Not having 911 services is a huge drain on a country’s economy—and yet so easy to fix

Any cell phone could be an emergency phone.
Any cell phone could be an emergency phone.
Image: Reuters/Kai Pfaffenbach
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Few technological advancements have been able to proliferate as quickly, and overcome wealth disparities as effectively, as the mobile industry. With global mobile phone penetration approaching 80% in less than 25 years, even the most remote communities in developing countries now have access to banking, job training, and health care. However, there’s still a basic need—a public utility, you might call it—that the mobile industry has failed to provide: access to 911.

I’ve spent 10 years working to improve emergency medical systems (EMS) in Latin America and the Caribbean and I’ve witnessed countless incidents where access to basic emergency care and rapid transport would have significantly improved patient survival and long-term outcomes. Whether in response to a car wreck, a complicated childbirth, or cholera, there is little doubt that access to basic emergency care and transportation can improve a patient’s prognosis. Yet, the infrastructure has not been built up to serve this need. It’s hard not to wonder: if there are nearly 4.5 billion mobile phone subscribers in the developing world, how come virtually none of them have a reliable way to call for help?

The mobile industry has had limited interest in providing emergency medical dispatching systems for developing countries for three main reasons:

  1. No one really knows what to do. The high-priced, advanced dispatching technologies commonly utilized in developed nations are usually too expensive and largely impractical for most developing nations. Even if poorer countries were able to afford a 911 dispatching system, which are focused on dispatching a limited number of designated ambulances, it’s a difficult task to perform on a consistent basis, especially when the vast majority of the population is inaccessible by road.
  2. Nobody thinks it can make money. Mobile operators likely don’t see it as a profitable business endeavor. When the tried and tested solutions don’t translate to poorer countries, there’s limited incentive for innovation.
  3. Governments have not made it a priority. Few government officials in developing countries benefit from a legacy of effective emergency telecommunications, or sufficient funding to undertake what appears to be an expensive and complex development program.

Whether or not there is a formal, ambulance-based 911 system, it is a natural human instinct to try and preserve life. As a result, emergency medical response regularly happens anywhere there is a car wreck or a person in need. In most developing countries, it typically involves untrained good Samaritans using the vehicles already on the road and the cellphones in their pockets. The systems are largely ad hoc, uncoordinated, and inefficient, but they are surprisingly robust, likely owing to the fact that developing countries are being overwhelmed by injury-related deaths. In developing countries, road traffic injuries are the number one cause of death for people aged 15 to 29, and among the top three for 5- to 44-year-olds.

More than just a matter of good public health, the absence of 911 is also a drain on the economy. In 2010, the WHO reported that the economic costs of road traffic crashes cost developing countries between 1-5% of their GDP. While premature death has an undeniable effect on a family’s livelihood, the long-term effects of injury can have equally profound negative impacts. Dinesh Mohan, an Indian research professor, describes it in plainer terms: “When someone in a poor family is injured and is bedridden…the whole family gets involved in the care of the patient. This results in the re-allocation of labor of all family members—those on daily wages lose their income; children may not go to school, and older family members may spend less time in the care of children and infants.” And though emergency medical care may not directly prevent injuries from happening, it can certainly prevent them from getting worse. 

In the ‘60s and ‘70s, the United States and other industrialized nations were equally overwhelmed by fatalities from road traffic and work-related injuries. In 1970, the United States suffered 52,627 fatalities from motor vehicle collisions alone compared to 32,885 in 2010. Over time, owing to advances in technology and increased political will (prompted by strong pressure from the medical community), the wealthiest nations began implementing basic EMS systems to provide care and transport for the critically injured. These systems have helped significantly in reducing premature death and disability from preventable causes. Results from a widely cited study found that among seriously injured patients in Ghana and Seattle, 81% of deaths in Ghana happened before patients reached the hospital, while in Seattle it was 59%. These difference have very little to do with the advanced trauma care available on Seattle’s ambulances, but rather with getting to the hospital quickly.

If we break it down, our high tech EMS system is really based around three things: people, vehicles and phones. As the World Bank wrote in a 2008 report on EMS (pdf): “Nowhere is the demand for efficient communication and rapid transportation more critical than in emergency medical care. The best teams equipped with state of the art technology and supplies will be wasted if they cannot be reached quickly or if they have no contact with the hospitals where patients are to be taken.” An increasing number of   initiatives are heeding this advice by experimenting with technologies that essentially crowd-source basic emergency care—above all for CPR—including in countries like Sweden, Israel, and the United States. However, aside from a few nascent initiatives to harness the potential for these technologies, including the efforts of my own organization, there is minimal discussion among telecom providers to deliver emergency dispatching technologies in the developing world.

Setting up an effective emergency dispatch system using text messages is as simple as connecting the people who are already helping during emergencies—like taxi drivers, police, and the ubiquitous youth selling phone minutes on every street corner. Sustainability is possible, too, in the same way it’s done in wealthy countries: universal service fees. Every telephone subscriber in the United States pays a fee to the local 911 system in their monthly phone bill. In 2011, Texas was able to raise over $200 million dollars through a nominal surcharge for its 911 system. Thus, by simply raising the cost of text messages or voice minutes by only a fraction, sufficient revenue can be generated to maintain an effective dispatch system.

While the mobile industry is squarely focused on the next biggest thing, or in the words of Mark Zuckerberg, Facebook’s CEO, making connecting to the internet as easy as dialing 911, it would be a mistake to leave such a basic service by the wayside. To do so would be to literally add insult to injury.