Out of the words associated with mHealth, ‘sustainability’ is likely at the top of the list. It has become a very significant issue, with pilot after pilot failing to scale or get continuous funding. Could it be the transient nature in which we regard pilots? Being “project-like” in nature, there is always a finite amount of time a pilot can exist, so perhaps we fix our minds to this final date? Even as we moan about ‘pilotitis’, we must acknowledge that pilots help us test, research and explore before committing further resources in the adoption phase. The assumption is sometimes that a successful pilot equals outright adoption, which we know is not always the case. Why?

Pilots reveal several things about our ideas that impact on sustainability:

1. Complexity: Sometimes simple ideas that were so obvious at conceptualization turn out to be a complex maze, with twists and tangles that could never have been imagined. Does that make it a failure? No. In the spirit of research, it adds to the existing body of knowledge. That is why it is important to publish challenges and lessons learnt from as many pilots as possible.

2. Capital expenditure: The total cost of bringing an idea to life can only be estimated prior to implementation. Once a project begins, the true costs emerge: Infrastructure, training, software development, and consultant/expertise costs. The output may be simplified (e.g. collect nutrition data, or disease symptoms), but setting up of resources necessary may cost huge sums.

3. Operational expenditure: The real cost of the logistics necessary for operation are often encountered in action. Once again, a simple output like delivering results to facility could mean large contracts with distribution and logistics firms, a complex communication infrastructure, or even remote airtime top-ups for a vast army of hands needed to achieve the output.

4. Weaknesses: Pilots help reveal significant weaknesses in concepts, ideas, applications or envisioned systems. Having shared handsets in the home, for example,  could reveal the weakness of limiting simple actions like alerting a user on their health status, the inability to read even local language, or even cultural taboos regarding certain topics. It is usually beneficial that pilots are small scale, hence cushioning impact of such weaknesses.

5. Stakeholder positions: Lastly and perhaps most important of all, is stakeholder positions. No matter how grand or noble an idea is, stakeholders will always make or break it. I recall a story of an organization that pitied women in the remote North of Kenya who travelled miles to fetch water from a water pan in extreme heat on a daily basis. With all noble intentions, they fundraised to dig up a well and install a hand pump within close proximity to the village. The pump however was often avoided. On inquiry, it turned out that the walk to the water pan had become part of the social fabric, and was an opportunity for women to catch up, teach, learn and encourage each other. Having a hand pump five minutes from their homes meant social time was limited to fifteen minutes a day, and the women preferred the hardship of the walk, for the benefits of support from their friends. Stakeholder perceptions and impacts on local ways of life are always the bottom line.

Each of these factors, though not comprehensive, has a huge impact on the sustainability of the service or intervention. It is therefore increasingly important to begin to collate and publicly share lessons learnt from one pilot to another. Just like research, applying the same method to the same group, but at a different time, may yield varying results. Could your lessons learnt have been long before 3G data was available, or when mobile penetration was still low? Did you discover a cheaper way of doing things? Did you establish what stakeholders feel and want that made or broke your pilot? If we could learn from each other, we could increase the effectiveness of our interventions and the efficiency of implementing them, even as funding resources continually decline.

Have you shared your lessons learnt?