The Challenge to mHealth Scale-Up
Collaborative efforts pave the way for success
As a first-time attendee of the annual mHealth Summit, I was surprised, and frankly impressed, by the sheer size and scale of the convention. Though I had recognized mHealth as a rapidly evolving field that engaged multiple industries, the assortment of attendees, companies, and countries I saw indisputably underscored the momentum that mobile technologies have gained across health sectors. Seeing this vast inclusion of multiple participants unavoidably provoked questions about the challenges of collaboration and convergence.
Fittingly, the afternoon session that I attended on Monday was titled Scale-Up: Creating an Enabling Environment. It addressed the topic of how to enable pilot programs to move beyond preliminary stages, and reach the next step of supporting and expanding the user base as a sustainable model. The discussion produced three key takeaways:
1) Define what is being scaled. Dr. Garrett Mehl from the World Health Organization was the last of three presenters, yet his argument was well taken. Scalability often refers to general expansion, yet it requires precision to pinpoint what program components are able to adapt to increased demands. Dr. Garrett defined three main areas to examine when programs were looking to expand: project, platform and strategy. These three areas encompass vastly different aspects that govern and affect programs. “Project” refers to a micro-level examination of programs, ranging from geographic location to engagement strategy. “Platform” involves the IT and operating systems, which affect mobile tech development. Lastly, “strategy” refers to the effectiveness of interventions, from assessment of efforts, to understanding and monitoring behavior change in end-users.
2) Collaboration is key. The second presenter, Sarah Emerson from the CDC Foundation stressed the importance of collaboration as a component to successful scaling, especially in the form of public-private partnerships. Citing Tanzania’s Ministry of Health & Social Welfare as an example, Ms. Emerson described how “Hands for Health,” an independent organization, was adopted by the Ministry and scaled up as a national campaign in 2009. The campaign has since released several different programs, the most recent being “Wazazi Nipendeni” (or “Parents Love Me”) which uses text messages to encourage pregnant women and their families to take the necessary steps to help ensure a healthy pregnancy and safe delivery. Within thirteen days of a recent launch, the campaign reached 20,000 engaged users. She concluded that collaborative partnerships require each party to know their own needs well (in order to have them met), and to set realistic expectations with each other, so that they can remain flexible if plans go awry.
Along this line of thinking, Hajo van Beijma from Text to Change also spoke on the importance of collaboration. His perspective was that scale is not achievable without a strong communication strategy. He cited that as of last year, the company released its proprietary software as open-source and freely available, in order to further collaborate with others in the field.
3) Don’t believe the magic-bullet. Mr. Van Beijma also spoke of the rapidly emerging hub of mobile technologies in developing countries. For several years, growing public interest has only increased the hype surrounding technology as a “magic bullet,” whose successful implementation will improve access to, or quality of, healthcare in many low-income or rural communities. Yet expansion is accompanied by growing challenges, which are not likely to be solved by quick-fix solutions. Rather, efforts to scale up are long-term endeavors that, at the present, require more financing and cooperative efforts. Currently, the primary pool of financing is chiefly given to early stage pilot programs over second-stage growth programs, which limit industry-wide growth. Mr. Van Beijma suggests that this mounting challenge with mhHealth is a reality check – one that may incentivize further collaborative efforts within the industry.
To conclude, the overarching theme at this year’s mHealth Summit appeared to push for more collaboration within the industry. In the end, it is not the sophistication of the technology, nor the amount of donor financing that makes the solutions – rather it is the ultimate achievement of positive health outcomes that should determine measurable success.