SCALING UP MOBILE HEALTH:
H
DEVELOPING MHEALTH
PARTNERSHIPS FOR SCALE
Authored by Jeannine Lemaire
SECOND REPORT IN A SERI...
CASE STUDIES: CROSS-
COUNTRY SCALE UP
RECOMMENDATIONS:
CHALLENGES
CONCLUSION
REFERENCES
ABOUT ADA
ACKNOWLEDGEMENTS
ACRONYM...
02
I
would like to convey my deepest gratitude to Coumba Touré, the Founder and
President of Advanced Development for Afri...
ACKNOWLEDGEMENTS&ACRONYMS
03
Advanced Development for Africa
Base of the Pyramid
Community Health Worker
Corporate Social ...
Scaling up Mobile Health
FIRST REPORT
04
Policy environments, business models and funding
schemes around mobile health (mH...
Scaling up Mobile Health
FIRST REPORT
05
FIRSTREPORT
Image Credit: mTrac, Sean Blascke, UNICEF Uganda.
06
01 Background & Overview
INTRODUCTION
INTRODUCTION
In a world of 7 billion people and over 6 billion mobile phone
subsc...
07
01 Background & Overview
INTRODUCTION
INTRODUCTION
5
Research by Dalberg Global Development Advisors. 2012.
6
Useem, A....
08
to determine how they have achieved this scale, by identifying key
success factors that other budding partnerships coul...
09
CASESTUDIES:IN-COUNTRYSCALEUP
IN-COUNTRY SCALE UP
8
The information presented in these case studies, including project ...
10
Disease Surveillance & Mapping Project
� LOCATION: BOTSWANA, KENYA (PLANNED), MOZAMBIQUE (PLANNED) � STATUS: SCALING UP...
11
CASESTUDY:DISEASESURVEILLANCE&MAPPINGPROJECT
The objective is to shorten the outbreak identification process
and improv...
12
KimMNCHip
� LOCATION: KENYA � STATUS: ONGOING, WITH NATIONAL SCALE AS A TARGET
2
The Kenyan integrated mobile Maternal ...
13
CASESTUDY:KIMMNCHIP
KimMNCHip is designed from the beginning to be implemented at national scale.
KimMNCHip focuses on ...
14
mDiabetes
� LOCATION: INDIA � STATUS: ONGOING, WITH PROJECT TARGET SCALE OF ONE MILLION REACHED ONE YEAR EARLY.
3
mDiab...
15
CASESTUDY:MDIABETESmDiabetes creates a value-added service for Nokia presenting a strong investment case, and uses thei...
16
mHealth Tanzania
Public-Private Partnership
� LOCATION: TANZANIA � STATUS: SCALING UP
4
The Ministry of Health and Soci...
17
CASESTUDY:MHEALTHTANZANIAPUBLIC-PRIVATEPARTNERSHIP
All projects are performed through major partnerships, including Waz...
18
mTrac
� LOCATION: UGANDA � STATUS: SCALING UP, WITH NATIONAL SCALE PROJECTED WITHIN 2013
5
mTrac11
is part of a nationw...
19
CASESTUDY:MTRAC
02 In-country scale up
CASE STUDIES
both Health Facilities and community members is available on
mTrac’...
20
H
21
CASESTUDIES:CROSS-COUNTRYSCALEUP
03 Cross-country scale up
CASE STUDIES
CROSS-COUNTRY SCALE UP
12
The information prese...
22
Mobile Alliance for Maternal Action
� LOCATION: BANGLADESH, SOUTH AFRICA, INDIA � STATUS: MAMA BANGLADESH: SCALING UP.
...
23
CASESTUDY:MOBILEALLIANCEFORMATERNALACTION
03 Cross-country scale up
CASE STUDIES
PARTNERS ROLES
USAID Providing funding...
24
03Cross-country scale up
CASE STUDIES
subscribers registered for the service thanks to the 1,500
community health worke...
25
03 Cross-country scale up
CASE STUDIES
MAMA carefully selected its partners based on their added value. Engaging and wo...
26
Mobile Technology for Community Health
� LOCATION: GHANA, INDIA � STATUS: SCALING UP IN GHANA AND ROLLING OUT TO NEW A ...
27
CASESTUDY:MOBILETECHNOLOGYFORCOMMUNITYHEALTH
03 Cross-country scale up
CASE STUDIES
15
Available at: http://www.grameen...
28
Programme Mwana
� LOCATION: ZAMBIA, MALAWI � STATUS: SCALING UP
Programme Mwana is a mobile health initiative implement...
29
CASESTUDY:PROGRAMMEMWANA
03 Cross-country scale up
CASE STUDIES
16
For more information on the project design of Progra...
30
SMS for Life is an innovative public-private partnership ini-
tially led by Novartis and supported by the Tanzanian Min...
31
CASESTUDY:SMSFORLIFE
03 Cross-country scale up
CASE STUDIES
Sustainability has been achieved through securing governmen...
32
In partnership with mobile network operators Vodafone
and MTN, Switchboard has created a free calling network
for every...
33
CASESTUDY:SWITCHBOARD
03 Cross-country scale up
CASE STUDIES
Switchboard designed their program for scale from the begi...
34
04 RECOMMENDATIONS
Introduction
RECOMMENDATIONS
04
Introduction
Strategic partnerships combine the distinct core compet...
35
RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP
04 Partnership experts
RECOMMENDATIONS
RECOMMENDATIONS:INTRODUCTION&PARTNERSHIPE...
36
04 RECOMMENDATIONS
Recommendations Overview
Perform a
thorough
landscape
analysis of
local
contexts
Employ an
inclusive...
37
4.1 Building the Partnership
RECOMMENDATIONS
RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP
BUILDING THE
PARTNERSHIP
Building t...
38
4.1 RECOMMENDATIONS
Building the Partnership
The first step is to perform a landscape analysis to develop a thor-
ough ...
39
Amir Dossal, Founder and Chairman of the Global Partnerships
Forum, advises employing a multi-stakeholder partnership
a...
40
Developing partnerships with local government officials and
institutions can be a key success factor to ensuring the sc...
41
Partner with the private sector.
•	 Partnering with private sector players can provide important know-how and technolog...
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
Developing mHealth partnerships for Scale
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Second report in a special series on Scaling Up Mobile Health, commission by Advanced Development for Africa. Focuses on case studies of partnership-driven scale up of mHealth in the field, and provides sets of recommendations for building, implementing, sustaining and scaling mHealth partnerships.

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Developing mHealth partnerships for Scale

  1. 1. SCALING UP MOBILE HEALTH: H DEVELOPING MHEALTH PARTNERSHIPS FOR SCALE Authored by Jeannine Lemaire SECOND REPORT IN A SERIES OF SPECIAL REPORTS ON SCALING UP MOBILE HEALTH Commissioned by Advanced Development for Africa
  2. 2. CASE STUDIES: CROSS- COUNTRY SCALE UP RECOMMENDATIONS: CHALLENGES CONCLUSION REFERENCES ABOUT ADA ACKNOWLEDGEMENTS ACRONYMS FIRST REPORT INTRODUCTION: CASE STUDIES: IN-COUNTRY SCALE UP Scaling Up Mobile Health: Elements Necessary for the Successful Scale Up of mHealth in Developing Countries Disease Surveillance & Mapping Project KimMNCHip mDiabetes mHealth Tanzania Public-Private Partnership mTrac CONTENTS 02 21 34 62 66 67 68 03 04 06 09 10 12 14 16 18 22 26 28 30 32 37 46 52 58 35 36 Background: Mobile Health Overview: Partnerships & Scale Up Mobile Alliance for Maternal Action Mobile Technology for Community Health Programme Mwana SMS for Life Switchboard PARTNERSHIP EXPERTS OVERVIEW Building the Partnership Implementing the Partnership Sustaining the Partnership Ensuring Partnership-Driven Scale Up
  3. 3. 02 I would like to convey my deepest gratitude to Coumba Touré, the Founder and President of Advanced Development for Africa, who commissioned this impor- tant report. This report would not have been possible without her commitment to addressing the challenges in applying ICTs for health in developing country contexts through knowledge sharing, empowerment and capacity-building. I would like to express my sincere thanks and appreciation to the experts who com- mitted their time to sharing invaluable insights, perspectives and expertise from different sectors through interviews: Sean Blaschke, Health Systems Strengthening Coordinator at UNICEF Uganda; Awa Marie Coll-Seck, Minister of Health for Senegal; Amir Dossal, Founder and Chairman of the Global Partnerships Forum; Sarah Em- erson, Country Director of the mHealth Tanzania Public-Private Partnership; Kirsten Gagnaire, Global Director of the Mobile Alliance for Maternal Action (MAMA); Patri- cia Mechael, Executive Director of the mHealth Alliance; and Judy Njogu, Product Manager for eHealth and eLearning at Safaricom. I would like to extend my gratitude and appreciation to our Expert Review Panel who provided careful, in-depth reviews and important feedback to the report, ensuring realities and various experiences are reflected: Yunkap Kwankam, CEO of Global eHealth Consultants; Chris Locke, Managing Director of GSMA Mobile for Development; Carole Presern, Executive Director of The Partnership for Maternal, Newborn and Child Health (PMNCH); Sandhya Rao, Senior Advisor for Private Sec- tor Partnerships in the Office of Health, Infectious Diseases and Nutrition at USAID; and Véronique Thouvenot, Head of the International Women and eHealth Working Group at Millennia2015. Special thanks to Soumya Alva, Senior Technical Specialist at the International Health & Development Division of ICF International, and Vaibhav Gupta, Technical Officer in the Private Sector and Innovation Division of the World Health Organi- zation, who contributed important concepts and feedback to this report. Several insights were also drawn from speakers at the 2012 mHealth Summit Global Health Track convened by the mHealth Alliance. I would therefore like to convey acknowl- edgement and appreciation to the individuals that put the Global Health track together and the mHealth Alliance for its leadership in this space. Jeannine Lemaire Advanced Development for Africa Lemaire.Jeannine@gmail.com ACKNOWLEDGEMENTS
  4. 4. ACKNOWLEDGEMENTS&ACRONYMS 03 Advanced Development for Africa Base of the Pyramid Community Health Worker Corporate Social Responsibility District Health Information Software 2 Early Infant Diagnosis of HIV GSM Association Health Management Information System Information and Communications Technology Information Technology International Telecommunication Union Interactive Voice Response Monitoring and Evaluation USAID’s Maternal & Child Health Integrated Program Millennium Development Goals Mobile Network Operator Maternal, Newborn and Child Health Ministry of Health Memorandum of Understanding Non-Governmental Organization Prevention of Mother to Child Transmission of HIV Public-Private Partnership Short Message Service United Nations Children Fund United States Agency for International Development Unstructured Supplementary Service Data World Health Organization ADA BOP CHW CSR DHIS2 EID GSMA HMIS ICT IT ITU IVR M&E MCHIP MDGs MNO MNCH MOH MOU NGO PMTCT PPP SMS UNICEF USAID USSD WHO ACRONYMS
  5. 5. Scaling up Mobile Health FIRST REPORT 04 Policy environments, business models and funding schemes around mobile health (mHealth) have fueled the proliferation of pilot projects. Therefore in 2011, Advanced Development for Africa (ADA) commissioned the first report in a series of special reports on scaling up mHealth to assess various implementations of mHealth programs in developing country contexts that were either scaled up or in the process of achieving this. The objective was to iden- tify the important elements necessary for achieving scale. This report profiled select mHealth programs that had been piloted and were in the scale up phase, having proven enough success that they should be considered as potential models for other initiatives. Using the identified success fac- tors and interviews with experts in the field of mobile health, the report generated a set of best practices and specific pro- grammatic, operational, policy and global strategy recom- mendations to create an enabling environment for mHealth and support organizations in achieving scale. Mobile health can directly support policy-making and plan- ning within healthcare systems and improve the health of local communities, particularly remote populations, through the dissemination of health information, more accurate and timely data for disease surveillance, decision support for health workers and health information management. The primary goal of ADA’s first report is to provide recommenda- tions and best practices that will allow mHealth initiatives to better plan their own scale up beyond successful pilot phases. To download the first report, click on the image. The following report is the second in a series of special reports, focused specifically on partnership-driven scale up of mHealth containing sets of recommendations for building effective partnerships to achieve scale in mHealth. FIRST REPORT: Scaling Up Mobile Health: Elements Necessary for the Successful Scale Up of mHealth in Developing Countries SCALING UP MOBILE HEALTH ELEMENTS NECESSARY FOR THE SUCCESSFUL SCALE UP OF mHEALTH IN DEVELOPING COUNTRIES WHITE PAPER COMMISSIONED BY ADVANCED DEVELOPMENT FOR AFRICA Prepared by Actevis Consulting Group Researched and Written by Jeannine Lemaire December 2011 First report in a series of special reports on scaling up mHealth. To download the First Report, click on the image above.
