About the author: Dr. Ebele Mọgọ is a doctor of public health with over 10 years of experience in designing, implementing and evaluating transformative public health projects. She is the principal of ERIM Consulting, which uses research evidence and business insights to advance public health impact.
Have you developed yet another groundbreaking mobile health solution? If so, you must be thrilled to think of just what it can do, and the way you can improve many lives with it. The excitement is not uncalled for; digital health tools, such as mobile health tools, hold the potential to improve disparities in access to health services, make up for resource limitations in formal health infrastructure, and reduce the cost of health services.
However, it is important to know that although there are several mobile health pilots globally, only a few of these projects have been able to sustain their operations over time and scale, or to enable increasing members of the population access to the goods and services they offer. In fact, just a small handful have been able to achieve a coverage of over a million users. Mobile health tools also tend to be used by younger, more educated, healthier, and richer members of the population. As a result, despite their promise, such tools can also widen disparities if they do not help people overcome challenges like literacy and technical skills that make such technologies inaccessible to people who may need them the most.
The key to creating mobile health solutions that will build a healthier world is to remember that you have just created a tool, not the solution. Innovation is not simply creating a new piece of technology, it is solving a problem and creating value. Therefore, your journey has only just begun. To set up a mobile health solution that will scale, truly achieve impact, and close disparities in access, you need to do the things that the very few mobile health projects that scale have. Here, we will draw from best practices from USAID’s in-depth profile of mobile health programs that achieved scale, as well as the learnings of mobile health programs across the world.
Focus primarily on the user, not just the tool
Even the fanciest tool is not guaranteed to solve the problem if it doesn’t quite suit the user. There is no shortcut to understanding your user, and doing so is one of the best investments to make if you aim not just for activities, but for impact. Solutions that scale involve the end user in planning, creating, executing, and assessing the impact of the new mobile health solution. Remember to consider not just the most accessible users, but those from marginalized groups such as women, children, people with disabilities, and people in conflict and disaster settings.
CareMore reports in the Harvard Business Review that by creating technology to respond to the needs of their end users, they reduced health plan transportation costs by over a million dollars, and also improved patient satisfaction and technology adoption. South Africa’s MomConnect was able to engage end users through communicating in language that they could understand, tailoring communications to the gestational stage of the mother-to-be, and providing useful resources and parenting support that helped them establish an emotional connection.
Caring for the user goes beyond adoption and satisfaction. It also extends to protecting their interests, particularly by assessing and mitigating risks associated with their data privacy. In addition to talking to your end user, you can get more information on the context by networking among related communities of practice, and by understanding the local laws to help design a solution in line with the existing regulations.
Design for sustainability
Remember Steve Covey’s advice, to "begin with the end in mind"? Solutions that scale keep this goal in mind from the onset, and not as an afterthought. This means that understanding the contingencies that may limit scaling from the very beginning and making plans to mitigate them. Pay attention to the design of your technology and make sure that it can be scaled regionally and locally. Test for and demonstrate impact from the beginning.
Solutions that scale think about sustainability from the get-go. Financial health is critical for your program’s growth and its ultimate impact, and to stay long enough for impact you will need long-term financial commitment. Whether through earmarked government funds, donor funding or profits, long-term financial commitment is especially important around the core functions of your mobile health program that cannot be compromised.
However, sustainability is not just about money — it is about talent and capacity, as well as processes and partners. This means that you start scanning the landscape for partnerships that can support your solution’s growth, and begin negotiation on these, from the very beginning. Start early with documenting processes that you can replicate. Your methods, tools, platforms, and frameworks should be “recyclable” — that way, you can build on top of them as you scale. Solutions that scale work with and invest in local communities, because their growth allows them the capacity needed to grow.
Work closely with your strategic partners
Solutions that scale optimize their partnerships and their systems for collaboration. One aspect of this is building buy-in with the government. How can you work with the government in your context to ensure that a solution is integrated into the health system in line with the national, regional, and/or local public health strategy? In integrating MomConnect with the health system, the project was able to build demand through facility-based registration, the use of a facility code for tracking, and the use of a help desk that generated data to strengthen supply.
Designing interoperable systems using open-source software and open standards makes it easy not only to integrate your solution into the health system, but to also use the same platform for future population groups and other related public health targets. For example, a hypertension management project may eventually add targets for physical activity. Or, a maternal health project may add on use cases for early childhood development. Keep this potential in mind in the beginning.
Advocates in the government are a big win and can be a catalyst for sustainability. South Africa’s MomConnect built buy-in with the National Department of Health's Minister of Health, Aaron Motsoaledi. He served as a visible champion of the project. MomConnect also had local focal points in addition to high-level political support. Think of partners across disciplines, sectors, and areas of expertise, such as not for profits, for profits, community groups, academia, and funders. Each partner can support various pieces of the puzzle: operations management, evaluation, capacity building, community mobilization, political will, and technical leadership, among others. However, just as it is important to build partners, it is also important to have a clear plan to align communications across all such partners.
Measure everything
Finally, create solutions that scale design for evaluation. This allows them to measure impact. From the onset, you will need to identify your data needs and gaps to design your project for evaluation. This includes not only measuring activities but also measuring outcomes. You also need to explore how the information you get from your systems and partners will inform your management decisions. South Africa’s MomConnect has regular monitoring processes, including weekly reports across the user journey that are discussed regularly by the senior leadership of each provincial department of health and used to troubleshoot and improve quality.
So — you have an mobile health idea or solution. How can you apply these tips to ensure your project is sustainable, affects a greater and more equitable portion of the population, and can achieve the impact you seek? By putting these tips into practice, you will have a solution that truly fixes the problem and, therefore, something to truly get excited about.
