Many governments, donors and program implementers are enthusiastic about the role of mobile phones and associated technologies in a wide range of initiatives, including strengthening health systems and improving health outcomes.
Groups such as the Mobile Alliance for Maternal Action are convening thought leaders in mHealth and maternal child health. There is also a growing body of evidence that mHealth can support maternal and child health goals in some critical areas.
However, over the last few years there has been growing conversation about what some call mHealth “pilotitis” — the phenomenon that while there have been many mHealth pilots, from sub-Saharan Africa to South Asia, the majority have not been taken to scale, with even fewer success stories.
GSMA’s “Pan-African mHealth Initiative” provides a good sense of the landscape in sub-Saharan Africa. The scaling challenges in mHealth have led some development practitioners to become skeptical about the reality versus the hype of mHealth, and where it should fit into global health funding and programs given many other competing priorities.
As the global health community organizes around a post-2015 agenda, where does mHealth fit into program and funding priorities? There are three perspectives I believe program implementers, technology solution innovators and social investors should consider when thinking about mHealth in the post-2015 environment.
Pilots are important in mHealth, but our approach to pilots may need to change
Pilots and experimentation are at the heart of uncovering new ways to solve challenging problems in global health. One issue we face that makes mHealth — and information and communication technologies for development — pilots different from other types of pilots is the need for rapid feedback and product iteration within the context of an ongoing program.
Technologies like those used in mHealth typically enable broader program goals and thus are implemented in a programmatic context. The rapid feedback and product iteration approach to testing a new mHealth solution does not often align well with traditional development financing paradigms.
Challenge grants for mHealth innovations could be one way in which funders are looking to address this issue for new concepts, but the disconnect between traditional development and the accelerated testing of mHealth solutions needs to also be considered across the whole funding ecosystem for mHealth innovations, from concept inception to scale.
Organizations such as PharmAccess combine an mHealth research lab that allows for rapid iteration on the research side with a ready-made channel for taking the best performing solutions into a scale planning and implementation process.
If the goal is to scale regionally, solution pilots and testing should push regionally quickly
Typically, mHealth pilots start exploring the impact of a new solution in a specific country or community. The localized approach is part of what led to the proliferation of mHealth pilots I described earlier.
While specific community-based pilots are important as a starting point, it is worthwhile to test solutions regionally early in the product design process if the goal is to design a highly scalable mHealth solution addressing a pervasive challenge to global health. This could mean throughout different regions in a country or across a several countries, depending on the innovation being tested and program implementer’s objectives.
Regional implementation will help inform the testers about how resources can be best invested to make the product relevant in many contexts, while retaining a level of localization. With ClinicCommunicator, a health technology product designed by the company I founded, we started work with health facilities in Uganda, but have moved very quickly to start testing the product with other partners across East Africa.
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We find this regional approach to be helpful in informing our product design process today so that the investments we make receive feedback from a broader context. Ultimately, an organization or fund investing in an mHealth initiative will benefit from program implementers bringing clarity to their scaling goals early in the process, enabling them to determine whether the real impact of their innovation is localized and will take some time at that level of testing or whether the goals can be expanded and scaled up in many country contexts.
The U.S. Agency for International Development’s Development Innovation Ventures is an example of a program that helps groups distill the scale issue in the application process based on the stage of their innovation and the associated phase of the grant for which they are applying.
Interoperability with existing systems that are getting traction supports scale, for both open source and proprietary systems
Innovation ecosystems usually involve both big and small players alike. Big players offer infrastructure and support across a wider range of potential markets and regions, while smaller players are needed to bring focus to the needs of particular communities and types of end-users.
In the end, the solution has less to do with whether the approach taken is open source or proprietary, than it does with the nature of the needs presented and the types of problems to be solved. DHIS 2, OpenMRS, and Vumi (of the Praekelt Foundation) are all open-source solutions that are getting increasing traction in the global health environment. They are being adopted by governments, nonprofits and other social enterprises in many countries. Solution providers that are currently designing new mHealth innovations, I believe, will benefit the sector by considering interoperability with the existing solutions that are already getting traction.
Such an approach can create the potential for rapid scaling of the new solution while also lowering the cost of technology adoption for groups that have already made bets on products such as those described above.
Moreover, while open source solutions are important, there are other private sector mHealth innovators that offer very strong and pervasive platforms. For example, Microsoft’s “4Afrika Initiative” identifies commercial startups that show an ability to combine synthesis with innovation.
Salesforce has increasingly made its platform accessible to nonprofit organizations working in international development through its corporate social responsibility initiatives. While some social entrepreneurs and governments can be skeptical of proprietary solutions, many large for-profit technology companies, including Microsoft 4Afrika, are beginning to shift toward open standards and interoperability.
I believe that the most successful, most scalable solutions will find a pathway that embraces the best of both worlds from an open source and proprietary platform perspective.
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