  6. 6. Scaling up Mobile Health FIRST REPORT 05 FIRSTREPORT Image Credit: mTrac, Sean Blascke, UNICEF Uganda.
  7. 7. 06 01 Background & Overview INTRODUCTION INTRODUCTION In a world of 7 billion people and over 6 billion mobile phone subscriptions, this remarkable adoption of mobile phones presents concrete opportunities for increased access to health care, thanks to the growing field of mobile health. Mobile health, or mHealth, is the use of mobile technology in health and can be a powerful tool in improving health, particularly in places where health care is unavail- able or access is limited. According to the International Telecom- munication Union (ITU), mobile phone networks cover 90% of the world’s population today, with just over 75% of mobile subscriptions held by nearly 80% of the population in low- and middle-income countries.1 While there is still a need for a stronger evidence-base of mHealth health impacts and cost-effectiveness, some studies have already demonstrated the positive effects of mHealth. One study showed that two daily text messages to health care workers in Kenya improved pediatric malaria care by 24.5%.2 Another trial identified significantly improved ART adherence and rates of viral suppression thanks to weekly mobile text messaging and follow-up improving HIV drug adherence.3 Interest from NGOs, companies, government institutions, and donors in mHealth is rapidly expanding. To illustrate the current global landscape: • The mHealth Alliance’s HealthUnBound mobile health directory lists over 300 mHealth programs around the world, while the mHealth Working Group Inventory of Projects lists 400 mHealth projects in 79 countries. • The GSMA’s Mobile for Development Intelligence portal maps 376 organizations from a wide variety of sectors working on mHealth. • USAID funds more than 100 mHealth activities across the globe. Background: Mobile Health Overview: Partnerships & Scale Up 1 ITU World Telecommunication, ICT Indicators Database 2011. 2 Zurovac D et al. (2011). “The effect of mobile phone text-message reminders on Kenyan health workers’ adherence to malaria treatment guidelines: a cluster randomised trial.” The Lancet. 3 Lester, R. T., Ritvo, P., Mills, E. J., Kariri, A., Karanja, S., Chung, M. H., Jack, W., et al. (2010). “Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial.” The Lancet. 4 Leon, N., Schneider, H., and Daviaud, E. (1 January 2012). “Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa.” BMC Medical Informatics and Decision Making. Scale up related to mHealth has been defined in various ways, in- cluding technology replication in multiple contexts, or an expansion or national scale of a project, platform or organization. Although increasing organizational scale and scaling up the diffusion of mHealth platforms and strategies is a great achievement for organ- izations, such as Text to Change (which has delivered 70 mHealth projects in 17 countries), this report focuses on program or project scale at a national or cross-country level. Achieving scale may not be required or appropriate for all projects, particularly those that prove a particular concept does not work. However, governments in developing countries are increasingly frustrated with the prolifera- tion of pilots and fragmentation within their borders. This has re- sulted in the South African National Department of Health and the Ugandan Ministry of Health placing moratoriums on the implemen- tation of new telemedicine and electronic health (eHealth) projects, respectively, until national strategies are in place.4 The movement away from pilots presents a common objective for mHealth initia- tives today: scale up. Players from the public, private and non-profit sectors are now ac- tively seeking partners to collaborate with in order to increase the capacity, reach and impact of their projects. A concrete example of this was shared by Judy Njogu, Product Manager for eHealth and eLearning at Kenya’s leading mobile network operator, Safaricom. She identified partnerships with partners from different sectors as a key factor for enabling Safaricom to go beyond their limits as a mobile network operator. “Without partnering with organizations from different sectors, Safaricom would just be focused on m- vouchers and mobile money transfers in the healthcare space. Now 01
  8. 8. 07 01 Background & Overview INTRODUCTION INTRODUCTION 5 Research by Dalberg Global Development Advisors. 2012. 6 Useem, A. (11 December 2012). “Mobile health initiatives look to service providers for scale.” DevexImpact. Available: https://www.devex.com/en/news/mobile-health-intitia- tives-look-to-service-providers-for-scale/79932 (Cited on 10 January 2013) 7 Sturchio, J. (8 January 2013). “The Evolving Role of the Private Sector in Global Health.” The Huffington Post. Available: http://www.huffingtonpost.com/jeffrey-l-sturchio/the- evolving-role-health_b_2432823.html (Cited on 10 January 2013) that we’ve partnered with different organizations with different expertise areas, we are able to go much further,” says Njogu as she describes Safaricom’s partnership initiatives on mHealth micro-insurance and maternal health messaging. Historically, 85% of funding for mHealth was dedicated primar- ily to early-stage R&D or pilot programs.5 Although funding for pilots can be important for rationalizing the mHealth field, fund- ing towards growth, coordination and scale up is also needed. Dr. Esther Ogara, Head of eHealth at Kenya’s Ministry of Medical Services, says there are many projects launched in Kenya with- out an idea of who will fund them in the long run, highlighting the fact that donors are reluctant to underwrite on-going pro- grams, and that host governments cannot be a catch-all funding mechanism for every pilot. Therefore, Ogara conveys that part- nerships offer the best hope for bringing mHealth projects to scale.”6 The landscape described by Ogara is a strong incentive for the emergence of partnerships to bring together alternative methods of financing projects. Today, partnerships are employing new methods of cooperation, new business models, and demonstrating greater measurable results. A realization is emerging that the fragmentation of efforts is a big barrier to achieving large-scale impact, and that the right partnerships can bring about scale through joining distinct sets of core capabilities and collaboration directed towards common goals. Diversity in partners can bring together new ways of think- ing, technology, methods, best practices, lessons learned, markets, innovative ideas and more to support the scale up of a project. The USAID alone has formed nearly 700 public-private partner- ships (PPPs), a huge increase from the 50 PPPs that existed in the 1980s.7 Partnerships with the private sector have evolved over time — moving beyond simple philanthropic and charitable models towards collaborations based on business models and sharing risks, rewards, responsibilities and investment. There is consensus that partnerships hold the key to scaling up successful projects. Therefore, Advanced Development for Africa (ADA) commissioned this report to determine how to best build and sustain partnerships between public, private and non-profit sector players, and how to ensure partnership-driven scale up of mHealth, with three main objectives in mind. Through a thorough examination of the landscape of partnerships in the field of mHealth, the report’s first objective is to provide an as- sessment of a set of partnerships that have demonstrated or are in the process of achieving regional, national or cross-country scale, through a series of case studies. The second objective is GSMA Mobile for Development Intelligence map of 376 organizations working on mHealth © www.mobiledevelopmentintelligence.com Mobile for Development Intelligence Organisations Map, 30/5/13
  9. 9. 08 to determine how they have achieved this scale, by identifying key success factors that other budding partnerships could draw from. The final objective is to present the expertise and experiences of brokers, stakeholders, and key decision-makers within large-scale cross-sector partnerships through concise sets of recommendations focused on the different phases of partnership development. The intended audience for this report is the international develop- ment sector in emerging markets and stakeholders working with this sector on mHealth. Our goal is to amalgamate and share the knowledge and perspectives of experts from various sectors in order to support the international development sector in devel- oping partnership initiatives geared towards greater impact and scale. In-depth research and interviews, as well as a full review of the report by an Expert Review Panel, was performed with stakeholders and representatives from different partnerships that demonstrate strong cross-sector collaborations. As partnerships typically bring together individuals and organizations from differ- ent sectors and fields, this report will carefully present the varying needs, challenges and recommendations from various sectors. We hope this report will be valuable to organizations from all sec- tors seeking to partner with others as it presents diverse perspec- tives that are critical to understanding how to build successful, scalable and sustainable partnerships. Our goal is to amalgamate and share the knowledge and perspectives of experts from various sectors in order to support the international development sector in developing partnership initiatives geared towards greater impact and scale. ” “ 01 Background & Overview INTRODUCTION
  10. 10. 09 CASESTUDIES:IN-COUNTRYSCALEUP IN-COUNTRY SCALE UP 8 The information presented in these case studies, including project data, is sourced from online research, project docu- ments, communications, and interviews with personnel involved in the management of these initiatives. 02 CASE STUDIES 1. DISEASE SURVEILLANCE & MAPPING PROJECT 2. KimMNCHip 3. mDIABETES 4. mHEALTH TANZANIA PUBLIC-PRIVATE PARTNERSHIP 5. mTRAC The following set of case studies present mHealth partner- ship initiatives that have achieved or are working towards scale within a country and present concrete elements of success that can be incorporated in other partnership initiatives looking to achieve regional or national scale.8 02 In-country scale up CASE STUDIES
  11. 11. 10 Disease Surveillance & Mapping Project � LOCATION: BOTSWANA, KENYA (PLANNED), MOZAMBIQUE (PLANNED) � STATUS: SCALING UP 1 The Disease Surveillance and Mapping Project is an initia- tive of the public-private partnership formed between HP, Clinton Health Access Initiative (CHAI), Botswana Ministry of Health (MOH), CDC Botswana, mobile network operator Mascom, and Positive Innovation for the Next Generation (PING), a local Botswana non-profit organization. It covers the implementation of a mobile disease surveillance and mapping project to aid Botswana’s fight against malaria with the use of mobile phone technology. The program equips health workers with mobile devices that collect malaria data and can be viewed in a geographic map of disease trans- mission to generate more context-aware information about outbreaks in order for workers to respond accordingly. This allows health workers to report real-time disease outbreak data, tag the data with GPS coordinates, and send out SMS disease outbreak alerts to all other healthcare workers in the district, and allows facilities to submit regular reports back to the MOH. The data is then aggregated in real-time on the backend and graphs and reports are generated in a matter of seconds. This enables MOH officials to promptly collect and analyze context-aware data on malarial outbreaks, track developments in real-time and quickly dispatch medicines and mosquito nets, and monitor treatments using GPS coordinates. Results since the program rolled out in June 2011 in Botswana’s Chobe region: • Improved response times to notify authorities of malaria outbreaks from four weeks to three minutes in the first year of the program. • 1,068 real-time notifications and updates on disease pat- terns to MOH officials and health workers. • 93% of facilities now reporting on time, compared to 20% previously. OBJECTIVES & GOALS The long-term vision of this project is to move away from paper-based reports by equipping health workers at clinics across Botswana with mobile phones, enabling them to sub- mit real-time reports to the MOH. The objective is to shorten the outbreak identification process and improve response times of medical intervention to outbreaks using mobile- based disease surveillance solutions. SCALE UP ACHIEVED The project expanded its scope to cover tuberculosis and was rolled out to an additional 100 facilities in Botswana. FURTHER SCALE UP PLANNED The Botswana MOH, PING, HP and Mascom are currently planning a full national scale up of the current system (cover- ing malaria and tuberculosis) that will cover 100% of all health districts across the country. Botswana’s government aims to add another 16 diseases to the project, and increas- ing the scope to all notifiable diseases. PING is also looking to adapt the program to improve the broader health system, including the National Cancer Registry and blood supply logistics. HP and CHAI have started working with Kenya’s MOH and are in talks with Mozambique’s government to expand the program to these countries. Kenya’s government is already using the platform to track the spread of 11 diseases, includ- ing malaria. CASE STUDY PARTNERS ROLES Botswana MOH, CDC Botswana, Clinton Health Access Initiative (CHAI) Implementers HP, Mascom (leading MNO in Botswana) Providing technology, funding, and technical expertise (HP provided smartphones and cloud solutions, MASCOM provided free data transmission) Positive Innovation Next Generation (PING) Initially only technology provider (mobile application platform), now directly supporting implementation In-country scale up CASE STUDIES 02
