mHealth for Maternal Health: mHealth Pilotitis - Time for Recovery or Relapse?

mHealth for Maternal Health is an ongoing blog series that aims to share the knowledge and experiences of academics, implementers and funders from the mHealth and maternal health communities. As part of the series, we reached out to experts to gain insight on pressing questions around financing, partnerships, challenges and innovations in mHealth for Maternal Health. The post below includes responses by Patty Mechael, Executive Director of the mHealth Alliance and Ken Warman, Senior Program Officer at the Bill and Melinda Gates Foundation.

The last few years have seen a proliferation of mHealth pilots, particularly in Asia and Sub-Saharan Africa. A review published in PLOS Medicine showed that more often than not, these pilots failed to reach scale, leading to the coining of the term “mHealth pilotitis”.

Due to a lack of coordination between organizations, pilots often lead to duplication of efforts and can take scarce time and resources away from local governments. Uganda’s decision in 2012 to place a moratorium on mHealth pilots was a wake-up call for the ICT4D community that perhaps it was time to take a step back and reconsider the scatter-shot approach that had become the norm. However, while organizations are eager to scale up their mHealth interventions, it has quickly become apparent that there might not be an easy cure for pilotitis. Despite the number of pilots, there is a lack of a strong evidence base and consensus regarding what would work at scale.

To gauge where the mHealth community should focus its efforts moving forward, we asked experts and donors the following question: Do we still need more pilots in mHealth or do we know enough to say what works and should be scaled?

According to Patty Mechael, Executive Director of the mHealth Alliance, “When asked the question on whether we need more pilots- my general response is absolutely not – except in the increasingly rare case of a completely new use of mobile technology within the health sector or for health promotion that has never been tried.  We do know a great deal about what works.  The reality is that, you can make almost anything work in a pilot phase with enough undivided attention and resources.

Rather than viewing the development of a successful mHealth intervention as a binary transition between the pilot phase and scale-up, organizations should be willing to take an iterative approach. Mechael adds, “The latest thinking is to design for scale from the outset and approach implementation as well as complementary monitoring and evaluation in phases- similar to any technology development and/or program life cycle- where by assessments of each phase informs the next- including the decision to abandon course or adapt when something does not seem to be working in the early stages.”

In the poetic words of Samuel Becket, “Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better.”

However, for an organization to successfully adopt an iterative approach, it is critical that donors also shift their mindset. According to Ken Warman, Senior Program Officer at the Bill and Melinda Gates Foundation, “Many mHealth interventions take several iterations to become operational and integrated into a health workers daily routine.  Most pilots are not sufficiently funded to reach this milestone so they are never really adopted and embraced for going to scale.  I feel we, the mService community are still focused on vertical, niche applications and are not yet paying enough attention to larger, systemic issues and working towards an integrated ecosystem servicing a broad array of user needs.”

For mHealth to move to the next phase in its development and become integrated into health systems, there need to be collective efforts by developers, implementers, donors and governments to work together to collect robust evidence about what works, and act nimbly to adapt and improve programs at different phases in their life-cycle.

Do you have an opinion on the role mHealth can play to improve maternal health? What do you see as the biggest advantages of mHealth? The limitations? If you are interested in submitting a blog post for our ongoing guest blog series on mHealth for Maternal Health, please email MHTF Research Assistant Yogeeta Manglani.