The potential of mobile and ICT to support behavior change, supply chain, health financing, health worker enablement and other critical services has been well documented but we have yet to see significant scale and integration into the health system.
Mobile is dependent on volume to drive the economies of scale but mHealth has been largely unable to demonstrate significant scale due mainly to fragmentation, inadequate partnership brokerage and an inability to access business-to-business (B2B) payment mechanisms.
With more than 85% of Total Healthcare Expenditure (THE) existing in a B2B or reimbursive payment environment, mHealth stakeholders have to be able to demonstrate strong economic evidence (cost) of their be impact on specific health interventions.
We have been tracking the growth in mHealth since 2010, looking for evidence to support this sustainable B2B integration of mobile into the fiscal budgets of national or regional health providers. Our first literature review helped us understand that, of more than 800 peer-reviewed publications, less than 1% demonstrated a cost implication to the health intervention and/or health system.
Four years later and we are now tracking more than 1,300 mHealth services being deployed across emerging markets. The phenomenal growth in the number of new services has not, unfortunately, seen a parallel growth in the evidence base of these services, particularly economic (cost) proof points. 90% of services are reliant on donor funding and/or a consumer payment model, both of which we would argue are unsustainable, given the short term nature of funding and the inability of consumers at the bottom of the pyramid to contribute significantly to out of pocket health expenses.
Building towards scale and sustainability, we need to be conscious of the fact that mobile services are built around a high volume, low margin business model. Most of the mHealth services we analyse are not able to achieve this tipping point of active users that allows for economies of scale.
An example we often use when trying to highlight this is that the vast majority of sustainability models are designed for thousands or tens of thousands of users. When we present an opportunity from one of our GSMA members, Samsung, to pre-embed health services onto ~80million devices across Africa over the next two years, only a handful of service providers are able to adjust their offering to take advantage of this opportunity, and support a potential 80million users across Africa.
We also have to consider how to better leverage the mobile ecosystem to drive scale and sustainability. Internet.org was able to secure zero rated connectivity agreements with Airtel in Zambia recently with a strong brand value and product offering. MTN and Airtel Group have committed to similar offerings across their portfolio of operations if mHealth stakeholders can demonstrate a win-win value proposition. Gemalto, the largest SIM manufacturer, have ~350million SIM’s in circulation across Sub-Saharan Africa and have committed to distribute health content and enable civil registration. Samsung, in addition to pre-embedding Smart Health onto ~80million devices, have committed to make their Samsung ecosystem available. It is hoped that financial and non-financial incentives will drive demand for health services: for example, a week’s free access to the Samsung music store for completing an immunization schedule.
Realizing the potential of mHealth will dependent on creating sustainable, low margin, high volume business models. This volume is dependent on strong demand from the end user. Demand can be catalyzed through an ecosystem of delivery partners, aiming to: drive down the prohibitive cost of handsets and connectivity; leverage strong marketing, distribution and public relations campaigns; and, aggregate the multitude of mHealth services onto a single user interface.
Dr Craig Friderichs, MD, MBA is Director of Health at GSMA and has pioneered the GSMA ecosystem partnership and the Pan-African mHealth Initiative.