  12. 12. 11 CASESTUDY:DISEASESURVEILLANCE&MAPPINGPROJECT The objective is to shorten the outbreak identification process and improve response times of medical intervention to out- breaks using mobile-based disease surveillance solutions. ” “ Technology partners play an active role in implementation: • PING was initially a technology partner, but has since evolved into a hands-on implementation partner by leading train- ings, support and maintenance, as well as interacting regularly with health worker end-users and performing site visits with the MOH. • HP and Mascom, who are private sector partners, were actively engaged in the program by sharing skills and expertise in project implementation, instead of simply donating technology and resources. The partnership project presented strong value propositions to its private sector partners. For example, by providing free data transmission for the project, Mascom sees an opportunity to build market share while fulfilling its strong commitment to social responsibility. The MOH was directly involved in project design and implementation from the beginning, ensuring country ownership of the program and, based on the success of the pilot, is now supporting scale up of the program. Success factors 93% of facilities now reporting on time, compared to 20% previously. 02 In-country scale up CASE STUDIES
  13. 13. 12 KimMNCHip � LOCATION: KENYA � STATUS: ONGOING, WITH NATIONAL SCALE AS A TARGET 2 The Kenyan integrated mobile Maternal and Newborn Child Health (MNCH) information platform, or KimMNCHip, is a national-scale mHealth initiative for maternal and child health run by a cross-sector partnership between the Gov- ernment of Kenya, Safaricom, World Vision, Care, AMREF, and NetHope. KimMNCHip aims to support Kenya’s efforts in meeting MDGs 4 and 5 focusing on reducing child mortality and improving maternal health by offering three complementary services:  1. Public information via an mHealth advisory service for pregnant women who register and provide their due date. They receive a mix of “push” SMS and voice messag- es, and access to call-in advisory hotlines and information databases for MNCH issues. These messages provide the women with timely health information scheduled in ac- cordance with the national MNCH plan. SMS/voice charges are being covered by private partners (funded via text or voice message advertising). 2. Mobile financial (mFinancial) services for health that provide pregnant women with electronic vouchers to redeem in a collaborating clinic of their choice. The vouch- ers act as an incentive for clinics to enhance the quality of their services and attract more pregnant women, through a results-based payment system. The voucher also includes a social protection cash transfer to support the women with the costs of delivery. KimMNCHip is exploring other uses of mPayments to support maternal and new- born care. Funding of the vouchers is being sourced from social protection funds and contributions from donors and the private sector. 3. Primary care via mobile support (mSupport) services along the continuum of care, for mothers and for primary health care workers. These will be based on access to electronic medical records, appointments, reminders, and checklists to deliver better community health services, and monitor and respond to MNCH indicators.  OBJECTIVES & GOALS KimMNCHip aims to support Kenya’s commitment to the UN Global Strategy for Women’s and Children’s Health through one integrated system, providing women with mHealth support along the continuum of care from pre- pregnancy to post-natal stages. CASE STUDY PARTNERS ROLES World Vision Partnership broker Safaricom, Mezzanine Private sector partners providing the technology (cloud- based application and technical architectures), mServices and business models CARE International, Aga Khan University Hospital, AMREF Non-profit implementing partners NetHope, mHealth Alliance Global platform partners providing expertise and supporting information sharing Ministry of Public Health and Sanitation (MOPHS) Supporting implementation and scale up In-country scale up CASE STUDIES 02
  14. 14. 13 CASESTUDY:KIMMNCHIP KimMNCHip is designed from the beginning to be implemented at national scale. KimMNCHip focuses on the brokering and partnership processes necessary to develop a national service through implement- ing a partner brokering monitoring framework. Safaricom, World Vision, Care, AMREF, the Ministry of Medical Services, and the MOPHS have formed a taskforce to define KimMNCHip’s requirements. This taskforce includes representatives from the Division of Reproductive Health, the Divi- sion of Child and Adolescent Health, the Division of E-health, the Division of Community Promotional Services, and other NGOs. KimMNCHip members also actively engage in key committees responsible for family planning, maternal and child health, and community health indicators. Efforts are ongoing to form focus groups of mothers to provide feedback on KimMNCHip. High-level commitment from the partners was secured, resulting in the initiative being recently endorsed as the principal Maternal Newborn and Child Health initiative in the country at an mHealth and eHealth Stakeholders Conference hosted by the MOPHS. Success factors KimMNCHip will be implemented at all health facilities across the country (over 8,000). The initiative plans to achieve national scale to reach 6-10 million mothers and 200,000 community health workers in 200 districts. Its objectives are to: 1. Strengthen Kenya’s community health system/referral services by linking households, community health workers, and health facilities in a real-time health information system that tracks pregnancies, births, and maternal deaths and provides updates and reminders for timely interventions; 2. Provide push and pull target-based health messaging for mothers and household members; and 3. Promote and popularize mSavings and eVouchers for mothers and related family members. KimMNCHip will link the end-to- end process from mother, community health worker, health facility and back with data aggregation at a national level. SCALE UP ACHIEVED KimMNCHip is in the process of national roll out. Initially, there was a CHW component through which Safaricom equipped CHWs with 650 mobile devices. Now KimMNCHip is being scaled to a national level covering all health facilities, at the request of the MOPHS. FURTHER SCALE UP PLANNED KimMNCHip will be implemented at all health facilities coun- trywide (over 8,000). The initiative plans to achieve national scale to reach 6-10 million mothers and 200,000 community health workers in 200 districts. ” “ 02 In-country scale up CASE STUDIES
  15. 15. 14 mDiabetes � LOCATION: INDIA � STATUS: ONGOING, WITH PROJECT TARGET SCALE OF ONE MILLION REACHED ONE YEAR EARLY. 3 mDiabetes is a large-scale diabetes prevention mHealth initiative being implemented in India using text messaging to increase awareness and prevention of diabetes among the Indian population. This nationwide mHealth project is implemented by the US non-profit Arogya World in partner- ship with Nokia, and supported by a consortium of partners in the US and India. Arogya World is providing free access to mDiabetes content for an initial period of six months to both current and new Nokia customers in India who have the Nokia Life applica- tion on their mobile phones and subscribe to Nokia’s health channels. Their business model is based on user fees - once the six-month trial is over, customers will have the opportu- nity to opt-in to receive the diabetes awareness and preven- tion messages at a nominal fee. The content of the project was developed in partnership with Emory University and consists of 56 diabetes aware- ness and prevention text messages in 12 regional languages. The messages have been reviewed for cultural relevancy and technical accuracy, and potential for behavior change, through Arogya World’s Behavior Change Task Force made up of medical, health promotion and consumer communica- tions experts. mDiabetes implementation activities were launched in January 2012. The project considers measurement and evaluation critical to project success, and therefore is im- plementing a rigorous effectiveness evaluation plan. Initial consumer testing of messages with 750 consumers and analysis of feedback was performed; the results revealed that the messages were found to be clear, useful and com- pelling. Effectiveness studies and evaluation of behavior change is currently underway. OBJECTIVES & GOALS The goal of mDiabetes is to educate Indians on diabetes prevention and to bring about behavior changes proven to prevent diabetes in 50,000 people in India. The initial aim was to enroll one million consumers in the program over a period of two years. This initial enrollment target has already been met, one year ahead of time. SCALE UP ACHIEVED Between January 2012 and January 2013, 1.05 million consumers from across India opted in and were enrolled in mDiabetes through the Nokia Life platform. As of April 2013, mDiabetes has sent out over 45.9 million text mes- sages through the program, with over 185,000 people hav- ing already completed the initial six-month program.9 CASE STUDY 9 Data is not available on what percentage of the 185,000+ have continued to subscribe to mDiabetes by paying a nominal fee. In-country scale up CASE STUDIES 02
  16. 16. 15 CASESTUDY:MDIABETESmDiabetes creates a value-added service for Nokia presenting a strong investment case, and uses their existing large-scale network of consumers on the Nokia Life platform to deliver diabetes awareness and prevention messaging. Over 95 million consumers in India, China, Indonesia and Nigeria have experienced Nokia Life services, which also recently launched in Kenya in March 2013. mDiabetes launched with a business model built into the project, whereby consumers can access the content for free for the first six months, after which they have to pay a nominal fee to continue receiving diabetes messaging. According to Arogya World, the marginal cost of enrollment is about 40 cents per person, thereby presenting a potentially cost-effective model for chronic disease prevention. Arogya World is employing a strong monitoring and evaluation strategy with multiple phases, particularly to evaluate the effectiveness of the intervention in changing behavior in both urban and rural areas. Coupled with this, Arogya World is maintaining a flexible and adaptable approach to mDiabetes, allowing for corrective changes informed by interim results to be applied to improve program effectiveness throughout the implementation period. Success factors PARTNERS ROLES Arogya World Implementer and evaluator providing strategic leadership Nokia Implementer and technology provider: providing Nokia Life platform, translation and transmission infrastructure, and ac- cess to consumer network. Nokia is also providing funding by subsidizing program costs. Synovate (now Ipsos) Providing market research Biocon, Johnson & Johnson (LifeScan Inc.) and Aetna Providing financial support for the program and measurement and evaluation insights Emory University Providing support on content development FURTHER SCALE UP PLANNED mDiabetes aims to send 58 million text messages over a two- year implementation of the program and scale up the program to reach more of India’s mobile subscribers, depending on re- sults. Through a rigorous effectiveness evaluation of mDiabe- tes, Arogya World aims to establish a scalable, cost-effective model for chronic disease prevention to be replicated in other countries. 02 In-country scale up CASE STUDIES
