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Why mHealth Initiatives Should Not be Sustainable

By Wayan Vota on October 28, 2009

mhealth sustainability

Whenever we talk about mHealth, there is always much hand-wringing around sustainability. And by that we usually mean we want to find the mHealth model that can be like mobile phones – paid by users and funded by deep-pocketed, aggressive private firms. That way, we can escape the limitations of donor funding and move past the many mHealth pilots that never seem to scale, to truly global healthcare solutions.

I would like to be a heretic and put forth an idea that’s be brewing since last week’s Technology Salon sustainability discussion where our comments even suggested that all ICT4D efforts are sustainability failures:

mHealth isn’t sustainable

International development efforts in mHealth focus on bringing resources and solutions to communities who are unable to provide their own. This can mean remotely checking on patients in rural areas miles from the nearest clinic, or delivering health PSA’s to urban youth in Nairobi nightclubs, to even educating affluent women in India on their menstrual cycle.

But in all these instances and more, the recipient is either unwilling or unable to pay for the service. So why do we keep looking for ways to have them fund mHealth initiatives? Why do we think private payment is the sole sustainable model? Let’s look at who has the will to pay for such services and expect them to underwrite mHealth initiatives.

mHealth is fundable

Public health is a high priority for governments. A healthy population is a happy, productive one, and therefore every government has a keen interest in providing healthcare solutions to its populace. Some of these solutions are government funded without question – in the USA we don’t expect the Centers for Disease Control or Medicaid to be self-funded in a pay-for-service model.

Some solutions are a public-private hybrid – general healthcare services are almost always a mix of public, business, insurance, and private funds. And other solutions can be either – HIV testing and treatment varies by country and even by client.

But in any of these scenarios, do we hear talk about sustainability? Outside arguments about the cost of these programs, no one is advocating that governments stop funding for CDC’s or HIV treatments. So why then, when we talk of mHealth, do we try to force a fully private-payer model?

Finding funding is the problem

One reason that this private-payer sustainability model is so desired is the high variability of donor funding and a paucity of government funds. mHealth projects are multi-year endeavors – multi-decade if you want to effect a real change, but few donors can see past the next 2-5 year donor cycle. Even worse, almost no donor wants to fund an ongoing project – they want to launch the new-new solution. This can leave great ideas unfunded just as they are about to scale.

But let’s be honest, donor funding exists because many developing world governments do not have the political will or bureaucratic efficiency to run their own mHealth programs. Even when they are shown the public and economic benefits of effective healthcare solutions, local government change and adoption comes agonizingly slow.

Accept donor funding as sustainable

I actually do believe mHealth is sustainable, just not with the common definition of sustainability. If we open up what we mean by sustainable to include all funding – and especially donor funding – as valid sources of project income, then mHealth can be very sustainable. One example is FrontlineSMS.

Started in 2005 by Ken banks, FrontlineSMS has grown in scale to be called “one of the largest and most ambitious mHealth programs in the world,” by a UN report. Its used all over the globe, by everyone from Zimbabweans supporting HIV/AIDS awareness and terminal illness to Cambodians reporting landmine victims. But not a single end user pays Ken Banks to use FrontlineSMS.

Ken and his growing consortia of FrontlineSMS applications (Medic, Credit) are all donor funded – by many donors in many ways. Yet, they all have an income, the project keeps growing and innovating, and we’re all envious of their user growth – very real indicators of sustainability.

I can also see Ken charging for specialized services – brining a private-payer model to Frontline, if he hasn’t done so already, but again, this pay-for-service would be with governments, multi-laterals, and foundations buying services for large initiatives, not individual client income.

So the next time you hear a moan about the lack of mHealth sustainability, question the complaint. mHealth can be sustainable, if you’re willing to think outside the private-payer box.

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Written by
Wayan Vota co-founded ICTworks. He also co-founded Technology Salon, MERL Tech, ICTforAg, ICT4Djobs, ICT4Drinks, JadedAid, Kurante, OLPC News and a few other things. Opinions expressed here are his own and do not reflect the position of his employer, any of its entities, or any ICTWorks sponsor.
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2 Comments to “Why mHealth Initiatives Should Not be Sustainable”

  1. Hi Wayan,

    Thanks for the thought provoking post but I think your missing the importance of the many opportunities that lie in sustainable projects eg. local commercial empowerment, generation of commercial motivations for entrepreneurs who want to work towards improving healthcare, etc.

    I also feel using FrontlineSMS as an example to prove that “end users shouldn’t be expected to pay” is incorrect. END USERS DO PAY EG. THEY PAY TO SEND MESSAGES FROM THEIR MOBILES TO THE SERVICE PROVIDER (who in turn may indeed be funded by donor contributions).

  2. Wayan Vota says:

    You miss my point, David. End users don’t pay FrontlineSMS. They may pay local fees of one sort or another, but not to the originator of the mHealth system. FrontlineSMS is funded by donors, not users. Yet, would you say they are not sustainable?