The phenomenon of “pilot exhaustion” in many countries has been well documented. Over and above this trend, we also see the same mobile health projects being replicated in a single country, sometimes even the same region, hitting the same end-user in different ways. In India alone, there are threee or four different programmes for collecting health records for a mother and child with the result that a community health worker needs to maintain almost 11 different registers. In other places, the innovation in technology does not keep up with the acceptance from the medical establishment. These problems can never go away fully because health systems are by their nature complex and integrating the technological possibilities of the mobile channel with a suitable business model that sits well with healthcare financing of a particular country is no simple matter.
We have begun to collect our findings from these projects and feed them back to the community in forums such as these so that we can connect people and begin to get better at this. The obvious first step is for everyone to understand the health need in the market, and overlay that with the mobile opportunity. One can argue that everyone understands national health needs fairly similarly, but actually what we’ve found is that different stakeholders understand the same heath need in different ways. It is also important for different parties to appreciate where other stakeholders are coming from and their particular contribution to filling health needs. Having a common framework to work from improves understanding between parties much better. Having a discussion between implementers, regulators, commercial and public parties helps align what everyone is doing.
Once the health need is commonly understood, parties are then in a position to determine the right mix of mobile health services to best suit that need. Typically, services are classified as being on a continuum of care – ranging from prevention, diagnosis, treatment, and monitoring. Two aspects are particularly important to mHealth but are not usually classified as core. First is demand generation which is the exercise of creating awareness for health and mobile health within the target population. Health unfortunately is by itself not a sexy service. In some of the places we have worked, the mobile health program is complemented with a building of general awareness through TV, radio and other means of marketing to generate buzz and excitement for the programme. This lays the foundation for mobile health being adopted by the general public. The second aspect is capacity-building also known as systems strengthening. This has to do with both the capability of the health system itself, meaning both the skill levels of the people that work in it as well as the systems and infrastructure that support them.
With a mobile launch, incentives are not just for consumers but also understanding the incentives to the community health worker as well as medical professionals and the commercial entities around them. Here in the GSMA we have begun a research program to understand these stakeholders, and what motivates them, as a means to design better programs to appeal to them. Incentives may sometimes be completely unrelated to the service being offered. For example, the key pain point for government-paid community health workers in many emerging economies is not being able to get their incentive payment because of corruption in the system. Linking the program with a mobile payments mechanism that gives the community health workers both financial inclusion as well as an incentive to use the service is absolutely critical in them adopting the system.
For mobile health to work, we often need to work out where there is restrictive regulation in terms of data privacy, security, medical consent and practice and re-evaluate in terms of what the mobile channel can do. Often this does not only involve governments but also medical professional councils who set professional guidelines rather than regulation. Sometimes, the challenge is in identifying where there is a lack of regulation in the system. For example there is no regulation in Brazil about whether consultation is allowed via the mobile phone. Discretion is left to the medical professional. In such a case, the fear of medical liability is such that tele-consultation services cannot be provided and so we lose a potentially valuable way for consumers to access health advice especially in rural areas where there is little availability of primary care.
It is unavoidable that in an ecosystem like this there will be many players, some of which need to work in partnership, and many of which will be duplicated. The real challenge here is to acknowledge that this will always happen, and have a framework that both represents the different necessary components, as well as describe how the parts of the system can co-exist side by side. In addition, the framework has to describe how different parties can help each other achieve their goals and what degree of infrastructural and data sharing can make this happen.
The last items are intimately linked. We talk of sustainability a lot in this space particularly in low resource settings. The bottom line is there are different streams of funding and all need to be called into play in order to make this work. The private sector can help in channelling consumer spend into health activities to a certain extent, governments can channel public funds through the healthcare reimbursement system, and donors can channel funds through the fundraising process. All three need to work together in partnership but at the same time all parties will require evidence in order to distribute those funds effectively. Donors and governments need evidence of health impact, and the private sector will need evidence to be able to continually market to consumers as well as to potentially receive health reimbursement from the health system. Keeping both happy are important steps towards the goal of sustainability.
Kai-lik Foh is a program manager for mobile health in the GSMA's Development Fund.
The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members.