  17. 17. 16 mHealth Tanzania Public-Private Partnership � LOCATION: TANZANIA � STATUS: SCALING UP 4 The Ministry of Health and Social Welfare of Tanzania (MOHSW) leads the mHealth Tanzania Public-Private Partnership (PPP), with support from the US Government Center for Disease Control and Prevention (CDC), as well as numerous Tanzanian and international public and private sector partners. The PPP focuses on addressing ministry- defined public health priorities by convening partners and supporting national-scale solutions that work in concert with initiatives underway at the Ministry. The PPP supports several active mHealth programs includ- ing the Blood Donor SMS Messaging Service (led by the MOHSW National Blood Transfusion Services), as well as the scale-up of the Electronic Integrated Disease Surveil- lance and Response system (led by the Epidemiology and HMIS sections). This case study focuses on the national launch of the ‘healthy pregnancy’ free text messaging service of the ‘Wazazi Nipendeni’ campaign. A key commitment of the PPP and the MOHSW is to improve maternal and child health during pregnancy, delivery, and newborn babies’ first part of life. This com- mitment is part of the Campaign on Accelerated Reduc- tion of Maternal Mortality in Africa in Tanzania (CARM- MAT).10 Therefore, the MOHSW launched the “Wazazi Nipendeni”, or “Parents Love Me”, countrywide multi- media campaign in late November 2012 with the support of several key partners, to operationalize CARMMAT. The campaign is supported by providing free healthy pregnancy SMS messages in Swahili to pregnant women and mothers of newborn babies (up to 16 weeks of age), as well as her supporters, including the husband, friends and family. The PPP and MOHSW developed official Government of Tanzania-sanctioned SMS messages, in close collaboration with several departments at the MOHSW, and leveraging ‘fetal development’ messages from the global MAMA program. Wazazi Nipendeni involves a multi-media campaign that includes promo- tion of the free (reverse-billed) SMS messaging service by listing the short-code 15001 on campaign materials and instructs anyone interested in more information on healthy pregnancy for free to text the word ‘MTOTO’ (‘baby’) to the short-code. OBJECTIVES & GOALS The objectives of the PPP are to improve the flow of infor- mation across and between levels of the health system and community, reduce the response time of providing critical ser- vices, increase evidence-based planning and decision-mak- ing, and improve public awareness on key health priorities. The PPP works on leveraging the rapid expansion of mobile networks and technologies by exploring numerous applica- tions of mHealth technology, such as increasing direct patient care, rapid lab results communication, health worker training, and drug supply-level information management. The PPP aims to strengthen Tanzania’s public health systems by sup- porting a scalable, cost-effective and sustainable foundation for enhanced national health information systems. This will CASE STUDY 10 Campaign on Accelerated Reduction in Maternal, Child and Newborn Mortality: http://www.carmma.org In-country scale up CASE STUDIES 02
  18. 18. 17 CASESTUDY:MHEALTHTANZANIAPUBLIC-PRIVATEPARTNERSHIP All projects are performed through major partnerships, including Wazazi Nipendeni. The PPP convenes multiple partners from different sectors, combining expertise and resources to implement sustainable and scalable public health programs that leverage the rapidly expanding mobile phone and network infrastructure in Tanzania and existing activities of local partners. These partners were selected based on their core strengths and complementary abilities that could be leveraged for the campaign. For example, EGPAF contributed their technical expertise in PMTCT to support the development of SMS content on this topic, as well as utilized their extensive on-the-ground experience in supporting over 1,300 health facilities in Tanzania to help orient health facility workers to assist women enrolling in Wazazi Nipendeni. The Wazazi Nipendeni free SMS service utilizes the multi-media campaign to reinforce awareness of the service and the shortcode, while employing a reverse-billing approach to enable pregnant women and their supporters to access the SMS service for free. The PPP works across departments, sections, units, programs and projects at the Ministry, under the leadership of the Ministry’s mHealth Coordinator who is in the Department of Policy and Planning. The PPP supports the Ministry in developing a national mHealth Strategy that will link with the eHealth Strategy and other Government of Tanzania and MOHSW strategic plans. It also works in concert with initiatives underway in the MOHSW, including integration with the national enterprise architecture. Success factors PARTNERS ROLES Tanzania Ministry of Health and Social Welfare Strategic leadership US Government Centers for Disease Control and Prevention (CDC) Funding and technical assistance support CDC Foundation Partnership Administration and Management Support Text to Change Provider of technical assistance and SMS Text Messaging Technology Platform Johns Hopkins Bloomberg School of Public Health, USAID, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Aga Khan Health Services Technical, implementation and financial support involve leveraging private sector interest in mHealth and related areas of ICT to develop long-term public-private partnerships, while continuing collaboration with other governmental and non- governmental implementing partners. SCALE UP ACHIEVED Wazazi Nipendeni was launched as the MOHSW’s national healthy pregnancy campaign in late November 2012. The SMS component of the multi-media campaign has proven to be the most successful (measured by volume) national-scale mHealth program in Tanzania to date, with 100,000 active, unique sub- scribers within the first 15 weeks of the campaign. FURTHER SCALE UP PLANNED National scale of the Wazazi Nipendeni healthy pregnancy campaign. 02 In-country scale up CASE STUDIES
  19. 19. 18 mTrac � LOCATION: UGANDA � STATUS: SCALING UP, WITH NATIONAL SCALE PROJECTED WITHIN 2013 5 mTrac11 is part of a nationwide health systems strengthen- ing initiative launched by the Ugandan Ministry of Health (MOH), the National Medical Stores and the President’s Monitoring Unit, with support from UNICEF, WHO and DFID. It consists of a mobile-based disease surveillance and medicine tracking system that provides real-time data for response while monitoring health service deliv- ery performance. mTrac achieves this by digitizing the transfer of Health Management Information System (HMIS) data via mobile phones. The initial focus of mTrac is to speed up the transfer of HMIS Weekly Surveillance Reports (covering disease outbreaks and medicines). Powered by Rap- idSMS, mTrac collects the weekly surveillance reports from Health Facility workers who use their own basic handsets to send the data using SMS and USSD. This data is then amassed and presented on an online dashboard for MOH officials to observe the data in real-time. All mTrac data is also automatically fed into the national District Health Information Software 2 (DHIS2) database. Using mTrac, the Ministry of Health is receiving real-time information on medicine stocks, and district health of- fices are able to successfully lobby the National Medical Stores for resupply based on their ability to present reli- able and timely data. mTrac also focuses on providing a mechanism for commu- nity members to report on service delivery challenges by implementing a toll-free SMS Anonymous Health Service Delivery Complaints Hotline, supported by an initiative called uReport - UNICEF’s social monitoring network with almost 200,000 registered reporters in Uganda alone. Data from CASE STUDY In-country scale up CASE STUDIES 02 11 mTrac was featured in the first ADA report on mHealth focused on scale up. It has been included again here, with significant updates, given the national scale up of the program as of the first quarter of 2013. PARTNERS ROLES UNICEF Technical partner focusing on community management, negotiations brokering with private sector, and providing technical assistance to the MOH WHO Technical partner focusing on national training curriculum, national data usage and analysis, and providing technical assistance to facilities DFID Funder USAID and local Implementing Partners Supporting implementation by requiring USAID implementing partners to include DHIS2 and mTrac in program plans Local NGOs and Community Service Organizations Supporting implementation, advocacy and community mobilization
  20. 20. 19 CASESTUDY:MTRAC 02 In-country scale up CASE STUDIES both Health Facilities and community members is available on mTrac’s web-based dashboard, where District Health Teams are expected to follow up on incoming reports (such as drug stock- outs and health worker absenteeism). The aim is to empower District Health Teams by providing timely information for action. National level government stakeholders also monitor this, ensur- ing accountability and action. OBJECTIVES & GOALS The goal of mTrac is to tackle the challenge of access to disag- gregated health data, identification of bottlenecks and timely follow-up, by strengthening Uganda’s health management information systems. The objective of mTrac is to avoid unneces- sary stock-outs and to improve transparency and accountability within the healthcare system. SCALE UP ACHIEVED Following an 18-month pilot program, mTrac is now taken over and operated by the MOH and has sustained a 90% response rate for weekly reports via SMS. At district-level, mTrac is fully rolled out. mTrac is also serving as the MOH’s national communications tool, with over 15,000 registered and trained CHWs already in the database. mTrac was used to send out alerts and refresher training information during the 2012 Ebola outbreaks. UNICEF Uganda’s related initiative, uReport, has 190,000 people registered, while their anonymous hotline receives 1,200 to 1,500 reports per month. As part of the mTrac roll-out, UNICEF has put in place computers and access to the Internet at all 112 district offices and set up an online dashboard to allow them to validate and review the official data that comes in, as well as receive SMS alerts when certain notifiable diseases are identified. FURTHER SCALE UP PLANNED mTrac is being scaled up nationally in Uganda, with all 5,000 government Health Facilities expected to be using the system by May 2013 (as of March 2013, mTrac is already being used in 70% of all Health Facilities). Ownership and operation of mTrac has shifted to the MOH. mTrac has secured high-level government involvement through the appointment of an inclusive steering committee by the Permanent Secretary, which comprised the MOH, the National Medical Stores (in charge of distribution of all drugs to govern- ment facilities and includes state houses monitoring unit for accountability issues, transparency and corruption), along with a number of other external stakeholders. A technical working group has also been put in place by the Permanent Secretary with representatives from each of the program divisions, including the users of the National Malaria Control Program, surveillance division, pharmacy unit and MOH resource center. mTrac employs strategies, such as avoiding heavy hardware or software costs, that enable the initiative to both scale very quickly as well as put in place a system that the government is comfortable taking on by not imposing a huge hardware burden that other systems may have required. For example, Health Workers use their personal mobile phones to send in the data, addressing issues of sustainability by eliminating the need for the government to manage and support tens of thousands of electronic devices while keeping recurrent costs at a minimum. Success factors Sustainability and scale up of mTrac has been achieved thanks to several factors:
  21. 21. 20 H
  22. 22. 21 CASESTUDIES:CROSS-COUNTRYSCALEUP 03 Cross-country scale up CASE STUDIES CROSS-COUNTRY SCALE UP 12 The information presented in these case studies, including project data, is sourced from online research, project documents, communications, and interviews with personnel involved in the management of these initiatives. 03 CASE STUDIES 1. MOBILE ALLIANCE FOR MATERNAL ACTION 2. MOBILE TECHNOLOGY FOR COMMUNITY HEALTH 3. PROGRAMME MWANA 4. SMS FOR LIFE 5. SWITCHBOARD The follow set of case studies present mHealth partnership initiatives that have achieved or are working towards scale across different countries and present concrete elements of success that can be incorporated in other partnership initia- tives looking to achieve cross-country or global scale.12
