I first had the opportunity to visit Malawi six months ago as part of a group providing specific technical assistance to mHealth service providers involved in maternal and child health. I have since been back a second time – this time as part of a formal GSMA initiative to help scale mHealth across 10 African countries.

What struck me on both visits, apart from the overwhelming warmth and friendliness of Malawians, is the sense of enthusiasm for the potential of mHealth, shared by people within the private sector, the NGO sector as well as the public sector.

Certainly, there are challenges.  Malawi is one of the poorest countries in the world, with over 40% living under the poverty line.  The country’s health budget still depends significantly on the donor community.  I was told of a program that showed great promise which was shelved because funding ran out for, unbelievably, the cost of running three desktop-grade PCs storing clinical information.  The mobile sector is also understandably still occupied with issues of expanding coverage across the nation, selling voice, SMS, and to a much lesser extent, data services.  Value-added services, which typically come at the next stage after basic mobile services are entrenched, are a relatively new concept to the market.  Consumers are still grappling with the concept of the ability to procure music (via ringtones and ringbacks) and news (primarily sport) over mobile.

I believe though that there are two areas which distinguish Malawi as a potentially exciting base for innovation in mHealth:

The Mobile Operator Perspective 

First, is the mobile sector’s potential appetite for mHealth.  There is a relatively low level of mobile penetration (35%, which puts it at about 46^th within all African countries) compared with the GSM coverage (80%, which puts it at about 8^th in Africa).  This tells us there is a strong push for increasing mobile penetration in order to bring it to par with coverage and recovering the mobile operators’ investments in infrastructure.   The majority of the population that live in rural areas will make up most of this potential.  Operators are responding with investments in power capabilities to address Malawi’s energy shortages, selling non-contract phones at subsidized prices and mobile money products targeted at the rural unbanked.  Services such as mHealth, which effectively speak to the needs of the rural poor, are going to be the next growth area for the mobile sector.

Advanced Collaboration between mHealth Players

Secondly, is a relative sense of harmony and collaboration between the players active in mHealth in Malawi.  Fragmentation in mHealth service delivery is common in many countries on the African continent, often with multiple initiatives addressing overlapping areas – rife with unfortunate political and operational consequences.  In Malawi, Dr. Chris Moyo from the Ministry of Health and Marije Geldof from D-Tree (an innovative NGO leading in mHealth implementation) chair a group representing most of the major players, exchanging ideas on a regular basis and working together to resolve common issues facing them on the ground.

The road, much like the one I rode on from the country’s capital to magnificent Lake Malawi, won’t be the easiest in the world.  Operators are still grappling with infrastructure and delivery issues, and the ever-elusive sustainable business model for mHealth will need to be tackled, in particular finding a small enough unit of value which a typical Malawian within the rural poor will be able to afford.  However, the destination will make it worthwhile.

For more information on the GSMA Mobile for Development mHealth, please contact us at [email protected]. For information on various mHealth initiatives, click here. For more information on GSMA mHealth resources, click here.