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Monday, March 16, 2009

Mobile Health for Development: Challenges and Opportunities

By David Lehr

Reaching Remote Populations through mHealth.

The UN Millennium Development Goals (MDGs) set out clear and ambitious targets for reducing child and maternal mortality worldwide, but a growing shortage of healthcare workers and other economic and environmental trends have made achieving these goals by 2015 more and more unlikely. As mobile phone usage continues its explosive growth, mHealth, the use of mobile devices in health solutions, has the potential to revolutionize healthcare delivery in much of the developing world. mHealth includes a range of applications such as remote data collection, education and awareness, remote monitoring, communication and training for healthcare workers, disease and epidemic outbreak training, and diagnostic and treatment support.

A recent announcement in February 2009 by the Rockefeller Foundation, United Nations Foundation and Vodafone Foundation to form the mHealth Alliance to facilitate global innovation and ensure maximum impact in the field of mobile health (mHealth) has drawn attention to this area. The Alliance will expand upon the mHealth initiatives of multiple organizations around the world.  It will also encourage the development of scalable, sustainable, and open-standard health solutions that can be made widely available while supporting projects and research focused on increasing opportunities for mobile health, particularly in emerging economies.

In conjunction with the announcement, a report authored by Vital Wave Consulting titled mHealth for Development, The Opportunity of Mobile Technology for Healthcare in the Developing World, was published. The report examines the role of mobile technology in healthcare delivery - looking at both the evolution of mHealth in developing countries and the critical success factors for making mHealth applications more widely available.

The report focuses on the dynamics of mHealth sustainability with special attention devoted to the incentives required for a successful mHealth value chain, calling for a concerted action by all stakeholders - NGOs, governments, funders and the private sector - for mHealth to reach its full potential. 51 implementations across 26 developing countries were looked at with India, South Africa and Uganda standing out for their level of mHealth activity. While this overview is not conclusive, Vital Wave Consulting speculates that the prevalence in India could be due to the degree of technology innovation there, while in Africa, the very large rural populations, which are often outside the reach of traditional IT or health infrastructure may be one of the drivers.

It's increasingly becoming accepted that without scale, sustainability suffers. This is even truer when the technology sector is engaged. For mHealth delivery, mobile operators and handset and application providers are integral partners, but they depend on scale to achieve revenue goals. Scale has always been somewhat tricky to define with The Skoll Foundation referring to scale in a social venture as a significant increase in impact including size, amount or extent leading to exponential growth with others talking about scale in terms of reaching several hundred thousand users.  For the private sector, scale is measured in millions of units (or users) in multiple geographies and without that scale there is little chance of profitability and it is difficult to engage these partners on a commercial basis.

Unfortunately, few mHealth implementations today have discovered a sustainable business model. The case studies presented in the report rely largely on seed funding from philanthropic organizations or are part of a corporate social responsibility initiative. These early implementations demonstrate real proof-of-concept and initial positive results, but once donated funding dries up the projects are often prematurely terminated. This leaves those most in need, people living at the BoP, back where they started - with few health services available.

The next stage for mHealth is to increase the scope and scale of operations by building on the lessons learned from current successful implementations. The report points to key building blocks for scale that include: 

  • Forging strong partnerships
  • Designing with the end user in mind
  • Tailoring communication to social, ethnic  and demographic groups
  • Building a long-term funding plan
  • Setting measurable goals
  • Collaborating with other mHealth organizations

Today, health challenges may well be the most significant barrier to sustainable global development. The next few years present both an overwhelming challenge and an important opportunity to take advantage of the momentum of mobile health, thus realizing dramatic improvements in healthcare delivery at the bottom of the pyramid.

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  • Managing Partners

    William Davidson Institute
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    Citi Foundation
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    IADB
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