Sustainable Financing in mHealth: What is it and how do we achieve it?

As thousands of researchers, policymakers and practitioners have descended on the Gaylord National Convention Center, located just outside of Washington, DC, for the [2012 mHealth Summit](http://www.mhealthsummit.org/), presentations and discussions have covered just about every aspect of mHealth and its uses, from surveillance and population research to health workforce capacity development. But, in the global health arena, one theme has cropped up repeatedly: mHealth financing and sustainability.

Participants and presenters seem to agree that sustainability relies on a number of factors (e.g. sustainability through community buy-in to a project) but that financial sustainability is a particularly important one. Yet financial sustainability itself can be a complicated thing; it can take a variety of forms each with its own unique challenges.

Many presenters identified **government funding and participation** as a worthwhile way to pursue sustainability. Nevertheless, partnerships with the government can be tricky to navigate. Sarah Emerson of the [CDC Foundation](http://www.cdcfoundation.org/) laid out a number of factors that she sees as crucial for successful partnerships, including creating mutual benefit, knowing who one is talking to across the table, and having realistic expectations (e.g. in terms of timeline), among others. Dr. Esther Ogara of the Kenyan Ministry of Health also noted that it is important to bring governments in early on so that they can feel a true sense of ownership over the project.

Several presenters also spoke about the challenges and opportunities associated with **user-generated revenue**. While this model of financing has a number of advantages, it can also be difficult to achieve when trying to serve low-income populations. Nevertheless, Stanley Li of [DXY.cn](http://www.dxy.cn), which has produced a number of health-related phone applications for the Chinese market, emphasized the importance of identifying the “big opportunity” in each market. For example, Mr. Li identified a number of characteristics of the Chinese health market that have allowed for the success of DXY’s phone applications:

* A large population
* A high incidence of chronic disease
* The rapid growth of smart phones
* The rapid growth of healthcare market
* Growing standards of living
* The fact that the government is unable to meet the full need for health care

Other implementers thought outside-the-box when trying to find user-generated revenues while serving low-income populations. For example, [Switchboard](http://www.switchboard.org), which partners with large telecom providers to allow doctors in various African countries to call each other for free to share ideas and advice, helps bring large numbers of doctors onto one phone network, thus providing the telecom provider with new revenues when these doctors make paid calls to family and friends. In Ghana, Switchboard’s model helped Vodaphone and MTN generate US$1.5 million in additional revenue and they predict that they could produce up to US$6.5 million in additional revenue in Tanzania. Moving forward, Switchboard aims to use a share of these profits to ensure its own sustainability.

One key advantage to utilizing these more sustainable forms of financing as opposed to donor funding is the greater opportunity for scaling projects. Several presenters, such as Victoria Hausman of [Dalberg Advisors](http://www.dalberg.com/) and Dr. Ogara, commented that donor funding seems to be heavily focused on pilots and “new” innovations, rather than on scaling current projects. In fact, according to Ms. Hausman, a full 85% of mHealth funding has been going to pilots.**

Government funding and user-generated revenues are just two models for sustainability - there are a many other opportunities that are being explored. As organizations experiment with these various models for sustainability, they would do well to continue to take opportunities such as the mHealth Summit to share the successes and challenges that they are encountering.

**_It should be noted that someone with the World Bank commented that the World Bank *is* particularly interested in scale up, but that many pilots are implemented without built-in plans for scale-up._