Commercial Sustainability in mHealth: Myth or Fact?

By Kai-lik Foh

The topic of sustainability (particularly attached to the word “commercial”), as a means of driving scale, often crops up in conversations about mHealth, particularly in developing countries. It is often followed by an uncomfortable silence, signalling a collective agreement that it is 1) a great thing to have and the silver bullet to scaling up mHealth in developing countries, but also 2) that no one seems to really agree as to what it actually looks like (at least in mHealth), and therefore 3) no one can really agree if there are indeed any examples of mHealth that have reached the nirvana of commercial sustainability in developing countries.

We won’t pretend to be able to answer this question – as it means different things to different groups, who have different objectives. However, I’ve found it useful to characterize it as an on-going debate that revolves around who pays, how much they pay, and the extent to which the payment covers (or perhaps exceeds) operational costs.

One extreme is the fully commercial mHealth model, where revenue needs to cover operational costs and generate a return superior to what it could have earned elsewhere. While this may be something that has been reached in the developed markets, it is probably something substantially further away in the developing markets.

One more moderate view that is held is that sustainability occurs when you have a service which end consumers are willing to pay some money for. Whether the receipts cover operational costs, is a second order issue. For those thinking about building a consumer-led business model with potential for scale – what’s important here is the notion of a service which delivers enough value for individual consumers to pay for (which reduces or removes reliance on external funding, whether it comes from a donor or a government agency).

On the other end of the spectrum is the argument that in healthcare, and particularly in developing countries and especially for the vulnerable, we should really not be in the business of designing solutions that are meant to rely on additional out-of-pocket payments from an end-consumer. Rather, the notion of commercial sustainability will depend on being able to locate and justify to an institutional payer of healthcare (which could be a government, or a donor, or a private insurance body) that the mHealth intervention costs less than and/or produces better health outcomes than a similar comparable intervention. That party also typically has the onus of funding health on behalf of the vulnerable – and it is our job to convince them that mHealth is a better, cheaper way of serving this need.

There are of course others who will contest a health financing system’s ability to distribute healthcare (which we won’t go into here). That said, it is safe to say that the size of the pie that can potentially come from a consumer’s pocket (particularly if that pocket belongs to a member of a vulnerable population), is probably not going to be as substantial as from an institutional payer.

In the GSMA’s on-going engagement in Africa, we are attempting to investigate both models – business models which rely on consumers, and business models which rely on institutional payers. The former are slightly more straightforward, and easier for mobile stakeholders to adapt, as they are similar to their current skillsets and business models, as well as having a higher potential to yield more immediate results. But we do feel that an institutional approach (though more fraught with the complexities of regulation, reimbursement justification, and politics) is probably the key to a longer term solution, particularly to solve the problem of sustainability for the vulnerable.

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