Enabling Environments for mHealth

Two weeks after attending the mHealth Summit in Washington D.C., I have had time to reflect on what I learned about the core issues facing the mobile health industry today. I, like many others attending the conference, gained valuable insight into the principal areas that need to be addressed in order for mHealth programs to thrive - namely scalability, financing, business model design, partnering, and data management. But what struck me the most about the barriers to sustainability of these programs is the “bigger picture” concept underlying and linking each of them – that in a developing country, it is the stability and effectiveness of the enabling environment for mHealth, executed by all of the various stakeholders involved, that is essential to achieving long-term impact.

Through identifying and analyzing the most innovative private sector programs and policies in health markets throughout the world, the Center for Health Market Innovations (CHMI) has uncovered this “big picture” trend in several key countries, including Kenya, India, South Africa, Bangladesh, and the Philippines (all of which were represented at the summit). Indeed, the mHealth programs in these countries stand out for their unique products, strategies, and implementation practices, as well as for their ability to effectively address deep-rooted health problems and generate positive health outcomes for societies. But what common trait has allowed the programs in these economics to thrive, while other emerging nations struggle to apply them successfully? Many of the participants at the summit, CHMI included, point to one overarching reason – the willingness and capacity of ALL stakeholder groups – from governments, to mobile operators, to health care providers, to NGOs, to funders – to connect and collaborate in order to promote the right mix of policies for yielding high growth and innovation in the health and technology fields.

In developing nations that are looking to adopt mHealth models, critics often worry about their organizational and institutional capacity to sustain such programs. Many mHealth industry leaders at the summit (in the “Maximizing Impact” session, for example) alluded to the fact that efforts to strengthen in-country capacity-building and sound policy environments have often fallen short, and that these obstacles must be overcome if a nation wants to see the same success in mHealth that Kenya and other nations have enjoyed. Nonetheless, mHealth providers continue to work toward achieving enabling environment “best practices.” Brooke Partridge of Vital Wave Consulting, for instance, mentioned she is working with the Mobile Alliance for Maternal Action (MAMA) in Bangladesh to put together more complete local teams to procure services and products needed to fill health care gaps, and with the Ministry of Health in Nigeria to train staff on performance-tracking to advance monitoring and evaluation initiatives.

But more needs to be done. In this era of mHealth program “pilot-itis”, as it has been termed, what role should each stakeholder along the mHealth chain play in order for these programs to expand? How can they work together to foster the collaboration necessary to sustain mHealth initiatives? In speaking with individuals from a variety of different organizations at the summit, I was able to better understand how all of the stakeholders interact and where conflicts emerge due to divergent interests and perspectives. In this regard, the following points stood out to me at the conference as to how these various actors might strengthen and improve their roles in the mHealth space:

**DONORS**
As Sally Stansfield of Deloitte mentioned, mHealth donors tend to put too much pressure on in-country leaders to adopt products or programs that may not necessarily be appropriate or beneficial to their population. Instead, donors need to look more toward these leaders to actually make the case for mHealth within their country and to make the “right choices” that will address the health needs of their population. In other words, donors need to take a more participatory approach rather than applying blanket program requirements across nations.

Andrew Whyborn of Greenmash Ltd seconded this point. He argued that mHealth leaders need to make sure they are working with country leaders to understand the key health issues at hand, as well as training implementers on how to use data. Essentially, data is meaningless unless it can be directly applied to the needs of the population and country leaders know how to use it accordingly.

**MOBILE OPERATORS**
I heard from several different individuals that they face challenges in partnering with mobile operators due to differing motivations and roles. One lesson here is clear - collaboration is key. Mobile operators should strive to align their efforts more closely with local policy-makers and NGOs to in order to maximize efficiency in addressing pressing national health issues. Rather than single-handedly driving efforts, they need to be more pro-active in creating joint solutions. While individual sustainability, profitability, business model design, and competition are clear priorities for mobile operators, they need to keep in mind the broader goal of mHealth to produce social good, and let this guide their actions.

**POLICY-MAKERS**
Policy-makers are in a unique position to shape and encourage the effectiveness of mHealth efforts. Governments of developing countries can do much more to encourage advancement in this space. For instance, they can provide grants for researchers and engineers studying and designing mHealth solutions, and run business plan competitions to drive innovation. They also can offer financial and tax incentives for health care providers who use new mHealth models that generate positive health outcomes and who effectively use mHealth technologies.

There is also a clear need for better communication between local policy-makers and mHealth providers. Whyborn argued that mHealth program developers and implementers need to work more closely with local leaders to make their products more patient-centered.

Finally, policy-makers need to work harder to balance regulatory environments in the health care and technology industries. In developing countries in particular, they tend to be heavy-handed and over-regulate the health industry, thereby limiting new product development and innovation. While a certain amount of regulation is, of course, essential, governments need to find the right balance so that mHealth services are more market than regulatory-driven.

In short, the overall message from the summit is clear: Stakeholders need to find ways to work together and streamline their efforts in mHealth in order to foster a sound enabling environment for programs to succeed in the long-term. Hopefully, they will begin to make strides in this direction.