๐ข๐ณ๐ฆ ๐ต๐ฉ๐ณ๐ฐ๐ถ๐จ๐ฉ ๐๐: ๐๐ฐ๐ฅ๐ข๐บโ๐ด ๐๐ ๐ค๐ข๐ฏ ๐ต๐ณ๐ข๐ฏ๐ด๐ง๐ฐ๐ณ๐ฎ ๐ฉ๐ฆ๐ข๐ญ๐ต๐ฉ ๐ค๐ข๐ณ๐ฆ ๐ด๐บ๐ด๐ต๐ฆ๐ฎ๐ด ๐ข๐ฏ๐ฅ ๐ด๐ถ๐ฑ๐ฑ๐ฐ๐ณ๐ต ๐ฉ๐ฆ๐ข๐ญ๐ต๐ฉ ๐ค๐ข๐ณ๐ฆ ๐ธ๐ฐ๐ณ๐ฌ๐ฆ๐ณ๐ด ๐ต๐ฉ๐ฆ ๐ธ๐ฐ๐ณ๐ญ๐ฅ ๐ฐ๐ท๐ฆ๐ณ.)
Supporting health workers with AI? No one can disagree with that.
๐ข๐ฝ๐ฒ๐ป๐๐ ๐๐ผ ๐๐ต๐ฒ ๐ฟ๐ฒ๐๐ฐ๐๐ฒ
The post was supporting the announcement of a new Gates Foundation / OpenAI initiative:
โToday, weโre announcing Horizon 1000, a pilot initiative with the Gates Foundation to support leaders in African countries, beginning in Rwanda, as they advance these AI capabilities for health. Together, the Gates Foundation and OpenAI are committing $50 million in funding, technology, and technical support to support their work, with the ambitious goal of reaching 1,000 primary healthcare clinics and their surrounding communities by 2028.โ
Having described the proposed work in Rwanda, Gates again stresses:
โThese AI tools will support health workers, not replace them.โ
๐๐๐ โฆ
Gates builds his argument like this.
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โIn Sub-Saharan Africa, which suffers from the worldโs highest child mortality rate, there is a shortfall of nearly 6 million health care workers, ๐ฎ ๐ด๐ฎ๐ฝ ๐๐ผ ๐น๐ฎ๐ฟ๐ด๐ฒ ๐๐ต๐ฎ๐ ๐ฒ๐๐ฒ๐ป ๐๐ต๐ฒ ๐บ๐ผ๐๐ ๐ฎ๐ด๐ด๐ฟ๐ฒ๐๐๐ถ๐๐ฒ ๐ต๐ถ๐ฟ๐ถ๐ป๐ด ๐ฎ๐ป๐ฑ ๐๐ฟ๐ฎ๐ถ๐ป๐ถ๐ป๐ด ๐ฒ๐ณ๐ณ๐ผ๐ฟ๐๐ ๐ฐ๐ฎ๐ปโ๐ ๐ฐ๐น๐ผ๐๐ฒ ๐ถ๐ ๐ถ๐ป ๐๐ต๐ฒ ๐ณ๐ผ๐ฟ๐ฒ๐๐ฒ๐ฒ๐ฎ๐ฏ๐น๐ฒ ๐ณ๐๐๐๐ฟ๐ฒ.โ (my emphasis)
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โRwanda currently has only one health care worker per 1,000 people, far below the WHO recommendation of about four per 1,000. ๐๐ ๐๐ผ๐๐น๐ฑ ๐๐ฎ๐ธ๐ฒ ๐ญ๐ด๐ฌ ๐๐ฒ๐ฎ๐ฟ๐ ๐ณ๐ผ๐ฟ ๐๐ต๐ฎ๐ ๐ด๐ฎ๐ฝ ๐๐ผ ๐ฐ๐น๐ผ๐๐ฒ ๐ฎ๐ ๐๐ต๐ฒ ๐ฐ๐๐ฟ๐ฟ๐ฒ๐ป๐ ๐ฝ๐ฎ๐ฐ๐ฒ ๐ผ๐ณ ๐ฝ๐ฟ๐ผ๐ด๐ฟ๐ฒ๐๐.โ (my emphasis)
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โ๐ฆ๐ผ, ๐ฎ๐ ๐ฝ๐ฎ๐ฟ๐ ๐ผ๐ณ ๐๐ต๐ฒ ๐ฐ๐ ๐ฐ ๐ฟ๐ฒ๐ณ๐ผ๐ฟ๐บ ๐ถ๐ป๐ถ๐๐ถ๐ฎ๐๐ถ๐๐ฒ, Minister of Health Dr. Sabin Nsanzimana recently announced the launch of an AI-powered Health Intelligence Center in Kigali to help ensure limited health care resources are being used as wisely as possible.โ (my emphasis)
๐๐ฒ๐โ๐ ๐๐๐ฎ๐ฟ๐ ๐๐ถ๐๐ต ๐ฅ๐๐ฎ๐ป๐ฑ๐ฎโ๐ ๐ญ๐ด๐ฌ ๐๐ฒ๐ฎ๐ฟ๐โฆ
This figure comes from the Rwandan Ministry of Health:
โ๐ช๐ถ๐๐ต๐ผ๐๐ ๐ฎ๐ป๐ ๐ฐ๐ต๐ฎ๐ป๐ด๐ฒ๐, it will take Rwanda close to 180 years to achieve the recommended healthcare worker to population ratio which threatens to stall and even revert the progress made. ๐๐ป ๐๐ต๐ถ๐ ๐ฟ๐ฒ๐ด๐ฎ๐ฟ๐ฑ, ๐๐ต๐ฒ ๐ ๐ถ๐ป๐ถ๐๐๐ฟ๐ ๐ผ๐ณ ๐๐ฒ๐ฎ๐น๐๐ต (๐ ๐ข๐) ๐ต๐ฎ๐ ๐ฑ๐ฒ๐๐ถ๐ด๐ป๐ฒ๐ฑ ๐ฎ ๐ฟ๐ฒ๐ณ๐ผ๐ฟ๐บ ๐๐ผ ๐๐ฟ๐ฎ๐ถ๐ป ๐ฎ๐ป๐ฑ ๐ฒ๐ป๐๐๐ฟ๐ฒ ๐ฎ๐๐ฎ๐ถ๐น๐ฎ๐ฏ๐ถ๐น๐ถ๐๐ ๐ผ๐ณ ๐ฎ ๐บ๐ถ๐ป๐ถ๐บ๐๐บ ๐ผ๐ณ ๐ฐ ๐ต๐ฒ๐ฎ๐น๐๐ต๐ฐ๐ฎ๐ฟ๐ฒ ๐๐ผ๐ฟ๐ธ๐ฒ๐ฟ๐ ๐ณ๐ผ๐ฟ ๐ฒ๐๐ฒ๐ฟ๐ ๐ญ,๐ฌ๐ฌ๐ฌ ๐ฝ๐ฒ๐ผ๐ฝ๐น๐ฒ ๐ฏ๐ ๐๐ต๐ฒ ๐ป๐ฒ๐ ๐ ๐ณ๐ผ๐๐ฟ ๐๐ฒ๐ฎ๐ฟ๐ ๐ฐ๐ฎ๐น๐น๐ฒ๐ฑ ๐๐ต๐ฒ โ๐ฐ๐ ๐ฐโ ๐ฟ๐ฒ๐ณ๐ผ๐ฟ๐บ.โ
