We work a lot in Africa and there are no Twilios here, and integrating with multiple carriers is both really expensive and really time consuming. So what we do instead is have the organization that is deploying a TextIt buy a cheap Android phone (they are less than $100) and load our app on it.
From then on SMS messages that are received by the phone are forwarded to TextIt and we route replies through it. It works amazingly well and lets people deploy apps literally anywhere in just a few minutes.