  23. 23. 22 Mobile Alliance for Maternal Action � LOCATION: BANGLADESH, SOUTH AFRICA, INDIA � STATUS: MAMA BANGLADESH: SCALING UP. MAMA SOUTH AFRICA: SCALING UP. MAMA INDIA: PLANNING PHASE. The Mobile Alliance for Maternal Action (MAMA) is a global mHealth public-private partnership that is initially mobilizing US$10 million over the course of three years to improve maternal and child health. The partnership will implement and support mHealth projects in three initial countries - Bangladesh, India and South Africa - that will deliver culturally-sensitive, evidence-based health informa- tion to pregnant women and new mothers. Subscribers to the service register by indicating their expected due date or the birthday of their recently born child and receive weekly messages and reminders during the pregnancy and up to the child’s first birthday. Messages include everything from proper nutrition, breastfeeding, vaccinations and referrals to local health resources. Each country program is different as they are tailored to local contexts. For example, in Bangladesh a high percent- age of the target beneficiary group is illiterate, therefore voice messaging via Interactive Voice Response (IVR) is a major delivery method. A smaller percentage of the popula- tion receives push SMS. In South Africa, literacy rates are much higher but SMS messages are very expensive at scale. Thanks to the high penetration of data-enabled feature phones, this then allowed the use of mobile web (mo- bisites). The program also uses USSD, a text-based interac- tive platform that works on the lowest-end phones but is cheaper than SMS. MAMA South Africa offers specialized support to mothers enrolled in prevention of mother-to- child transmission of HIV (PMTCT) programs. MAMA India is currently performing a landscape analysis and mapping effort using cross-sectoral partners to assess how to best design the program. MAMA also provides a library of free, adaptable mHealth messages for programs that are using mobile phones to inform and empower new and expectant mothers. These health messages and reminders are comprehensive, stage-based and available for use in SMS and audio (IVR) programs. The messages are based on WHO and UNICEF guidelines and can be adapted to different languages, cul- tures, regions, and to address specific needs. OBJECTIVES & GOALS MAMA is a global partnership that seeks to accelerate the use of mobile technology to improve the lives of expect- ant and new mothers in developing nations by engaging an innovative global community to deliver vital health informa- tion through mobile phones. MAMA’s objectives are to help coordinate and increase the impact of existing mHealth mes- saging programs, provide resources and technical assistance to promising new business models, and build the evidence base on the effective application of mobile technology to im- prove maternal health. Lessons learned from these and other initiatives will be shared globally in a coordinated exchange of information. SCALE UP ACHIEVED MAMA Bangladesh was the first country program to launch a national mHealth service, called Aponjon, after complet- ing an 11-month pilot phase. Aponjon is delivering critical stage-based information to new and expectant mothers and their families. Since launching, Aponjon already has 40,000 CASE STUDY 03Cross-country scale up CASE STUDIES 1
  24. 24. 23 CASESTUDY:MOBILEALLIANCEFORMATERNALACTION 03 Cross-country scale up CASE STUDIES PARTNERS ROLES USAID Providing funding, strategic leadership, access to local USAID missions and expertise through MCHIP Johnson & Johnson Providing funding, technical expertise in communications and branding UN Foundation Providing support for communications, advocacy and public outreach, and linkages to UN organizations mHealth Alliance Serving as MAMA Secretariat, and providing technical mHealth expertise and a forum to exchange knowledge and share best practices BabyCenter LLC Providing adaptable messages library (both text and audio messages) and expertise MAMA BANGLADESH113 D.Net MAMA Bangladesh partnership coordinator and primary implement- ing agency, with its own consortium of partners, including BRAC Bangladesh Ministry of Health and Family Welfare (MOHFW) Providing health content review and approval; leadership of the MAMA Bangladesh Advisory Board; promotion through state media and public sector health system Local partners Providing in-cash and in-kind support MAMA SOUTH AFRICA Praekelt Foundation, Main local implementation and service design Cell-Life, WRHI partners Vodacom Foundation Provision and promotion of free access to MAMA South Africa for Vodacom subscribers 13 There are over 30 partners in Bangladesh, including five mobile network operators, over five outreach (NGO) partners including BRAC, Smiling Sun Franchises, and Mamoni (Save the Children), as well as the MOHFW and corporate sponsors such as Multimode and Beximco.
  25. 25. 24 03Cross-country scale up CASE STUDIES subscribers registered for the service thanks to the 1,500 community health workers coordinating this process, trained by key local partner D.Net, a social enterprise in Bangladesh and lead project implementer. Aponjon is a service where most (about 80%) of the subscribers opt-in and pay for the service at a subsidized rate. Only about 20% of the sub- scribers who meet the criteria for being the poorest get the service entirely for free. MAMA South Africa was launched nationally in May 2013 and announced its first partnership with a mobile network operator, Vodacom (via the Vodacom Foundation), one of the country’s leading telecommunications companies. The partnership will give all 25 million Vodacom subscribers free access to MAMA’s mobile website (askmama.mobi) and will support a free SMS program offered through two inner-city clinics in Hillbrow, one of the lowest-income areas of Johannesburg. MAMA’s adaptive messaging library has been accessed by more than 120 organizations in 50 countries14 . The library is constantly being expanded with new content, including messages on PMTCT, post-partum family planning, breast- feeding, immunization, as well as messages for husbands and mothers-in-law. These adaptable messages have reached 200,000 new and expectant mothers and have been translated in 10 languages. FURTHER SCALE UP PLANNED MAMA Bangladesh aims to reach two million new and expectant mothers, as well as household decision-makers, by 2015. MAMA South Africa aims to reach 500,000 women and household decision-makers over two years. The program uses multiple channels of message delivery: they are cur- rently rolling out SMS, USSD, and mobisite services and aim to add voice and MXit services in 2013. Aponjon is a service where most (about 80%) of the subscrib- ers opt-in and pay for the service at a subsidized rate. Only about 20% of the subscribers who meet the criteria for being the poorest get the service entirely for free. ” “ 14 To request access to use MAMA’s adaptable mobile messages library, visit this page: http://www.mobilemamaalliance.org/mobile-messages.
  26. 26. 25 03 Cross-country scale up CASE STUDIES MAMA carefully selected its partners based on their added value. Engaging and working closely with diverse global, regional and local partners enabled MAMA to tailor each country program to local contexts and use different mechanisms for message delivery that best suit local market structures and target populations to ensure uptake. MAMA identified different types of business models, such as variable pricing, to ensure sustainability of the service. For exam- ple, Aponjon engages local community health agents from different partner organizations in order to assess eligibility of users for different price tiers, thereby targeting different segments of the BOP. Aponjon is available for free for the poorest, while the other 80% pay a small user fee, consistent with prices charged for other mobile information services. A benefit of applying user charges is that implementers can assess whether users value the content, as they would unsubscribe if not. MAMA Bangladesh is currently exploring the use of sponsorship tags on IVR services to generate an additional revenue stream to ensure long- term sustainability. MAMA country programs are employing a comprehensive approach in program design and implementation. MAMA is working with a wide variety of local partners in each country, including NGOs, mobile network operators and government institutions, to inform the program design, perform direct implementation and drive scale up. Success factors CASESTUDY:MOBILEALLIANCEFORMATERNALACTION
  27. 27. 26 Mobile Technology for Community Health � LOCATION: GHANA, INDIA � STATUS: SCALING UP IN GHANA AND ROLLING OUT TO NEW A GEOGRAPHIC AREA IN INDIA. The Mobile Technology for Community Health, or MOTECH, project is a joint initiative between the Grameen Foundation, the Ghana Health Service, and Columbia’s Mailman School of Public Health, that addresses maternal and neonatal health and mortality among the rural poor using mobile technology. Through its “Mobile Midwife” information service, MOTECH sends targeted, time-specific, evidence-based voice and text messages with vital health care information to pregnant women and new parents in their local language throughout the pregnancy and during the first year of their child’s life. These messages contain advice on pregnancy-related issues, important facts about fetal development and reminders about upcoming clinic check-ups and care visits. A complimentary service called Mobile Nurse enables rural community health workers to record and track the care pro- vided to women and newborns in their area. Using a basic mobile phone, community health workers enter data from patients’ clinic visits and upload the records to MOTECH servers for authentication. Patient records are analyzed to establish personalized care schedules, and notifications are sent to nurses about care visits. This information is also used to personalize the Mobile Midwife alerts, reminders and information sent to the pregnant woman. The system also sends weekly notifications to nurses on various patient updates, such as new defaulters (patients who miss appoint- ments) and upcoming and recent deliveries. Mobile Nurse enables nurses to automate the generation of their monthly reports, which used to take 4-6 days per month of their CASE STUDY 03Cross-country scale up CASE STUDIES 2 time, thereby helping the nurses save valuable time as well as improve the accuracy of their reports. Mobile Nurse also facilitates the identification of patients who have missed certain care visits. The system also sends detailed data on health service delivery and outcomes to the Ghana Health Service, giving policymakers an accurate and detailed pic- ture of health conditions in the country. OBJECTIVES & GOALS The objectives are to enable the delivery of maternal health information over mobile phones to pregnant women in rural areas, while helping nurses record and track care delivered to women and newborns in their area. MOTECH aims to use mobile phones to increase the quantity and quality of an- tenatal, postnatal and neonatal care in rural Ghana, as well as the demand for such services, with a goal of improving health outcomes for mothers and their newborns. SCALE UP ACHIEVED In Ghana, there are now over 25,000 people registered for the service and almost 300 community health workers us- ing mobile phones to track their patients. The Ghana Health Service is expanding the service to additional districts to
  28. 28. 27 CASESTUDY:MOBILETECHNOLOGYFORCOMMUNITYHEALTH 03 Cross-country scale up CASE STUDIES 15 Available at: http://www.grameenfoundation.org/sites/default/files/MOTECH-Lessons-Learned-Sept-2012.pdf Grameen Foundation designed MOTECH for long-term scale and replication from the outset by building components that could be reused in other geographies and other health domains. Grameen Foundation worked with organizations such as Dimagi and InSTEDD that had complimentary technologies to make their services interoperable, resulting in the MOTECH Suite. Much value is placed by the Grameen Foundation in developing strong partnerships and working collaboratively to address the myriad operational details required to build a successful mHealth intervention. Grameen Foundation employs a strong monitoring and evaluation approach, and has publicly shared their documented their lessons learned and experiences from Ghana in documents available online.15 Success factors PARTNERS ROLES Grameen Foundation Program implementer and manager Columbia Mailman School of Public Health Providing program support Bill & Melinda Gates Foundation (for Ghana), Johnson & Johnson (for India) Funders Ghana Health Services Supporting scale up and implementation help meet its top-priority goals: increasing the number of women who receive four antenatal care visits, the number of deliveries that happen with a skilled birth attendant, and the number of newborns who are seen by a health worker within the first 48 hours of life. FURTHER SCALE UP PLANNED MOTECH is now being expanded to a new geography and health prior- ity with Grameen Foundation’s HIV/AIDS program in India. MOTECH is enabling organizations to send messages to HIV-positive patients reminding them to take their antiretroviral medication. It is working to provide tools and training to 200,000 health workers reaching the poorest communities in Bihar, India. MOTECH is also helping health workers track their clients in World Vision programs in seven countries, such as Afghanistan and Zambia.
