CycleTel in India: Using Pilot Results to Inform mHealth Business Planning
CycleTel™ in India: Using Pilot Results to Inform mHealth Business Planning INSTITUTE FOR REPRODUCTIVE HEALTH, GEORGETOWN UNIVERSITY Victoria Jennings, Ph.D. Priya Jha, MSW Esha Kalra, MPH Meredith Puleio, MBA OCTOBER 30, 2012 American Public Health Association 140th Annual Meeting & Expo SESSION 4318.2 Innovations in International Health 2
Presenter DisclosuresThe following personal financial relationships withcommercial interests relevant to this presentationexisted during the past 12 months: No relationship.
Agenda1. Introduce Standard Days Method® and CycleTel™2. Explain research phases and results3. Demonstrate how research results inform business planning
Standard Days Method® (SDM) Modern fertility awareness-based method of family planning Method characteristics: Appropriate for women with menstrual cycles between 26 and 32 days long Identifies days 8-19 of menstrual cycle as fertile Helps a couple avoid or plan pregnancy 95% effective with correct use Typically used with CycleBeads® (at right) to identify fertile days & communicate with partner Available since 2002 in range of programs, but has not realized full potential
Expanding Access:Direct to Consumer Approaches SDM IS WELL-POSITIONED TO BE OFFERED DIRECTLY TO CONSUMERS Knowledge based Does not require a visit to a provider (for initiation or re-supply) Easy to teach & learn VALUE PROPOSITION Effective, non-hormonal method of family planning that has no health side effects Direct-to-consumer approaches expand access to SDM thru avenues outside of health services
SDM on the Mobile Phone CycleTel™: SMS-based service
The Indian telecom market is immense. Over 900M subscribers in India (1.2B population). Worlds 2nd largest telecom market, and growing. Over 28% of women own mobile phones (compared to 40% men), and another 20% have access to mobiles Source: Telecom Regulatory family of India, August through Authority and 2012. friends.
Model: Formative Research to Scale Product Launch Partnership & Scale Development up Business Planning Planned 2013 2012 Automated Jan-Feb ‗12 TestingProof-of- Jul ‗11-Jan ‗12Concept Sep ‘09 – Jul ‗11
Proof-of-Concept: Structure & Findings 3 Phases ObjectivesFocus Group Understand phone use patterns Determine potential interest among targetDiscussions audience54 participants Explore appropriate messaging and preferences for the serviceCognitive Interviews Verify comprehension of messages18 participants Adapt and finalize messages (in English & Hinglish)Manual Testing Enroll women for 2 cycles to assess feasibility,26 women in Lucknow satisfaction and correct method use21-28 years old, housewives Initially used a low-cost open source software to manually send/receive messages (FrontlineSMS)88 women in New Delhi Troubleshoot problems and determine how to24-33 years, working women improve service Determine target audience
Key Results—Manual Testing Satisfaction & Helpline Male Willingness Ease of Use Support Involvement to Pay92% were very 37% of 76% said it was 83% of users theysatisfied with participants called easy to tell their were willing to payCycleTel to prevent the helpline during husbands about on average Rs. 33pregnancy the 1st cycle of unsafe days per month for the use, 15% called service (range95% participants during the 2nd About 70% reported from Rs. 15-400)reported receiving cycle of use showing theirSMS at the husbands messagesappropriate times 23% wanted their husbands to receive unsafe day alerts *Proof-of-concept results justified investment in technology development*
Technology Development Identified technology partner in India—ThoughtWorks Participatory, iterative process between IRH and a dedicated project team of ThoughtWorks developers Working prototype within 12 weeks Continued to build out and improve features based on user feedback ThoughtWorks helped us navigate the ecosystem to set up required deployment partnerships
Automated Testing— Methodology715 female participants recruited to sign upand use CycleTel for 2 cycles 197 follow up interviews after 1 cycle of use 653 exit interviews with female participants 131 male exit interviews conducted PROFILE Age 19-36 (average 30) Education level: ―higher secondary‖ or above Need for family planning 28% were employed
Key Results—Automated Testing(Pilot)What did users like most about CycleTel (n=653)? As a family planning method… As a mobile health service… % % It is low-cost/free 53.9 Easy to use 78.7 Doesnt affect health 80.1 It maintains my privacy 79.5 No side effects 88.4 Timely reminder 87.4 My husband opposes using another 17.2 method Messages come when expected 66.6 Religious/moral reasons 9.0 Right amount of messages 65.5 It is easy to use 72.9 Accessible helpline 27.6 It is effective 56.5 Frequency features 9.2 It is convenient 49.2 Other 36.6 Other 6.3
Key Results—Automated Testing(Pilot) 96% reported receiving SMS at the appropriate times 97% indicated receiving the right amount of messages
Key Results—Automated Testing(Pilot)While women would recommend the service tofriends, there was less interest to continue use ofthe service. WOULD RECOMMEND TO INTERESTED IN FRIEND/FAMILY MEMBER CONTINUING USEYes 10.4 YesNo No 47.3 52.7 89.6
Business Analysis Business planning was critical to understand the inputs (target market size, go-to-market strategies, prospective partners, financing, etc.) needed for CycleTel to be a sustainable venture in India at scale by 2017. The analysis was based on: 1) Proof of concept and pilot results 2) Interviews with industry experts 3) Secondary data sources 4) Rigorous financial analysis
Business Analysis: Steps and KeySteps Questions Key Questions (Examples)Identify target How many women of reproductive age in India (1) have ansegments and size the unmet need for birth spacing, (2) own a mobile phone and (3)market use SMS? What age group would be most attracted to CycleTel and why?Industry analysis to How many users does the service need to attract corporatedevelop core donors?business What % of mobile phone owners use and pay for mHealthassumptions services? Would telcos be interested in launching CycleTel? Why? What is the role of the aggregators and other stakeholders?Develop a Go-to- Prospective partners—who will work with us toMarket strategy acquire/sustain users? Prospective donors—who will be willing to provide seed capital? How do we market the service? Operating model—how will the venture operate?Identify possible Define a high achievement and modest achievement case. Inbusiness scenarios each case, what level of resources is needed to reach target #based on of consumers within a specified period of time?assumptions/risks
Business Analysis: Key Findings1. CycleTel should target ~16 million young Indian women (20-34 years old) with high birth spacing needs, and independent access to mobile phones in 2 phases. Different target markets for 2 phases, technology will be adapted2. Sustainability is possible within a 5-year period, but it will take significant investment from donors to reach break even3. Success would require broad based promotion via mix of channels—high engagement approaches (face to face) early on are key to attract customers
Q:How did proof of conceptand pilot results inform business analysis?
A: In the following ways…Data point Business implicationWILLINGNESS TO PAY Subscription-based servicePROFILE OF PARTICIPANTS Sizing the target market, focus on younger tier initiallyLIKES/DISLIKES Value proposition—easy to use, no sideabout the service and the family effects, reliableplanning methodCONTINUATION interest Need for high engagement model with end(lower in pilot only) users for acquisition and motivation overVarying levels of CORRECT USE timeMANAGEMENT of fertile days Packaging/advertisement with condoms would be effectiveRECOMMEND to a friend Referral service could support client acquisition
Key Learnings Formative research and pilot research results can in fact inform1. planning for sustainability—if sustainability is a goal, ensure key questions (as demonstrated on previous slide) are included in interviews.2. Ensure that theoftechnology canmarkets—this model can suit the needs distinct target be adapted over time to drive sustainability. Testing the service with different demographics will inform the business case. Business planning serves as a reality check for3. what level of investment is actually needed to take an mHealth innovation to sustainable scale.