How Do We Cure mHealth Pilotitis? Critical Lessons in Reaching Scale
Successful pilots are in abundance, but most of the sector has been slow to reach scale. This series of posts offers nine different perspectives from leaders in mHealth.
mHealth has the potential to transform healthcare, particularly for the hardest-to-reach women and children around the world. The debate about exactly how, when, and in what form is alive and well. Successful pilots are in abundance, but most of the sector has been slow to reach scale. In short, the sector has a case of mHealth Pilotitis. In the first debate of a series on mobile health, the Skoll World Forum on Social Entrepreneurship partnered with Johnson & Johnson and Stanford Social Innovation Review to surface important lessons and learning from some of the world’s leading organizations who have taken mHealth services to scale. This debate will also set the stage for a larger discussion on mobile for development at this year’s Skoll World Forum in Oxford, UK.
Access to quality health services remains an enormous challenge, especially for those living in rural, remote areas with weak infrastructure, few material and skilled resources, and extreme poverty. In the less-developed parts of the world, these communities comprise up to 75 percent of the population. Women and young children are disproportionately affected.
In Bihar, the poorest Indian state with a population of 104 million, 305 mothers die for every 100,000 live births, and we lose 77 children under age 5 per 1,000 live births—both figures are much higher than the national average. As more than 85 percent of these women and children reside in remote areas and do not travel far outside of their own village, delivery of essential medicines and quality health services is very challenging. However, studies show that 83 percent of all adult women in Bihar have access to mobile phones, though only 32 percent own one. Among health providers, including the estimated 200,000 informally trained ones serving as first-line providers in rural areas, mobile phones are universal. Such a resource caught our attention early on in the development of our rural health service delivery approach. We started incorporating the use of simple voice and text-based functions to extend the reach of our services, and we are adding more functionality day by day. These mobile tools have now become a necessity for our rural health infrastructure.
There are fundamental reasons why mHealth has not gone to scale. Of the three options available for service delivery—the public, private and NGO sectors—only the first two are amenable to functioning at scale (an estimated 3.3 million NGOs in India contribute less than 1 percent of health care). The public sector is usually reluctant to integrate new concepts, especially those involving drastic paradigm changes that will be underpinned by legal and medical concerns. The private sector offers the scale but is highly fragmented, particularly among providers offering primary health, where mHealth has the most relevance. The providers working beyond cities often serve a small population, which makes it difficult for viable markets to form for the technology investment.
This background explains the decision for World Health Partners (WHP) to engage with the private sector in the first phase and with the public sector in subsequent times to achieve scale. WHP uses the strategy of leverage: Harness resources that already exist so you can achieve scale quickly and cost efficiently. We are setting up a network of 16,000 rural providers, 300 paramedical facilities, and 100 medical clinics in a triaged architecture where technology plays a vital part. Training of providers focuses on improving current skills; low-cost technological solutions are used to connect with higher levels of care. Both functions give an added income, thereby building the strategy around the core profit-making DNA of the sector.
We implemented mHealth tools the same way we did with other components of our service delivery program, aligning them with existing health practices to serve as a value enhancer, as well as a complement to our integrated health service ecosystem. We paired simple applications on smartphones and tablets with a sophisticated back-end to manage product inventory, track lab samples, and generate reports. Internet and mobile-based consultation and diagnostic systems connect patients with remote, qualified doctors. Use of simple forms and interactive voice response applications help improve data integrity, patient tracking, and provide alerts and reminders, etc. The ability to use a mobile device for multiple functions made the tool more valuable and cost-effective, both for WHP programs and our network providers.
The results from our large-scale adoption of information communication technologies have been largely positive. Internal surveys indicate that there is a sharp increase in client load for our private providers, indicating that integration of technology adds commercial value; rural clients find the technology easy to accept, and response is particularly high amongst the poor (51 percent of the 75,000 patients treated so far come from the poorest two economic quintiles). We are seeing increased adherence to treatment, as well as an uptake of services by the rural poor due to the convenience and ease of seeking quality care in or near their village. We believe that additional point-of-care diagnostics, such as microscopy and sonogram, will greatly improve health outcomes.