  29. 29. 28 Programme Mwana � LOCATION: ZAMBIA, MALAWI � STATUS: SCALING UP Programme Mwana is a mobile health initiative implemented by the Zambian MOH with support from UNICEF and col- laborating partners to strengthen health services for moth- ers and infants in rural health clinics, with particular focus on improving Early Infant Diagnosis (EID) of HIV and improving post-natal care for mothers and their children. In Zambia, delivery of paper-based infant HIV test results typically averages 6.2 weeks given poor road infrastruc- ture and far distances between clinics and labs processing the results, thereby presenting long delays for EID. Such delays contribute to loss of follow-up and possible death of 30% of affected children if no interventions are provided. Programme Mwana launched a pilot in April 2010 to reduce these delays in results transmission from the HIV test labo- ratories to rural health facilities via SMS message. The pilot had two main SMS components: Results160 and RemindMi. Results160 was used by staff to securely deliver infant HIV results from the lab to the health clinics, while RemindMi was used by CHWs to remind the mothers to return to the clinics to receive their infant’s results. The following results were identified through a program evaluation: • Over 5,000 infant HIV test results have been delivered (as of September 2012). • The time between when the samples were collected and when the mother received the results was reduced by 56%. • 30% more results were successfully delivered to mothers thanks to the digitization of the results (as the paper cop- ies were often getting lost). A national scale-up plan was developed and is now being implemented, which commenced with a preparation phase and followed by shifting to an iterative phase where clinics are trained and added to the system and problems and suc- cesses are evaluated. Throughout the scale-up process, the project will be closely monitored to ensure the systems are having a positive effect on the targeted health challenges. OBJECTIVES & GOALS The primary goal of Programme Mwana is to use mobile technology to strengthen health services for mothers and infants in rural clinics, particularly EID as it is a significant problem for countries trying to improve prevention of maternal to child transmission of HIV (PMTCT). The limited amount of technology available to perform infant HIV diagnosis combined with very poor road infrastructure for delivery of results present major bottlenecks for EID. Programme Mwana was designed to reduce infant mortality by addressing these particular bottlenecks using mHealth, SMS-based interventions. SCALE UP ACHIEVED Programme Mwana was first piloted by the Zambia MOH in 13 districts in six provinces from 2010 with a goal of reaching nationwide coverage by 2014. Programme Mwana is now currently in more than 364 facilities and full national scale up is underway in Zambia. In Malawi, the program was adopted at national level in 2012 and RapidSMS has been rolled out to tackle other issues as well, including pre- and post-natal care, immunization, growth monitoring and nutrition promotion. FURTHER SCALE UP PLANNED In 2011, the Zambian MOH officially decided to scale Pro- gramme Mwana to 414 health facilities that provide EID ser- vices. The scale-up is taking place over three years, assisted by a wide range of government and NGO partners. CASE STUDY 03Cross-country scale up CASE STUDIES 3 PARTNERS ROLES Zambia MOH / Malawi MOH Implementer providing strategic leadership UNICEF Innovation, UNICEF Zambia / UNICEF Malawi Providing implementation support, technical expertise and technology/systems development. Boston University affiliate the Zambia Centre for Applied Heath Research and Development (ZCHARD), Clinton Health Access Initiative (CHAI), and other implementing and technical partners Implementing partners
  30. 30. 29 CASESTUDY:PROGRAMMEMWANA 03 Cross-country scale up CASE STUDIES 16 For more information on the project design of Programme Mwana, see the Case Example on page 59. Success factors The mobile solutions developed for Programme Mwana were designed with specific health objectives that were aligned with the national health strategies of Zambia.16 Upon completion of the pilot, all computer hardware, system software, partnerships with telecom companies and software developers were in place to simplify the scaling up of the system to a matter of training. The entire system and supporting processes and materials were designed in a way to make a single package that can be easily replicated in other countries. The team invested significant effort and time in understanding and strengthening the existing health interventions, rather than replace them with a new intervention. This was done in close partnership with the government and partner NGOs. MWANA INITIATIVE, ZAMBIA & MALAWI MOTHER CHILD 1ST TRIMESTER 2ND & 3RD TRIMESTERS CHW RURAL CLINIC DISTRICT COUNTRY CHW registers birth 6/6/6 visit reminder 6/6/6 visit reminder 6/6/6 visit reminder DBS sample registered Mother asked to visit clinic Mother receives results at clinic Results registered at national lab SMS results received Sample shipped and tracked KEY SYSTEM COMPONENTS PREGNANCY BIRTH & POSTPARTUM BIRTH & POSTNATAL MATERNAL HEALTH INFANCY CHILDHOOD USER REGISTRATION PATIENT REGISTRATION LOGISTICAL TRACKING REMINDER LOGISTICAL TRACKING RESULTS NOTIFICATION CONFIRMATION CONFIRMATION REQUEST FOR ACTION CONFIRMATION A national scale-up plan was developed and is now being implemented, which commenced with a preparation phase and followed by shifting to an iterative phase where clinics are trained and added to the system and problems and successes are evaluated. ” “ Programme Mwana mapped on the continuum of care. Credit: UNICEF Innovation
  31. 31. 30 SMS for Life is an innovative public-private partnership ini- tially led by Novartis and supported by the Tanzanian Minis- try of Health and Social Welfare (MOHSW), IBM, Medicines for Malaria Venture (MMV), the Swiss Agency for Develop- ment and Cooperation (SDC), Vodacom and Vodafone. The project comes under the umbrella of the global Roll Back Malaria Partnership. SMS for Life harnesses everyday technology to improve ac- cess to essential malaria medicines in rural areas of devel- oping countries. It uses a combination of mobile phones, SMS messages and electronic mapping technology to track weekly stock levels at public health facilities in order to: eliminate stock-outs, increase access to essential medicines, and reduce the number of deaths from malaria. Every Thursday, the system sends a stock request message to the mobile phones of all registered health facility work- ers. They then count how much stock they have and send the information back to the system via a free text message. If they have not done this by Friday, the system sends them a reminder. On Monday the system would send information about stock levels and non-reports to the district manage- ment officer, who can then monitor stock levels and order or redistribute medicine between sites accordingly. OBJECTIVES & GOALS The SMS for Life project was originally conceived to harness mobile resource management technology in eliminating stock- outs and improve access to malarial medicines in Tanzania. The partnership’s objectives are to bring weekly visibility to medi- cine stock levels at the remote Health Facility level, improve access to life saving medicines at the point of care by eliminat- ing medicine stock-outs at the health facility level, and provide an infrastructure to allow weekly collection of surveillance information. It tackles these by enabling real-time reporting of stocks using mobile phones and two-way text messaging. SCALE UP ACHIEVED SMS for Life has been rolled out nationally across Tanzania, with the staff of over 5,000 facilities trained and reporting on a weekly basis. Ownership of the initiative has been officially transferred to the Tanzanian MOHSW. The post-pilot partner- ship includes the Tanzanian Ministry of Health, the Medicines for Malaria Venture (NGO), Novartis Foundation, Vodacom, and the Swiss Agency for Development and Cooperation. FURTHER SCALE UP PLANNED Novartis is now planning to expand SMS for Life to several African countries. In Ghana, following a successful pilot in six districts sponsored by the Swiss Tropical and Public Health Institute (Swiss TPH), Novartis is working with the Ghana Health Service on planning a full country scale up. In Kenya, another successful and extensive pilot has been completed and Novartis is working with the National Malaria Control Program (NMCP) on a plan for a full country scale up. In Cameroon, with support from the Norwegian Agency for Development Cooperation (NORAD), Novartis and its partners are in the planning phase for a full country scale up of malaria medicine tracking, in addition to collecting patient surveillance data on the use of rapid diagnostic tests. In addition to Tanzania, Kenya, Ghana and Cameroon, there is interest in exploring SMS for Life integration in Zimbabwe, Madagascar, Chad and the Democratic Republic of Congo. SMS for Life � LOCATION: TANZANIA, KENYA, GHANA, CAMEROON � STATUS: TANZANIA: National scale achieved. Additional African Countries: Scale up and implementation ongoing or planned. CASE STUDY 03Cross-country scale up CASE STUDIES 4 Extract from SMS for Life Poster. Credit: RBM Partnership
  32. 32. 31 CASESTUDY:SMSFORLIFE 03 Cross-country scale up CASE STUDIES Sustainability has been achieved through securing government buy-in and ensuring ownership of SMS for Life programs by country governments, as well as sustainable funding as partners fund the initial systems cost associated with the pro- ject while the in-country training and implementation costs are typically covered by the country government itself. SMS for Life brings together a broad consortium of partners from a variety of sectors. A strong steering committee has been set up to manage the partnership and the initiative via the Roll Back Malaria partnership, including representatives from government, the private sector and non-profit partners (including Vodafone, Novartis and the Swiss Tropical Institute). Success factors PARTNERS ROLES Novartis Providing funding, technical expertise and strategic leadership Roll Back Malaria partnership (RBM) Providing strategic support and guidance by facilitating a steering committee and advocacy efforts Swiss Agency for Development and Cooperation, Medicines for Malaria Venture Initial funders IBM, Google, Vodacom, Vodafone Technical supporting partners providing technology and other support Country Governments Supporting implementation and national scale
  33. 33. 32 In partnership with mobile network operators Vodafone and MTN, Switchboard has created a free calling network for every doctor in Ghana and Liberia, and is now creating a free calling network for all health workers in Tanzania. Since 2008, physicians have been collaborating using the Switch- board network to improve patient care with over four million calls made. Physicians in Ghana were spending upwards of US$70 per month on calls to colleagues. With the development of Switchboard, physicians in Ghana and Liberia gained a nationwide support network, while telecoms gained valuable customers. As physicians in Ghana and Liberia registered for the Switchboard networks, Switchboard was able to create the first-ever doctor directories in 2010 and 2011.  Every physician received a print directory, allowing them to expand their support network nationwide, consult with new col- leagues, and refer patients more effectively. OBJECTIVES & GOALS Using even the simplest mobile phones, Switchboard aims to make nationwide networks of health workers enabling them to seek medical advice and make referrals free of charge. Switchboard works to achieve this by: (1) creating free call- ing networks between health workers enabling them to call or text each other for free; (2) building nationwide phone registries; and (3) implementing a bulk SMS messaging plat- form. This platform will enable bi-directional communication between health workers and MOH officials to relay disease outbreak information, drug supply levels and receive lab results in real-time. SCALE UP ACHIEVED Free calling networks have been established between all 181 doctors in Liberia and all 2,200 physicians in Ghana – gener- ating four million calls since 2008. FURTHER SCALE UP PLANNED Switchboard is expanding into Tanzania with the aim of creat- ing a network between all 34,000 health workers in Tanzania. Out of these 34,000, only 6,505 medical and clinical officers manage all rural health centers in Tanzania – acting as the main points of care for a population of 45 million. These isolated health workers are currently unable to seek advice from almost 2,500 urban doctors or receive government support. To allow health workers to freely seek advice nationwide, Switchboard is initially creating a free calling network for the 9,000 doctors, medical and clinical officers in Tanzania through local telecom partner, Vodacom. For every isolated health worker in Tanzania to receive best practices or disease outbreak alerts instantly on their mobile phone, Switchboard will work with the Ministry of Health to utilize their Bulk SMS platform, enabling them to send critical information to large groups of health workers, and allowing practitioners in the field to also reply to vital questions or report medical supply levels. Switchboard �LOCATION: GHANA, LIBERIA, TANZANIA (ROLLING OUT) �STATUS: GHANA, LIBERIA: National scale achieved (reach- ing 100% of doctors). TANZANIA: Ongoing, with the target of national scale (reaching all health workers). CASE STUDY 03Cross-country scale up CASE STUDIES PARTNERS ROLES Switchboard Lead implementer and partnership broker MTN (Liberia), Vodafone (Ghana), Vodacom (Tanzania) Technology providers: providing free calling networks Ghana Medical Association (GMA), Ghana Medical & Dental Council Liberia Medical & Dental Association, Liberia Medical & Dental Council Local implementers Ghana MOH, Ghana Health Service; Liberia MOH; Tanzania MOH Supporting and implementing scale up Google.org Providing strategic funding for scale up in Tanzania 5
