Recently I had the honour of representing the GSMA at University College London (UCL) at the inaugural mHealth conference “How can mobile technology improve health in low and middle income countries”. The event itself was concerned with the growing need to provide consistent and robust evidence of the impact of mHealth.

The GSMA was invited to speak in a panel session on the topic of the “Scaling up [of] success in mHealth: what influences policy makers? And what role for the private sector?” Among the esteemed company was the Ethiopian Minister of Health Dr Kesetebirhan Admasu, and senior figures from the WHO, D-tree, The British Medical Journal and the Zambian Centre for Applied Research.

The topic was particularly appropriate, given the GSMA’s unique position in bridging the worlds of funding and academic institutions and the commercial realm of the telecoms industry and corporate social responsibility (CSR).

In a prepared response to the question put forward by UCL, the GSMA highlighted the two main roles currently occupied by the private sector:

• Providing access and support to mHealth services, as part of strategic CSR requirements or in response to legislative demands from regulatory bodies e.g. as part of licensed spectrum requirements. From a business perspective, this approach is characterised as relatively passive.
• Providing access and support to mHealth services, as part of a realised and viable commercial opportunity in its own right. From a business perspective, this approach is characterised as aggressive/proactive.

The GSMA highlighted the sometimes divergent view of mHealth success, which, in the commercial realm, concentrates on commercial viability or the opportunity to “sell” either direct to consumers or through reimbursement from central government (business-to-business-to-consumer), in comparison with the funding environment’s concept of success. It is fair to say that the two are not necessarily mutually exclusive. In many ways the commercial approach can be defined as sustainable, meaning that it has long-term potential. From the MNO perspective, understanding the volume of use in mHealth can lead to premium revenues, generated direct from the mHealth service itself or via cross-sell with other data services (mHealth offered as a feature of a bundled offering). There are additional incremental business models based on reimbursement, whether direct from government or advertising-based,but common to all is the drive, or better yet desire, to ensure the service sustains and grows. This drive is based on the aspiration to create premium revenue, as a long-term aim toward ROI on data network rollout. As mHealth service propositions grow, customer sophistication, surrounding the use of services, evolves and the mHealth service proposition itself moves further up the service evolution pathway.

Reaction to this position from the audience was direct and touched upon many of the challenges that stakeholders face, when working to unify commercial and aid-based approaches. The challenges could be categorised into two main areas in relation to mHealth evidence:

• A general problem, that NGO and aid-based players highlighted, was a certain fatigue coming from mobile operators to requests for the zero rating of services. In some instances, proof of concept or pilot schemes needed zero-rating before additional funding could be found. The reticence to provide free or heavily subsidised access meant that these proof of concept requirements might not be met, which would lead to a problem with scaling up mHealth initiatives (i.e. lack of evidence to scale up) further down the line.  There was also some divergence in strategic aims from group level versus op-co level, on the requirement for short-term yield.
• Influencing policymakers requires strong evidence points in the mHealth space, which fulfil the exacting criteria of scientific method. However, operator commercial criteria of proof are generally less exacting. This leads to a disconnect between the evidence requirements of policymakers and mobile operators.

It is the bringing together of these conflicting criteria’s for evidence that is one of the major challenges facing the industry. It was agreed that consistent and cohesive communication between both parties is the way forward.

The GSMA has sought to tackle these challenges in a number of ways. A recent initiative is its market access and costing/forecasting tool. This 9-month project will look to identify mHealth proof points, by analysing the market in 10 Sub-Saharan African (SSA) countries, using well tested protocols laid down by the pharmaceutical industry when accessing new health markets. The aim is to provide communication of the comparative cost and efficiency benefits of mHealth, and to transfer these findings to procurement policy makers to empower them to include mHealth in central procurement contracts.

The project will consider multiple inputs and produce a set of market access reports and an Excel based costing/forecasting tool. Analysis categories will include but are not limited to:

• Consideration across all stakeholders to find:
  • Comparative cost of legacy vs new mobile powered approaches
  • Tangible and intangible costs e.g. efficiency improvement criteria and/or efficiency ratios
  • Different mobile approaches (SMS, USSD and data) for various health needs e.g. registration
  • Quantified evidence of impact, through health economics

By taking such an approach, the GSMA hopes to strengthen the efficacy of mHealth and provide evidence that is robust within scientific proof criteria and communicates in a language understood commercial players. We believe that mHealth can be sustained and grown to the benefit of all end-users.

The GSMA will continue to bring together all relevant stakeholders and ensure the best solutions for all involved.

For more information on GSMA Mobile for Development mHealth, please see here or contact us on [email protected]. For information on global mHealth initiatives, click here.