Pilot-itis: What's the cure?
Head of ICT in India for BBC Media Action
Speakers at the GSMA Mobile Health (mHealth) Summit in South Africa bemoaned the 'Pilot-itis’ - the inability to break out of pilot stage - holding back mobile health in developing countries. Held in Cape Town from 29-30 May, the event brought together government representatives and leaders from the mobile phone industry and health and development sectors to discuss how mobile phones can be used to deliver health services around the world. The summit focused on two major themes: scale and sustainability.
A proliferation of small, technically-driven pilots across Asia and Africa – often testing similar applications – has created confusion in government health departments. The situation has become so extreme in Uganda that the government has placed a moratorium on mHealth pilots. The Ugandan government’s message is loud and clear: the time for pilots is over – we need scale.
So what’s preventing the majority of mHealth pilots in developing countries from scaling up? What are the barriers? In a presentation I gave at the Leadership Forum – an invitation only event following on from the Summit on 1 June – I outlined four major challenges:
1. Lack of understanding between the mobile and development/health sectors
Development organisations need a greater understanding of the mobile industry. They need to recognise that:
- Mobile Network Operators (MNOs) costs need to be covered or mHealth services will not be financially viable
- MNOs do not want to risk their brand with services that cannot meet their performance standards
- MNOs need scale – with smaller profit margins for mHealth services for less affluent, Base of Pyramid (BOP) subscribers – scale is required to justify resource allocation
MNOs need a greater understanding of the development sector and BoP subscribers. They need to recognise that:
- Delivery channels and pricing for higher income segments will not work for BoP
- Localised, relevant, engaging content is required
- Risks or profits need to be shared more equitably
- Not-for-profit development organisations cannot accept the level of liability that major multinational corporations can
2. Donors are funding short-term pilots
With a few notable exceptions, donors are funding pilots. Unfortunately, small grants for small mobile health pilots are unlikely to result in scalable solutions with sustainable business models. Sustainable business models for base of the pyramid subscribers depend on economies of scale because the profit margins are so small. And they can only be tested and proved at scale. Significant, patient investment is required to build sustainable, scaled mHealth services.
Taxes on mobile Value Added Services (VAS) in developing countries can be prohibitively high. For example in India, licence fees, spectrum charges and corporate taxes amount to as much as 57%. Unless governments recognise that taxation needs to be reduced to correspond to low profit margins for BoP subscribers, it will be difficult to make mHealth services sustainable.
4. Perceived lack of evidence
At the summit, some donors and governments expressed the view that there is still a lack of evidence that mHealth works. This was contested by mHealth experts within organisations such as the World Bank, Unicef and World Health Organization (WHO), who argued that there were numerous examples of successful mHealth pilots that have been rigorously evaluated and that have clearly demonstrated a significant impact on health outcomes. Participants at the Leadership Forum agreed that the issue was more that evidence wasn’t being collated and effectively shared and there was a plea from government representatives for the WHO to fulfil this role.
Speaking on the opening day of the summit, Axel Nemetz, Head of mHealth Solutions, Vodafone Global Enterprise, said that until the 'm' is removed from mHealth and mobile becomes just another mainstream channel for delivering health services, it will continue to languish at the margins.
Nonetheless, there has been significant progress since the mHealth Summit in South Africa last year. Summing up on the final day of the summit, Chris Locke, Managing Director of the GSMA Development Fund, pointed out that there were now several notable examples of successfully scaled mHealth services.