In other words the โcurrent pace of progressโ is history and Rwanda is committed to increasing its health work force.
โThe 4x4 reform was approved as a national priority by the Cabinet of the Government of Rwanda on 13th July 2023. The reform sets a goal of quadrupling the number of healthcare workers in the next four years to bring Rwanda closer to the WHO recommended target of healthcare worker density while enabling the countryโs health sector and medical education to evolve and be sustainable.โ
Gates fails to report that the whole point of the 4x4 reform โ hence its name - is to hit WHOโs target in 4 years.
In addition, his claim that the launch of an AI-powered Health Intelligence Center (HIC) is part of the 4x4 reform initiative is incorrect. 4x4 is solely focused on training doctors, nurses and midwives. They are both referenced in Rwandaโs Health Sector Strategic Plan V (2024โ2029) but in different pillars.
๐๐ ๐๐ผ ๐๐ต๐ฒ ๐ถ๐บ๐ฝ๐ผ๐๐๐ถ๐ฏ๐น๐ฒ ๐ฒ ๐บ๐ถ๐น๐น๐ถ๐ผ๐ป ๐ด๐ฎ๐ฝ ๐ณ๐ผ๐ฟ ๐ฆ๐๐ฏ-๐ฆ๐ฎ๐ต๐ฎ๐ฟ๐ฎ๐ป ๐๐ณ๐ฟ๐ถ๐ฐ๐ฎโฆ
This comes from a study published by BMJ Global Health. It concludes that between 2022 and 2030 the
โAfrican Region would need to more than double its 2022 health work force stock if the disease burden and growing population health needs are to be adequately addressed.โ
If Rwanda aims to quadruple its workforce in 4 years, why is doubling the workforce in 8 years so impossible? The study, indeed, comments that
โOver the last two decades, the African Region made noticeable progress in health workforce (HWF) development with a remarkable increase in investments towards training and education infrastructure, increasing the number of health professions education institutions and/or programmes to more than 4000 in 2018 from less than 1000 in 2005.โ
๐ง๐ต๐ฒ ๐ฎ๐ฐ๐๐๐ฎ๐น ๐ฝ๐ฟ๐ผ๐ฏ๐น๐ฒ๐บ?
Ignoring the dangers of the extraction of sovereign and personal data, the real problem is resource allocation. How does the shrinking pool of resources meet competing demands? Of course there is no simple resolution to this problem but the least that those with influence can do is not distort the discussion by misinterpreting evidence.
The subliminal impression one gains from reading Gatesโ article is that AI can reduce the numbers of health workers required. That is not what the evidence he deploys actually reveals.