The next frontier

Mobile phone on top of handwritten log of malaria diagnoses by household.

Digital health for scaled impact

The potential of mobile and information and communications technology to support behavior change, supply chain improvements, health financing, health worker enablement, and other critical health services has been well-documented. However, mHealth has yet to demonstrate significant scale and integration into the health system. Mobile is dependent on volume to drive economies of scale, but fragmentation, inadequate partnership brokerage, and an inability to access business-to-business (B2B) payment mechanisms have largely prevented mHealth services from reaching significant scale.

With more than 85% of total health care expenditures existing in a B2B or reimbursive payment environment, mHealth stakeholders have to be able to demonstrate strong economic evidence of mHealth’s cost impact on specific health interventions.

"Realizing the potential of mHealth will depend on creating sustainable, low-margin, high-volume business models."We have been tracking the growth in mHealth since 2010, looking for evidence to support the sustainable B2B integration of mobile into the fiscal budgets of national or regional health providers. Our first literature review helped us understand that out of more than 800 peer-reviewed publications, less than 1% demonstrated a cost implication to the health intervention and/or health system.

Four years later, we are now tracking more than 1,300 mHealth services being deployed across emerging markets. The phenomenal growth in the number of new services has not, unfortunately, seen a parallel growth in the evidence base of these services, particularly economic or cost proof points. Some 90% of services rely on donor funding and/or a consumer payment model, both of which we would argue are unsustainable given the short-term nature of funding and the inability of consumers at the bottom of the pyramid to contribute significantly to out-of-pocket health expenses.

Building toward scale and sustainability, we need to be conscious of the fact that mobile services are built around a high-volume, low-margin business model. Most of the mHealth services we analyze are not able to achieve this tipping point of active users that allows for economies of scale.

The vast majority of sustainability models are designed for thousands or tens of thousands of users. When we presented an opportunity from one of our GSMA members, Samsung, to pre-embed health services onto 80 million mobile devices across Africa over the next two years, only a handful of service providers were able to adjust their offering to take advantage of this opportunity to support up to 80 million potential users across Africa.

We also have to consider how to better leverage the mobile ecosystem to drive scale and sustainability. was able to secure zero-rated connectivity agreements with Airtel in Zambia recently with a strong brand value and product offering. MTN and Airtel Group have committed to similar offerings across their portfolio of operations if mHealth stakeholders can demonstrate a win-win value proposition.

Gemalto, the largest SIM card manufacturer, has about 350 million SIMs in circulation across sub-Saharan Africa and has committed to distribute health content and enable civil registration. Samsung, in addition to pre-embedding Smart Health onto 80 million devices, has committed to make its Samsung ecosystem available. It is hoped that financial and non-financial incentives will drive demand for health services. For example, users might receive a week’s free access to the Samsung music store for completing an immunization schedule.

Realizing the potential of mHealth will depend on creating sustainable, low-margin, high-volume business models. This volume is dependent on strong demand from end users. Demand can be catalyzed through an ecosystem of delivery partners aiming to drive down the prohibitive cost of handsets and connectivity; leverage strong marketing, distribution, and public relations campaigns; and aggregate the multitude of mHealth services onto a single user interface.

Photo: PATH/Laura Newman.