  34. 34. 33 CASESTUDY:SWITCHBOARD 03 Cross-country scale up CASE STUDIES Switchboard designed their program for scale from the beginning and incorporated strong incentives for each partner to participate, with a particularly strong commercial incentive for the mobile network operator. Switchboard designs and employs creative business models to engage private sector partners. For example, Switch- board’s free calling networks save doctors money on calls to colleagues to seek advice or refer patients, so they provide a significant incentive to switch carriers. Vodafone has only 18% market share in Ghana, yet they have all 2,200 physicians as subscribers. While practitioners make free calls to seek advice, they also make paid calls to friends and family – already generating $1.5 million in revenue for Vodafone and MTN. Switchboard believes these creative business models are the key to nationwide mHealth scale and expansion to new markets. Switchboard sought partnership agreements with Ministries of Health and the MNOs to ensure the type of monitoring and evaluation they needed internally to collect the data necessary to build their business cases. Success factors Liberia Doctors 181 People 4 million Ghana Doctors 2,200 People 24 million Tanzania Health Workers 9,000 People 45 million - 9,000 health workers in Tanzania - All 2,200 doctors in Ghana - All 181 doctors in Liberia The Ghana Doctor Directory in use at Korle Bu Teaching Hospital, Accra, Ghana. Credit: Dania Maxwell
  35. 35. 34 04 RECOMMENDATIONS Introduction RECOMMENDATIONS 04 Introduction Strategic partnerships combine the distinct core competencies, knowledge, exper- tise, resources, market access and networks of each partner in order to achieve scale and impact of an initiative that, if pursued as individuals, may not be possible. It pro- vides a unique opportunity to share risks, rewards, responsibilities and investments to achieve common goals. This section delivers recommendations on how to best proceed through different phases of partnership development for mHealth projects with a constant focus on achieving scale up. 1 2 3 4 Building the Partnership Implementing the Partnership Sustaining the Partnership Ensuring Partnership Driven Scale Up What are key success factors for build- ing and sustaining partnerships that can achieve scale of a mobile health initia- tive? How can partnership-driven scale up be ensured? These questions are an- swered through interviews with various major partnership brokers, stakeholders and decision-makers, with the content organized into sets of recommendations according to partnership development phases. The recommendations were then evaluated by an Expert Review Panel in order to ensure the perspec- tives of diverse fields were represented. The recommendations were crafted according to the following partnership development phases →
  36. 36. 35 RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP 04 Partnership experts RECOMMENDATIONS RECOMMENDATIONS:INTRODUCTION&PARTNERSHIPEXPERTS Partnership experts EXPERT INTERVIEWEES EXPERT REVIEW PANEL Sean Blaschke Health Systems Strengthening Coordinator, UNICEF Uganda Awa Marie Coll-Seck Minister of Health, Senegal | Former Executive Director, Roll Back Malaria Amir Dossal Founder & Chairman, Global Partnership Forum Sarah Emerson Country Manager, mHealth Tanzania Public-Private Partnership, CDC Foundation Kirsten Gagnaire Global Director, Mobile Alliance for Maternal Action (MAMA) Patricia Mechael Executive Director, mHealth Alliance Judy Njogu Product Manager for eHealth & eLearning, Safaricom Yunkap Kwankam CEO, Global eHealth Consultants | Executive Director, International Society for Telemedicine & eHealth Chris Locke Managing Director, GSMA Mobile for Development Carole Presern Executive Director, The Partnership for Maternal, Newborn & Child Health (PMNCH) Sandhya Rao Senior Advisor, Private Sector Partnerships, Office of Health, Infectious Diseases and Nutrition, USAID Véronique Thouvenot Head of International Women and eHealth Working Group, Millennia 2015 These recommendations were drawn from partnership experts with experience from a variety of sectors (non-profit, government, donor, and private sectors), and present a diverse set of perspectives and insights for a comprehensive view on what are the key elements for successful strategic partnerships to drive the scale up of mHealth.
  37. 37. 36 04 RECOMMENDATIONS Recommendations Overview Perform a thorough landscape analysis of local contexts Employ an inclusive multi- stakeholder approach Partner with government & private sectors Ensure strategic alignment & commitment Create a compelling partnership proposal Understand differing organizational cultures & how to work together Establish a formal partner- ship agreement & governance structures Employ a collaborative approach on pro- ject design for scale Agree on goals and targets; set realistic and flexible expectations Be aware of risks & rewards of partnering Establish a strong communication strategy Build trust & minimize human resource obstacles Implement a broad monitoring & evaluation strategy Maintain flexibility & adaptability Start small, think big, & design a smart model for scale Ensure government ownership & involvement Establish a cross-agency committee to steer scale up Avoid high human resource & technology costs Recommendations Overview Build Implement Sustain Scale
  38. 38. 37 4.1 Building the Partnership RECOMMENDATIONS RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP BUILDING THE PARTNERSHIP Building the partnership covers an in-depth exploration of the target issue, contexts, stakeholders, potential partners and possibility for alignment, and finally creating a win-win proposal to secure partners to form the desired core part- nership. This initial phase of partnership development can last from a few months to more than a year, depending on the scope and context. The following recommendations cover strategies for successfully building a partnership. 1 PERFORM A THOROUGH LANDSCAPE ANALYSIS OF LOCAL CONTEXTS EMPLOY AN INCLUSIVE MULTI-STAKEHOLDER APPROACH PARTNER WITH GOVERNMENT & PRIVATE SECTORS ENSURE STRATEGIC ALIGNMENT & COMMITMENT CREATE COMPELLING PARTNERSHIP PROPOSAL RECOMMENDATIONS:
  39. 39. 38 4.1 RECOMMENDATIONS Building the Partnership The first step is to perform a landscape analysis to develop a thor- ough understanding of the problem to be tackled, the existing solu- tions, the potential major stakeholders, and the national information and health infrastructures and systems in the area of implementation. Dr. Awa Marie Coll-Seck, current Minister of Health of Senegal and former Executive Director of the major public-private partnership Roll Back Malaria, advises having a clear and strong identification of the problem the proposed partnership wishes to tackle. She recommends analyzing the problem and the different ways in which to resolve the problem, as well as identifying what are the different sectors needed to participate in solving the problem. Once this is done, Sean Blaschke, Health Systems Strengthening Co- ordinator of UNICEF Uganda, recommends mapping what solutions already exist and what is being implemented, as well as what is working and what isn’t. Without such information, an initiative could easily run into trouble. One example is unknowingly investing a great amount of time and energy in proposing and getting funding for a duplication of an existing project, which would likely not get accepted or approved by the Ministry of Health (MOH). Another important element is ensuring there is an enabling environ- ment for electronic and mobile health (e/mHealth) in the country of implementation. “You really need to know what the existing laws and policies are. I’ve seen a number of projects fail where a donor gave money to an NGO who then hired a technology company to create a solution which, once presented to the Ministry, was rejected because certain things – like patient privacy – weren’t taken into consideration,” says Blaschke. For this reason, Blaschke says it is de- cidedly important to use the landscape analysis to determine what current government structures, policies and legislation are in place that can impact the project and to develop an understanding of the local ecosystem. If the partnership is lacking local knowledge of how the government works, and of the policies, legislation and frame- works in place, it is crucial to involve individuals with this knowledge as navigating the government can be quite complex and difficult. Seek out local communities of practice, such as the mHealth Com- munity of Practice in Tanzania, co-led by the Tanzanian Ministry of Health and Social Welfare and rotating co-chairs.17 Sarah Emerson, Country Director of the mHealth Tanzania Public-Private Partner- ship, shared how this community of practice provides a forum for sharing experiences, challenges and advice, as well as identifying potential collaborations within the Tanzanian ecosystem for mobile health. Blaschke says that Uganda, like many other countries, provides additional challenges because the government has not yet officially endorsed its eHealth strategy. There is also an eHealth moratorium in place since December 2011, meaning the Ministry is currently not considering new projects until the eHealth strategy has been completed. Ideally, with these strategies governments should be able to outline what their priorities are, where they are currently investing and where there is need for investment. While more than 80 countries have eHealth strategies in place, unfortu- nately very few countries in Africa have such a framework in place.18 The landscape analysis should also identify major potential stake- holders that can play a role in the partnership. After performing the landscape analysis, Blaschke identifies the next step as understanding how different information systems fit together in the country or area of implementation. This is something that many organizations don’t do in the early phases, even those looking to broadly strengthen health management information sys- tems (HMIS). What is not taken into account, according to Blaschke, is that “an eHealth enterprise-level architecture typically includes many domains, including logistic management information systems, patient records, and health insurance systems, all of which must work together.” As such, there usually are other information systems that overlap with the tools and systems being developed. Blaschke notes that UNICEF is working with the Ugandan MOH to identify what these areas of overlap are and to ensure that existing tools and those being developed can actually work together in a coherent and cohesive way. Perform a thorough landscape analysis in the local context(s) of implementation. • Clearly identify the problem, existing solutions, major stakeholders & local infrastructure and systems. • Ensure there is an enabling environment for e/mHealth & understand how information systems work together. 1 17 The Tanzania mHealth Community of Practice is currently co-chaired by the Tanzania MOHSW and D-Tree International, and has over 90 members from 30 organizations across government, industry and NGO sectors. The community can be accessed here: https://groups. google.com/forum/?fromgroups-!forum/tanzania-mhealth#!forum/tanzania-mhealth 18 A directory of national eHealth policies can be found in the WHO’s Global Observatory for eHealth: http://www.who.int/goe/policies/countries/en/index.html
