To Reach Scale, You Need to Build Trust

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.

For over a decade, the proliferation of mobile phones has fueled a new field called “mHealth”—the potential to transform healthcare through mobile phone technology in developing countries. However, the reality has not lived up to its promise—a survey conducted by the World Health Organization (WHO) in 2011 showed mHealth adoption at an all-time low in Africa.

Yet there is reason to be optimistic. Bill Gates recently said that mHealth’s time has come. Digitally empowered users are promoting adoption of positive, healthy behaviors. For me, there is no better example of this than reaching new and expectant mothers with vital health information. While there are many traditional health promotion channels, including radio ads, TV shows, posters, and advice from community health workers during periodic visits, the ubiquitous nature of mobile phones is uniquely positioned to reach scale. 

If we hope a new mother will listen and act upon the messages she receives, gaining her trust is the single-most critical factor in succeeding at scale. While infrastructure, regulations, and funding are frequently cited as potential barriers to scale, I urge practitioners and policy-makers to remember the importance of building trust with the mother.

At Johnson & Johnson, we have a legacy of putting the needs of mothers first. Johnson & Johnson is a founding partner of MAMA, a public-private partnership whose mission is to engage an innovative community to deliver vital health information to new and expectant mothers through mobile phones. One of our companies, BabyCenter, worked closely with a team of health experts to develop a set of adaptable text and voice messages written specifically for mothers in low-resource settings. More than 100 organizations in more than 40 countries have downloaded these messages.

I believe that there are three critical success factors in developing messages that mothers will trust:

1. Mobile phones allow for stage-based messages—mothers register with their baby’s due date, which allows personalized messages tailored to the exact week of pregnancy or newborn’s life. By providing “exactly the right message at the right time,” we start to develop a connection between the mobile phone and the mother receiving the message. Trust begins to form.
2. Messages are written for mothers. Messages are written by writers for a mother, not a doctor or health practitioner, and in words she can understand. Fast and iterative user testing also helps identify topics such as cultural superstitions and traditions that could be a barrier for moms acting on the advice they get from their mobile phone. 
3. Mothers are encouraged to share messages with their family and friends. Once a mom trusts the messages, she tells others, and the number of users starts spreading across a community.

One of the most powerful examples is the personal testimonial of a mother I met last year in Bangladesh. While visiting Asha Sarkar in Dhaka, I was struck by how she was empowered by these messages. She shared a story about how her newborn was not getting enough breastmilk. Her mother-in-law encouraged her to substitute with milk from the market. As in many households, the mother-in-law’s voice is important, and she is often a primary decision maker for a baby. However, Asha Sarkar got a text message just that morning letting her know that she could produce more breastmilk by feeding her baby more often. Having built trust with the mobile messages she received twice a week for 40 weeks over the course of her pregnancy, she listened to the text message instead of her mother-in-law. Soon, her baby was getting enough milk through breastfeeding. Based on her positive experience, she recommended the service to others, and now many in her community are using it. MAMA Bangladesh recently launched this service (known as Aponjon) nationally, and aims to reach two million mothers and their families.

There are more than 7 billion phones in the world; 5 billion alone are in developing countries. If we use these devices to reach mothers directly and build trust, then programs will scale.

Read more stories by Alice Lin Fabiano.