Want to scale your mHealth solution? Mobile health implementers say the key is to engage with the government early and often so that they will eventually take over the project and bring it to scale.
Many mHealth tools focus on improving access to services, level of care and gathering data, all of which often require engaging frontline government health workers, working with government-run health clinics and integrating into health information management systems.
Whereas in some cases in the past government has been engaged only superficially or is brought into the process after a program is underway, mHealth implementers are reaching a consensus that identifying and cultivating champions within government from the start of the project is critical to securing buy-in — and potentially handing the project over to the government to scale in the long run.
“If you don’t have government partnerships, it is such a major barrier to achieving scale that even a well-designed program is likely to fail and not achieve scale”, said Sean Blaschke, a health systems strengthening specialist for UNICEF.
CARE’s experience in India
CARE has a pilot project in Bihar, India, with 500 local community health workers being trained to use a mobile phone platform that registers clients, schedules services, allows for monitoring of those services and for any goods that may be distributed.
The platform is modular and allows for additions with relative ease. The initial model was designed to address about 70 percent of the tasks frontline workers carry out, while the government — which is now taking the project to scale across the state to 100,000 frontline health workers by the end of 2014 — will develop additional modules.
“This is what we always hope for — that once it is successful, we will be able to get government to do it,” said CARE chief of party Shamik Trehan.
There was initially quite a bit of cynicism that the government will not purchase the phones or believe in the ability of the frontline health workers to use the technology, but the successful pilot made a strong case, he said. CARE got government approval at the start of the project and shared information throughout, which also helped. By the time the chief minister approved scaling the project, after it made its way up the chain of government officials, he did so in about ten minutes.
“If there is a value proposition for the government and you truly offer something transforms their current work scenario, the government will take it up,” Trehan said.
D-tree International was in the process of implementing an mhealth project in Tanzania aimed at reducing child malnutrition — when its key government champion left.
“The ministry still supported it but without a champion it was very hard to move things forward,” said Marc Mitchell, founder and president of D-Tree International.
One way to mitigate against that challenge is to build relationships at all levels of government and integrate them more closely into the project.
The Grameen Foundation’s Mobile Technology for Community Health initiative in Ghana was created as a joint project with the country’s health service and engages government at the national, local and regional level.
Starting as partnership has been critical to getting the Ghana Health Service to take ownership of the project and enable its successful scale-up. MOTECH Ghana provides two main services: mobile midwife — a mobile messaging tool for pregnant women and nursing mothers — and a data management tool for frontline health workers to register patients, record data and upload it to central databases.
“This project would not have been possible without GHS,” in large part because the programs use government nurses and systems, said Anitha Moorthy, senior health advisor for the Grameen Foundation.
Since start of the pilot, the program has evaluated government needs and sought to address them, including through a national steering committee that is part of GHS.
“What we have is strong buy-in from GHS at regional and district levels,” she said.
It is important to understand the government’s roadmap, goals and plans when entering a partnership and implementing a program.
“Being MOTECH, even though we had initially a lot of the financial resources, the technical know-how and the technical resources, we still have to make that work within GHS’s plan,” said David Hutchful, director for technology innovation.
GHS got some funding in the project grant, which has helped keep them engage in the process.
The critical government partnerships are not always easy and often require a lot of patience, he said. Building those key relationships takes a considerable amount of time and requires someone managing the relationship at all levels to ensure that everyone is informed. If mHealth implementers aren’t carefully monitoring relationships, a perceived slight by a government official at the regional level could slow a program down for months.
“You need someone who is basically full-time engaging at all levels, making sure that everybody’s interests are aligned and everybody’s needs are being met,” noted Hutchful.
MOTECH is now in the process of handing over a lot of the operational pieces of the project to the Ghanaian government, and is now in five regions. The government is handling more of the on-the ground pieces and by March should have the capacity to handle the technology.
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As a Devex Impact reporter, Adva covers the intersection of business and international development. Previously, she has worked as a reporter at newspapers in both the US and South Africa. Most recently, she has been ghostwriting a memoir for James Kofi Annan, a former child slave and NGO founder in Ghana.