Last month, the Silicon Valley Microfinance Network cosponsored "Microfinance West: The Investment Opportunity Conference." This event, which brought together some of the leading commercial players in the microfinance field, was heavily geared towards institutional and retail investors in the financial community. The topics ran the gamut from attracting capital to mitigating risk to benchmarking against other asset classes.

Though the focus was clearly financial, heavyweights from the development side also presented, including Elizabeth Funk, Chairman of the Board of Unitus, and Mary Ellen Iskenderian, President of Women's World Banking. The most provocative comment, however, came from Janine Firpo of Sevak Solutions as she described the evolution of financial services in the US and how technology has continued to lower the costs of transactions.

Warning the audience in advance, Janine shared her thoughts on an area that many might consider to be heretical. She challenged the attendees to question whether default rates on microfinance loans were really the right place to focus, or if in fact the emphasis on achieving 99% repayment rates might be somewhat misguided. Most microfinance institutions today follow a high-touch model, relying on a loan officer that makes frequent visits to his or her clients to collect loan payments and continually reinforce their need to repay. While this has been extremely effective it is also inherently unscalable; as the client base increases, the number of loan officers needed to serve them must also increase.

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I've been spending the week at one of a series of 8 conferences on eHealth, brainstorming with other entrepreneurs, venture capitalists, health informatics specialists, and policy experts. The setting could hardly be more lovely--the Rockefeller Foundation's Bellagio center looking down on the deep waters of Lake Como and looking up at the sheer granite cliffs of the Alps.

The scale of the scenery seemed to match the scale of our task, to figure out how to unlock the eHealth marketplace—that is, unleash entrepreneurship and market forces combined with technology—to provide better health care, or for many rural communities in developing countries, any health care at all.

The barriers are well understood. Very limited access to health care facilities in rural and many peri-urban areas. An absolute dearth of doctors, nurses, and pharmacists in rural areas. Low quality care—few diagnostics, widespread fake drugs. High costs for drugs, doctors, and hospital care that can bankrupt poor families. Can technology help—especially information and communications technology? And how to jump start its use in poor countries when even rich countries have not yet adopted systematic eHealth strategies?

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