This is a guest blog written by Judy Varndell from Deloitte

Mobile adoption is expanding rapidly in low- and middle-income countries across Africa; and is increasingly being used to deliver health information to geographically diverse populations. mHealth projects in emerging economies are often required to be low-cost, widely available and easy to use. Moreover sustaining grant- or donor-funded mHealth services once funding has come to an end is a major challenge worldwide. This has largely been attributed to a lack of understanding of the true financial implications as well as a lack of empirical evidence of the effectiveness of such programmes.

In a number of emerging economies, this is further complicated by the fact that the mHealth ecosystem is relatively immature – there are only a small number of service providers and their services offerings generally do not compete or overlap. This makes it difficult to compare their services, costs and capabilities; as well as the outcomes that they are achieving.

While there is no single solution to manage the complexities of sustainability, programme buyers need to ensure that the most viable financing models are achieved. This involves investigating opportunities to reduce costs and exploring all avenues to unlock potential additional sources of revenue, whilst ensuring the programme reaches the maximum number of end users.

Taking all of this into account, it is necessary to develop sustainability measures so that maternal mHealth programmes extend beyond the donor funding first phase and that benefits can be realised. User experience will be fundamental in ensuring buy-in which in turn drives sustainability. As such, the opportunity exists to utilise global lessons as well as to consolidate diverse efforts to deliver effective and efficient programmes.

Considerations include:

Cost efficiencies
One method of ensuring the sustainability of a programme is to ensure that cost efficiencies are achieved. Overall, this will permit funding to be maximised. These cost efficiencies may be done in the following ways:
• Determine the most effective delivery channel
• Leverage other programmes and the devices already being utilised
• Develop training modules that can be driven without on-the-ground staff (cost containment and ensures new staff are easily coached)
• Ensure an open market process when employing service providers
• Achieve interoperability between the technology platforms

Scale
The ultimate aim of a maternal mHealth programme is to reach and impact the maximum number of people in the target group, which can be achieved through scale. To drive scale it is necessary to drive buy-in at the health practitioner level, as they will be the first point of reference to drive adherence at the community level.

Alternative revenue streams
The costs associated with a maternal mHealth programme are continuous. Though there are actions that can be taken to contain these, it is also necessary to explore alternative streams of revenue as this will also assist in ensuring that all funding is maximised. These streams include:
• Advertising either the MNO delivering the message or products relevant to the messaging and target group
• Monetising assets (data) through aggregating and anonymising data that can be utilised by various organisations
• Implement a sliding scale payment structure whereby higher LSM groups pay for the service as a whole or for premium content

Monitoring and evaluation
M&E is essential to track the progress of an mHealth programme and to determine whether it is achieving its aims and objectives. M&E will show the value and ultimately the cost savings achieved through the implementation of such a programme. By proving healthcare and economic benefits, it will be possible to justify the need for additional funding as well as gain buy-in from the various stakeholders for the programme. Some components that should be included in such a framework include:
• Uptake of programme
• Training of health practitioners
• Impact on the end-user
mHealth has been regarded as a method to deliver healthcare in an efficient, innovative and user-interactive manner, and the ideal mHealth solution should be scalable, commercially viable and socially benefit the bottom of the pyramid population. Sustainability is also crucial so that the positive impact on health outcomes will be realised for as long as the programme is operational.

Please take a look at this and more in the full report: Maternal messaging mHealth programmes. Empowering and enabling decision makers to include mHealth services into their budgets. Feedback is, as always, very welcome.

For more information on GSMA Mobile for Development mHealth contact us on [email protected].