Scaling Mobile Health Solutions the Hard Way

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.

“If you build it, they will come,” may make for good Hollywood drama, but when it comes to mHealth, it’s a false promise. We should know. We learned it the hard way.

Like many other organizations, when building our mobile platform we thought the technology was the hard part. Our social enterprise, Living Goods, operates networks of Avon-like microentrepreneurs who go door-to-door selling a wide range of life-changing products, including treatments for malaria and diarrhea, fortified foods, clean cook stoves, and solar lights. The mobile technology platform that Living Goods built delivers weekly marketing promotions and health education messages, collects and monitors treatment data in real time, provides automated treatment and pregnancy reminders, and tracks performance of field agents. It’s a smart system fully integrated into our operation—or at least that’s our aim. It turns out that building the technology platform was the easy part—getting users to embrace it was a far greater challenge.

What’s in it for me? Living Goods built a mobile platform to help our agents succeed—to improve their clients’ lives, and increase their own sales and profits. Naturally, we assumed that our agents would share our enthusiasm for this transformative technology. Wake up call—what we saw as an enormous opportunity to improve impact and sustainability, the agents saw as more work. To ensure the continuity and accuracy of data, we asked them to log their client interaction via SMS while still keeping paper records. Two times the work. We made other mistakes too. We didn’t sell the service to them. We simply instructed them to start using it. We didn’t emphasize how it would help them succeed. We didn’t highlight the free service we are providing their clients—for every new pregnancy, birth, and treatment they upload, Living Goods sends automated reminders to help their clients stay healthy. These reminders and marketing messages not only improve health impacts but also drive demand for the products our agents sell. They make for more satisfied, more loyal customers. But when we launched our system, we jumped right into training, we did not effectively showcase all the ways the new system would help them succeed.

Overcoming obstacles to adoption. We failed to foresee a host of other practical daily challenges for our users. The nice tidy world of prepaid wireless plans, single carriers, and easy access to electricity are foreign concepts in the communities where we work. Phone sharing, multiple SIM cards, and regular power outages were just a few of the obstacles we encountered. Many organizations fail to plan for these functional challenges of phone ownership at the base of the pyramid. Many also fail to fully understand their audience’s familiarity with mobile phones. Including us. The majority of our agents owned a phone but didn’t know how to use it beyond making voice calls. Many of them carried around slips of paper with friends’ numbers, not knowing they could store contacts in their phone. Basic texting was foreign for many. Since our reporting protocol relies on SMS, we needed agents to use SMS regularly and accurately. We couldn’t rely on American Idol to drive SMS adoption among the poor communities we serve in East Africa. So we provided intensive training and an incentive scheme to drive adoption. Many agents shared phones with their family members and did not always carry them in the field. Others had cheap, unreliable phones. In response, we started selling a decent-quality, low-price phone—more than 40 percent of agents bought one. Another, unsurprising impediment followed: Many agents had trouble keeping phones charged without their own power source. We stepped in and helped them buy solar chargers. After three months of attacking these practical problems, Living Goods increased user adoption from 25 percent to more than 60 percent—remarkable growth, but still short of our ambition of universal adoption.

We continue to make great progress toward realizing the full potential for our mobile platform. In the year to come, we will test new tools such as mobile money, consumer finance, and social selling via mobile. As we experiment with these exciting new tools and technologies, a core challenge will remain: The unglamorous work of deployment is the difference between a clever idea and a real impact driver. Organizations that master this skill stand the best chance of turning promising mHealth pilots into fully scaled systems.

Read more stories by Chuck Slaughter.