Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania

Abstract

BackgroundThere is increasing evidence that mobile phone health interventions (“mHealth”) can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania.MethodsWe delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume.ResultsIn three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs.ConclusionsThese results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program’s reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact.

Mapping mHealth (mobile health) and mobile penetrations in sub-Saharan Africa for strategic regional collaboration in mHealth scale-up: an application of exploratory spatial data analysis

“…Firstly, small mHealth projects with low population coverage are not taking advantage of the economies of scale in mHealth implementation. Partnerships among different countries can be an enabler for cost reduction, specifically for fixed cost such as costs for technology, administration, personnel and promotional costs [ 5 ]. It can also be helpful in minimizing overspending and the costs incurred by a system’s incompatibility and reengineering [ 6 ].…”

Evidence-based adaptation and scale-up of a mobile phone health information service

“…More research is required to answer questions about costs and benefits of mobile phone interventions for health improvement to better understand whether and how to scale (39,40). While we have explored financial sustainability of m4RH by developing and evaluating a series of costrecovery models (32), there are few cost benefit analyses of mHealth programs. Along with development of case studies on mHealth scale-up, mHealth costing studies must be prioritized.…”

“…They have also facilitated the forthcoming integration of m4RH into programs beyond the FP sector, including a maternal health program in Afghanistan and an education program in Malawi. In addition, a series of peer-reviewed journal articles have been published on m4RH that detail program content, reach, and impact (15,18,19), provide methods for adapting and piloting m4RH for young people (29), and model financial costs for sustaining m4RH (32).…”

“…All rights reserved. mHealth 2017;3:11 mhealth.amegroups.com materials (20,32). With this information available, program implementers can make an informed decision as to whether m4RH is appropriate to their context and needs.…”

Expanding the reach of probiotics through social enterprises

“…With widespread use of cell phones amongst all social classes, a texting app is currently being tested in rural Uganda to find out more about consumer responses to probiotics, and gauge whether availability of these fermented foods changes eating patterns. This methodology developed by the Dutch company 'Text to Change' has been proven useful in a number of studies to collect data from the field, on the demand as well the production site (De Lepper et al, 2013;Mangone et al, 2016).…”