Demand for AI is the bottleneck, so we’ll tackle it by starting with Africa
The debate on contemporary AI has focused almost entirely on supply: models, processors and hyper-scalable infrastructure. The real constraint, however, is demand, and this cannot be created simply by supplying more of the product
by Keyzom Ngodup Massally* and Ugyo Zine Edosio*
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Key points
Earlier this month, in the Luweero district of Uganda, a novice midwife used an artificial intelligence-based clinical decision-support tool – which operates entirely offline, without the need for an internet connection – during a complicated four-hour labour. The tool flagged a risk of eclampsia. The midwife investigated the situation further, carried out the necessary tests, ruled out the diagnosis based on clinical evidence, and made her own decision independently. The mother gave birth safely.
The tool was developed by Crane AI Labs using Google’s MedGemma model, as part of a Google.org Health AI grant, and is now being used in healthcare facilities supporting over 200 frontline healthcare workers. To the best of our knowledge, this represents one of the first documented cases of an AI-based clinical decision support system operating entirely offline in a rural maternity setting in sub-Saharan Africa. The case has been clinically verified by the study’s co-principal investigator.
It is important to consider what made all this possible. Not a cloud infrastructure. Not a high-end smartphone. Not even a stable internet connection. What made it possible was a series of enabling conditions developed in tandem: the right model, optimised for the clinical context; the right device, capable of performing offline inference; training for the midwife to interpret the results and, if necessary, disregard them; and a governance framework that kept the final decision in human hands. Had even one of these conditions been missing, the tool would not have existed, would not have reached Luweero, or would have risked causing harm rather than preventing it.
This is what it means to implement artificial intelligence by starting with real-world demand. And this is the central argument of this paper: the main global bottleneck for AI is not supply, but demand – understood as the structural capacity of communities, institutions and governments to absorb, adapt and govern artificial intelligence in accordance with their own needs and priorities. Such a capacity cannot be created simply by rolling out new products. It must be built up gradually, step by step.
Investment on the supply side makes AI available. Investment on the demand side makes AI truly effective, for communities and governments capable of managing it autonomously.