  40. 40. 39 Amir Dossal, Founder and Chairman of the Global Partnerships Forum, advises employing a multi-stakeholder partnership approach by engaging a variety of actors to address social problems in a cohesive way. Partners from different sectors and fields can offer different sets of assets and strengths to benefit the project. Consider not only their core competencies, but also their history, networks and reputation in the area of implemen- tation. Partners’ assets should be identified in early discus- sions to determine areas of expertise and knowledge, existing relationships, access to markets, etc. Dossal highlights specific competencies from different sectors that can support the part- nership, including: management skills of the private sector, nor- mative leadership of the public sector, and successful delivery mechanisms of NGOs and civil society who understand how to deliver programs on the ground. Emerson further recommends focusing on the complementary abilities of each partner that can leverage the project and carefully determining where each partner can and should play a role. According to Minister Coll- Seck, it is important to identify which partners are the best fit – based on what is needed for the project, where each partner adds value and how they fit with the other partners. Be inclusive and consider all stakeholders when building the partnership; always keeping scale up in mind. Local stakehold- ers, particularly community and traditional leaders, community health workers (CHWs) and local populations, should also be engaged as partners in the development and roll out of mHealth solutions. Blaschke suggests that partnering with local com- munity service organizations can be key to ensuring uptake of the initiative by the target beneficiaries. UNICEF’s uReport and mTrac’s Anonymous Hotline were able to leverage existing grass roots organizations to mobilize their communities around community monitoring. UNICEF identified various organizations including the Church of Uganda, Islamic Supreme Council and the Uganda Scouts Association who already have huge net- works that they could tap into to make people aware of these community-monitoring programs. “As an organization, a few years back UNICEF started looking at signing strategic partner- ship agreements with more local organizations,” says Blaschke, and this has certainly been beneficial for them. Kirsten Gagnaire, Global Director of the Mobile Alliance for Maternal Action (MAMA), recommends identifying what assets are specifically needed to scale the initiative: Access to a new market or demographic? Subsidized mobile services such as bulk SMS rates? In-depth local knowledge of a particular health issue and target population? Tailored content and delivery mechanisms for a specific demographic? Gagnaire advises organizations to use this information to carefully determine which partners are needed based on what is needed to support scale up. Choose partners with the strongest competencies based on the needs of the project and strive for the optimal combination of added value to support its success and be conducive to scale up. The idea for and formation of MAMA started at USAID headquarters in Washington D.C. USAID was interested in creating a model that was built for scale, by catalyzing country-based public-private coalitions to support the development and scale-up of sustainable mHealth services for maternal and child health, beginning in Bangladesh. USAID was keen to leverage and build local capacity, and decided to partner with a Bangladeshi social enterprise that would serve as the coalition coordinator. This enter- prise would “own” the service, created with initial catalytic funding from USAID, and it would create and maintain the relationships with mobile operators, outreach part- ners, corporate sponsors, government entities and others. Building on the model developed in Bangladesh, USAID worked with Johnson & Johnson, who had created a similar model in the U.S. with Text4Baby, to join forces and form the Mobile Alliance for Maternal Action, to scale this model to other countries, in partnership with the mHealth Alliance, the United Nations Foundation and BabyCenter. continued on the next page CASE EXAMPLE: FORMATION OF GLOBAL PUBLIC-PRIVATE PARTNERSHIP MAMA Employ an inclusive multi-stakeholder partnership approach when selecting the partners. • Carefully select each partner based on core competencies, strengths, areas of expertise, resources & networks. • Focus on complementarity & strive for the optimal combination of added value to scale the project. 2 RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP 4.1 Building the Partnership RECOMMENDATIONS
  41. 41. 40 Developing partnerships with local government officials and institutions can be a key success factor to ensuring the scala- bility and long-term sustainability of the initiative. Judy Njogu, Product Manager for eHealth and eLearning at Kenya’s leading Mobile Network Operator (MNO) Safaricom, explains: “You cannot achieve scale unless you are working with the government,” while describing Safaricom’s relationships with local Kenyan govern- ment leaders, including the Director of Public Health. Minister Coll-Seck specifically advises partnering with government bodies at the beginning of the project, and involving them in the entire planning and development processes to generate government ownership of the project, which can strongly impact the likelihood of sustaining and scaling the project. Once ownership is secured, this government body, such as the MOH, can then promote the project within the government itself at ministerial meetings and across the Ministeries. Therefore, the initiative would get present- ed within the government by a government official, driving the uptake and possibility for scale from within. The government’s perception of being part of the partnership, rather than having their country as a location for piloting the intiative, can be a key factor in securing buy-in for the project. Partnering and working with the government is critical for many other reasons. If the mHealth initiative involves the delivery of con- tent through mobile phones, this content may have to be reviewed, approved, and in some cases, endorsed by the Ministry of Health, according to Sandhya Rao, Senior Advisor for Private Sector Part- nerships in the Office of Health, Infectious Diseases and Nutrition at the United States Agency for International Development (USAID). Blaschke emphasizes the importance of partnering with the gov- ernment to ensure the initiative is aligned with their national strat- egies and vision, or plans for such national policies or strategies in contexts where they don’t yet formally exist. This is particularly true in contexts where national policies and laws related to eHealth, such as privacy and security of electronic health records, don’t yet exist. In the context of Uganda, the lack of a national policy, strategy and vision with regards to e/mHealth has been one of the main barriers to getting private sector investment in the health field. “For some risk averse companies, it is just too dangerous and people are too wary of investing at this stage,” says Blaschke. Links to the government are critical in this case because if a partnership is formed that the government is not involved in, and new legis- lation or policies are put in place that conflict with what has been developed or is being deployed, the partnership is then suddenly at a huge disadvantage. “You’d have to stop the project and change everything,” warns Blaschke. In order to build awareness of and be able to advocate to the government for supportive policies and laws related to eHealth to create an enabling environment for the scale up of mHealth, it is also important that the government be engaged in the partnership’s activities. Successfully getting government partners on board and ensuring uptake of the initiative is not always easy and may require differ- ent approaches. Blaschke recommends helping the government see the initiative from a systems point of view. For UNICEF Ugan- da to secure buy-in and uptake from the government for mTrac, they developed and positioned mTrac not as a project, but rather as a tool to strengthen and extend the local district health and information software (DHIS2) and health management informa- tion system (HMIS) by building an SMS transaction layer and an SMS communications engine that could then be used for supply tracking campaigns and for extending electronic medical records to the community level. This meant building an SMS tool for a wide range of government purposes that fit into the larger MOH strategy for how the government was going to deploy eHealth in the country. “This actually fit in with where the Ministry of Health Partner with the government. • Partner with government institutions in the local area of implementation to generate buy-in and drive local ownership, scale and sustainability of the project. 3 MAMA was initially formed as a three-year initiative with the founding partners, USAID and Johnson & Johnson, each committing US$5 million to the initiative in three country programs: Bangladesh, South Africa and India. Now MAMA is evolving beyond a three-year initiative to a longer-term entity. MAMA is also looking to embody a repository of tools, infor- mation, lessons learned and best practices, in addition to the existing mobile messaging library, that can be accessed and used by any program in the field looking to scale these kinds of MNCH programs. 4.1 RECOMMENDATIONS Building the Partnership
  42. 42. 41 Partner with the private sector. • Partnering with private sector players can provide important know-how and technology to scale the initiative. 4 PATRICIA MECHAEL, EXECUTIVE DIRECTOR OF THE MHEALTH ALLIANCE, SHARES HOW THIS PUBLIC- PRIVATE PARTNERSHIP CAME TOGETHER. The mHealth Alliance joined a new partnership with the Nigerian Federal Ministry of Health and Intel to leverage mobile computing and telecommunications technologies to support Nigeria’s Saving One Million Lives Initiative. The partnership is now developing an interagency adviso- ry group that cuts across Ministry of ICT, Federal Ministry of Health, National Primary Health Care Development Agency, and various different public agencies. It is now also engaging the private sector such as MNOs and multinational corporations through the business council to see how they can leverage the expertise of a diverse range of stakeholders. How was the partnership formed? All partners were present in Nigeria for the launch of Saving One Million Lives and there was a special session on the use of ICTs in this initiative where several commitments were made. Intel made a commitment to the Federal MOH to lev- erage their technology to train 10,000 health workers, while the mHealth Alliance proposed studying the enabling envi- ronment issues and helping facilitate the development of an ICT framework. The Federal MOH guided the partnership, requesting that each partner come up with a joint proposal that would link all these pieces together under the umbrella of Save One Million Lives. Patricia Mechael highlights that an important success factor is “thinking pragmatically and tactically about where different technologies are going to accelerate the achievement of the targets set under the initiative as well as enable the partners to systematically track progress against the goals being set.” CASE EXAMPLE: NEW PUBLIC-PRIVATE PARTNERSHIP LEVERAGING MOBILE TECHNOLOGIES TO SAVE ONE MILLION LIVES IN NIGERIA Engaging the private sector as partners can harness their tech- nical core competencies, technology, know-how and resources. These benefits are immediately obvious for mHealth programs looking for technology providers or mobile network operators as partners. However, consider also the ability to expand the scope of the program based on integrating partners with diverse products and services, such as partnering with an insurance provider and mobile money service to deliver mi- RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP wanted to go with their emerging [eHealth] strategy,” says Blaschke. From the initial phases, UNICEF started working on integrating mTrac with DHIS2 so it wouldn’t be a parallel project, but rather a way for health workers who didn’t have access to computers to enter their data into DHIS2 via their mobile phones using the mTrac tool. In order to secure government buy-in, it is really useful for organ- izations to look at government plans and policies, for example a five-year health strategy. Blaschke recommends looking at these first, and seeing if the initiative can be aligned with these government priorities. Using the same language, and prioritizing the same areas they and the donors have prioritized, will result in higher chances of success. Emerson also highlights the importance of government owner- ship or buy-in, coupled with the need to have realistic expec- tations of the amount of time that may be involved in securing government support. It may be possible to avoid protracted timelines associated with garnering government sponsorship; however, it is highly beneficial for the partnership in the long- run to invest time in securing this buy-in as early as possible. 4.1 Building the Partnership RECOMMENDATIONS

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