Government involvement key to scaling mHealth projects

Partnerships with government are critical to scaling up mHealth projects, according to mobile health implementers cited in a article. The key, they say, is to engage with government early and often so that they will eventually take over the project and bring it to scale.

"Whereas in some cases in the past government has been engaged only superficially or is brought into the process after a program is underway, mHealth implementers are reaching a consensus that identifying and cultivating champions within government from the start of the project is critical to securing buy-in--and potentially handing the project over to the government to scale in the long run," the article's authors write.

Sean Blaschke, a health systems strengthening specialist for UNICEF says in the article, "If you don't have government partnerships, it is such a major barrier to achieving scale that even a well-designed program is likely to fail and not achieve scale."

For instance, a pilot project in Bihar, India managed by the humanitarian organization CARE is training 500 local community health workers to use mobile phones to register clients and schedules services. While the initial implementation is designed to address about 70 percent of the tasks frontline health workers carry out, the government is responsible for developing additional modules and taking the project to scale with 100,000 frontline health workers by the end of 2014.

Another project cited by the article's authors is the Grameen Foundation's Mobile Technology for Community Health (MOTECH) initiative in Ghana, which was designed from the start as a joint project with the Ghana Health Service (GHS) and engages government across national, regional and local levels.

"Starting as partnership has been critical to getting the Ghana Health Service to take ownership of the project and enable its successful scale-up," the authors write. "Since start of the pilot, the program has evaluated government needs and sought to address them, including through a national steering committee that is part of GHS."

The project offers a suite of services delivered over basic mobile phones that provides relevant health information to pregnant women and encourages them to seek prenatal care from local facilities. After birth, the system addresses common questions about newborn care. At the same time, the MOTECH system helps community health workers identify women and newborns in their area who need healthcare services and automates the process of tracking patients who have received care.

"This project would not have been possible without GHS," in large part because the programs use government nurses and systems, according to Anitha Moorthy, senior health advisor for the Grameen Foundation. Currently, MOTECH is in the process of handing over many of the operational components of the project to the Ghanaian government, which by March should have the capacity to handle the technology.

Nevertheless, there appears to be little understanding generally about how to scale up mHealth projects. A 2013 article in PLoS Medicine found that despite hundreds of mHealth pilot studies there has been "insufficient programmatic evidence to inform implementation and scale-up of mHealth."

After more than 500 pilot studies tracked by the World Bank, the article concludes that, "we know almost nothing about the likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives." As a result, the authors say mHealth interventions "lack a foundation of basic evidence, let alone a foundation that would permit evidence-based scale up."

To learn more:
- read the article