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.

Mobile phones have become a pervasive technology in developing countries. But can information delivered over a mobile phone change the outcome of a pregnancy? Can a network of mobile phones be deployed that coherently engages communities and healthcare workers to save the lives of newborns? These were the questions that we first asked ourselves four years ago when considering the challenges of maternal and child mortality in Ghana. Our thinking led to the Mobile Technology for Community Health project, or MOTECH, a mobile health program that sends messages to “pregnant parents” in their local language throughout their pregnancy and during the first year of their child’s life, providing accurate information that helps them have a healthy pregnancy and newborn. A complimentary service enables community health workers to use mobile phones to enter information about the patients they have seen and the services they have delivered, increasing efficiency and accuracy on the healthcare side of the equation.

There are now more than 25,000 people registered for the service and almost 300 community health workers using mobile phones to track their patients. Ghana Health Service is expanding the service to additional districts to help meet its top-priority goals: increasing the number of women who receive four antenatal care visits, the number of deliveries that happen with a skilled birth attendant, and the number of newborns who are seen by a health worker within the first 48 hours of life.

From the outset, Grameen Foundation realized that there was nothing maternal health- or Ghana-specific about the technology components we were building. With an eye toward long-term scale and replication, we built components that could be reused in other geographies and other health domains. We also identified other organizations such as Dimagi and InSTEDD that had complimentary technologies and worked with them to make our services interoperable, creating the MOTECH Suite. Today, our suite of technology services is enabling organizations to send messages to HIV-positive patients in India, reminding them to take their antiretroviral medication; provide tools and training to 200,000 health workers reaching the poorest communities in Bihar, India; and help health workers track their clients in World Vision programs in seven countries, ranging from Afghanistan to Zambia.

However, the success of MOTECH is not a result of any technology we have built. The technology is the easy part. The true challenges come in developing strong partnerships and working together to address the myriad operational details required to build a successful mobile health intervention—we have documented many of our experiences from Ghana in a “Lessons Learned” document. Mobile technology is a tool that can make existing systems and services more efficient, and can deliver information directly to users, but the rest of the ecosystem needs support as well. For example, in our early Ghana pilot, we sent reminder messages to pregnant women living in remote rural areas to inform them that they had reached the point in their pregnancy where it was time to go to the nearest clinic and receive a tetanus vaccine. When they arrived at the closest clinic, some women discovered that the clinic had no tetanus vaccine in stock. To achieve the health outcome we sought, it was clear that we had to think about more than simply broadcasting messages.

We have several recommendations for organizations that are trying to develop mobile health services that will evolve beyond the pilot phase:

Design for scale from the outset. This requires making technology- and product-implementation choices that will enable you to reach patients and users at a national level, not just a regional level.
Engage partners that reach deeply into the health system. In most developing countries, this means collaborating closely with government health ministries and designing a system that augments existing programs.
Focus on operations, not technology. For example, it doesn’t do much good to define what a rural health worker will do with a mobile phone if you haven’t thought about how she will recharge her phone or deal with network outages.

There are significant challenges for which we still have not identified solutions—most significantly, we haven’t determined a way to offset the costs of deploying mobile phones and sending messages to patients using voice. However, I remain optimistic that mobile phones will be an effective way to disseminate and collect health information in developing countries, and that there will be a direct positive effect on health outcomes.