AudienceScapes overviews the World Bank’s latest study on the use of mobile applications for the health, agriculture and rural development sectors. What makes a successful mobile health project? How does a mobile app project become self-sustaining?

by Alexandra Walker, Editor, AudienceScapes

What makes a successful mobile health project? How does a mobile app project become self-sustaining? These were among the questions discussed at last week’s World Bank webcast (see agenda and slides here) about mobile applications and development.

The World Bank’s ICT Sector Unit held the event to share findings from their latest study on the use of mobile applications for the health, agriculture and rural development sectors. Titled “Mobile Applications: Case Studies and Business Model Analysis,” the live webcast connected participants from Armenia, Moldova, India, Rwanda, Tanzania and Uganda.

Two of the consultant organizations involved in conducting the World Bank’s study -- Dalberg Global Development Advisors and Intelecon -- delivered their findings. Practitioners working in India and Africa also shared their experiences.

Stuck in the Pilot Stage

One of the presenters, Andy Dymond from Intelecon, noted that “37 percent of apps don’t go past the pilot stage.” While he was talking specifically about apps for agriculture and rural development, the challenge of scaling up mobile app projects was a popular topic throughout the webcast. All speakers noted the difficulty of moving a project beyond the pilot stage. In this context, there was substantial discussion of the difficulties of shifting from donor to business financing and the importance of fine-tuning an application to make it relevant to the user.

Creating Linkages

Another theme that crossed sectors was the importance of locating mobile apps within the broader mobile “ecosystem.” Both presenters from the health and agricultural sectors mentioned the importance, for example, of connecting mobile app interventions with mobile money. The greater the linkages between these technologies, noted the presenters, the better for their own survival.

Need for New Financing Mechanisms

Many wanted to discuss strategies to transition a project that has been initially donor or government-funded to become commercially viable. Ideas for new mechanisms that would bring in private financing to help projects grow were discussed, including: challenge funds (like Gates Foundation has used with mobile money in Haiti) and venture capital or incubator funds.

Despite the lengthy discussion of challenges and limitations, all speakers seemed to believe in the enormous potential of mobile applications to make an impact on health and agriculture. One presenter who runs mobile health projects in India (sorry, didn’t catch his name and he wasn’t listed on the agenda) said:

Health Sector

From Dalberg, Victoria Hausman and Robin Miller described what they observed after studying almost 60 m-health interventions. The field of mobile applications for health interventions is still relatively young. The major drawback of this, reported the Dalberg consultants, is the lack of information about their success: “We’ve seen very few evaluations or monitoring that demonstrate impact.”

The Dalberg team described the types of m-health interventions they studied as fitting within the following categories:

• Data collection/disease surveillance
• Treatment adherence/appointment reminders
• Emergency medical response systems
• Health information and support tools for health workers
• Supply chain management -- Management of inventory and supply chain steps by mobile tracking and communication; includes advocacy informed by supply chain information
• Health financing -- Use of smart-cards, vouchers, insurance and lending for health services linked to mobile platforms (e.g., m-Pesa) or otherwise enabled using mobile
• Disease prevention and health promotion

Note: see slides from this presentation at the World Bank website: http://go.worldbank.org/V8LJUNLBD0

They shared their findings for realizing the potential of m-health interventions:

1- Creation of m-health services – It’s important to create linkages to encourage innovation, support for business models and financing. Groups like Mobile Alliance are great for this.

2- Scaling up and replication – One of the biggest challenges lies in achieving scale. To be successful in scaling up, projects must understand costs. They should use monitoring and evaluation to create an evidence base for decisions. There should be support for building capacity and training across the ICT industry. Content should be customized.

3- Importance of enhancing impact of health outcomes – As stated earlier, there is limited evidence of what the real impact of m-health interventions on health outcomes. A significant opportunity exists to invest in documenting outcomes.

4- It is essential that there is support for key inputs that help these ecosystems thrive, including -- Entrepreneurship, Incentives for mobile operators to partner, Investing in multipliers (not only looking at m-health, but looking at “e-health” more broadly...allows various interventions to interact with each other, like mobile money and m-health interacting)

Hausman and others emphasized how vital it is that m-health interventions are run by knowledgeable staff and deliver accurate information about health. Hausman noted the need for more training of employees in the health sector, maybe even certification, in addition to oversight and enforcement. “This HR capacity-building component will be a huge multiplier going forward,” she said.

Agriculture and Rural Development Sector

The common theme of all the applications reviewed in this sector, according to the Intelecon group, is “access.” The apps developed in this sector provide users with access to:

* Information
* Markets
* Resources
* Job opportunities
* Governance

Note: see slides from this presentation at the World Bank website: http://go.worldbank.org/V8LJUNLBD0

Dymond discussed how important it is in the agriculture sector for a mobile app to link together various players in a supply chain. He noted that the existence of mobile money “leverages the empowerment of small-scale farmers.”

Focus on Financing

The reason most of these apps don’t get past pilot stage, according to the Intelecon team, is the gap between initial government or donor funding and getting the app into sustainable use. Only 15 percent of the apps they studied are sustainable today. They said 45 percent are in commercialization phase.

Dymond said that it’s ok that some mobile app projects remain with PPP (public-private partnership) funding. If this is the case, however, he said there needs to be better planning for PPP. “PPP should not be forgotten; in fact it should be leveraged in the mobile app field,” said Dymond.

Learning from Failures

When explaining later why most apps don’t succeed, Dymond pointed to a couple of factors:

* Not enough awareness of app in target community.
* Funding is limited.
* Implementers often do not know what users demand or need nor do they know the user’s willingness to pay for it.
* More risk in scaling up.
* Advertising is much more expensive.

Somebody who is commercially oriented would not be surprised at these costs and risks, but it’s hard for donors to handle them.

One idea embraced by both presenters and participants was the creation of a central repository about mobile apps for development. Such a clearinghouse would collect findings from studies like the World Banks, as well as lessons learned from individual mobile app pilot projects, both those that succeed and those that do not. Not surprisingly, the Bank’s ICT Sector Unit was suggested as an obvious home for such a project.

Final Note: To learn about the many individual mobile app interventions that were discussed, review the presenter’s slides on the webcast website. The slides were not available to see for the first half of the webcast so it was difficult to follow the discussion of specific business models, thus it is not recorded here.