This post is the third part of a three-part series, 'Teach Yourself mHealth.' In Part 1, we focused on what mHealth is and what mHealth projects look like. In Part 2, we mapped out exactly how mHealth can strengthen communities and information systems, step-by-step. In this post, we'll explore some common design challenges in mHealth projects and review the best online resources for bringing your mHealth knowledge up to speed.
Now that you're familiar with some mHealth basics, it's worth looking closer at what we've learned about how to implement solid, scalable and sustainable mHealth systems. One benefit of the myriad mHealth pilots that are out there is a wealth of lessons learned on everything from project design to better monitoring and evaluation. Many of these challenges exist for other, less technology-focused aid projects as well, of course, but they're nonetheless a good reminder of where to pay special attention.
Design Hurdles in mHealth Projects
The following summary of design hurdles that mHealth projects commonly face is assembled from lessons learned from my own research and interviews. This is by no means a comprehensive list, merely some interesting things to think about if you're considering adding an mHealth component to your international health work.
1. Human-centered design: Designing with people in mind puts the service back into development work. mHealth systems improve communications and information systems when they meet a need better than traditional systems. To meet this need, a thorough understanding of the problem you're trying to solve and the multidimensional context it exists within is essential. Testing and improving ideas and designs with the stakeholders you're trying to serve ensures that their needs are more adequately met by your project, and that means a better and more sustainable system
in the long-term.
2. Interoperability: Customizing and deploying an mHealth platform that interoperates with the Ministry of Health's electronic information system is key to avoiding parallel information systems that can duplicate work and deplete motivation. For example, current iterations of RapidSMS can be customized to interoperate with DHIS2, the open source health information system used by many government ministries throughout Africa.
Creating standalone platforms is often unnecessary and can get especially confusing in a Ministry running multiple mHealth projects. Ensuring interoperability from the start means your SMS platform can be more easily scaled and will likely have an easier time getting Ministry and staff buy-in. After all, your system needs to be useful to the stakeholders that the project is for, otherwise, what's the point? If you're using SMS for health behavior change communications, interoperability may be less important.
3. M&E: Many mHealth projects have been
criticized for not developing a solid monitoring and evaluation framework to collect baseline and project data and accurately report on project effectiveness. Don't let this happen to you.
4. Map the tech4dev and telecommunications landscape: Any good project idea starts with a solid understanding of the current landscape and technology projects are no different. Before you start sketching out your mHealth idea, it's a good idea to map the landscape of your country and region for other mHealth projects, which could be using software platforms that you can piggyback on. Who else is working in your region? What have they found challenging? Reaching out to colleagues creates an atmosphere of shared collaboration and healthy competition, plus the benefit of shared lessons learned.
The same goes for understanding the mobile phone and telecommunications infrastructure in your country. What does cell phone ownership look like in your country? Is there anywhere where the signal is unreliable? Who are the main mobile network operators? Have they previously partnered on any mHealth projects? Understanding the landscape lets you know what your options and constraints are, so you can proceed with clarity.
5. Sustainability: mHealth systems can
be extremely cost effective, but implementation costs for SMS air time, server maintenance, and other needs can add up in the long term, especially as the program reaches a national scale. Taking these costs into consideration
early on will encourage you to design a system that is self-sustaining. The importance of including Ministry of Health and other Ministries' staff from the very start was discussed in my previous post, but suffice to say that their level of ownership over the project is directly related to the system's likelihood of long-term success.
Developing mHealth Expertise
If you'd like to
delve a little deeper into mHealth knowledge and start to think about including mHealth elements in your existing
programs and projects, check out the links to documents and mHealth communities of practice below. mHealth, like all technology for development innovations, is a field that's changing rapidly. For those of us who want to further develop mHealth expertise, subscribing to regular email updates with the latest research findings and new projects is very useful. So are posting questions and design challenges you're facing on mHealth forums online, where an experienced community of practice is often very willing to offer guidance by sharing their own experiences.
For those eager to incorporate mHealth into their international health work, I recommend two online documents that summarize best practices to date and lessons learned. Both can be read in about an hour and offer pragmatic, no-nonsense guidance on the ins and outs of mHealth programming and implementation.
The first is "How to RapidSMS", written by a friend and former UNICEF colleague, Evan Wheeler. RapidSMS is a customizable mHealth platform that requires technical programming skills to install, but this how-to document is a great primer on the basics of a good mHealth project. The review of different SMS shortcode options offered by mobile network providers is especially helpful for thinking about how to best set up a scalable and financially sustainable system.
The second resource is a white paper written by Jeannine Lemaire for Advanced Development for Africa, "Scaling Up Mobile Health: Elements Necessary for the Successful Scale Up of mHealth in Developing Countries." Lemaire interviewed leading mHealth experts to mine their knowledge and experiences for a concise and thoroughly-researched list of best practices and programmatic, operational, policy and strategic recommendations. This might take you a bit longer than an hour, but is well worth the read.
As with learning any new thing, you're bound to have questions, especially technical ones. In that case, it can be helpful to reach out to a community of mHealth practitioners on one of the many mHealth forums online. I've found that RapidSMS and FrontlineSMS have particularly active communities.
Of course, the best way to teach yourself mHealth is to do it. Design, set up and implement a simple SMS-based project to apply what you've learned, and see what happens.