how much does mhealth really cost? december 2014

How much does mHealth really cost?

December 2014

Abt Associates | pg 2

Outline

Summary of Activity

Case Review

Explanation of the budget handout

Compiling the prices

Discussing the variations


The big questions

How good are we at estimating what projects will cost?

What influences our estimates?

Does the project shape the budget or the budget shape the project?


What you can expect

FROM THIS SESSION

Open environment to share

Hands-on activity

Participant driven insights


Timing

15 min

30 min

10 min

20 min

Introduction/Case Review

Group Activity




Outline

Summary of Activity

Case Review





Case

MISSION Improve maternal care Address extremely high rates of

malnutri tion and malaria

About YOU NGO with more than decade of

experience in Guatemala Office in DC as well


By the numbers

78% Below the Poverty Line

~333,000 Population

54% Pregnancies with 1 or more risk factor

200 CHWs


Staff ProfilesProject Manager (expat) Sets overall strategy Ensures “the trains run on time” Handles all admin tasks

(budgeting, communications, etc.) Stakeholder management

Lead Designer (expat) Leads IT procurement tasks

(developing SoW, selecting solution provider)

Develops SWOT analysis and ensures system addresses risks and various stakeholders’ needs

IT Manager (LCN) Generally manages the office’s

computers and internet connection Is eager to learn, but doesn’t have

web development or mobile experience

Trainer (LCN/expat) Designs and leads training

activities, including refreshes Expat has experience with

something similar in another country. LCN does not


Outline

Summary of Activity

Case Review





Budget Handout

Desig

nDev

elop

men

tTe

st

Trai

n

Deplo

y & S

usta

in

Gen

eral


Budget Handout

Person-day = Total days for everyone in that position

You should account for all staff required for this effort

All non-Guatemalan employees are based in DC.

No need to account for:

– In-country travel or lodging

– Data plans

– CHW salaries


Outline

Summary of Activity

Case Review





Submit your prices

www.bit.ly/mhbudget


Outline

Summary of Activity

Case Review




For more information, please contact:

[email protected]

17

Developing Economies of Scale in mHealth

Jonathan Jackson, Dimagi CEODecember 10th, 2014

@dimagi

Why do I care about this?

Dimagi: 12 years experience implementing 300+ ICT projects in over 40 countries

Partnership: Dimagi and Grameen Foundation to create MOTECH Suite for achieving economies of scale

Me: Still one of the biggest technology skeptics out there

Big question is why isn’t most mHealth scaling…

….we say that most mHealth shouldn’t scale.

Good or Bad Idea?

Your M&E Program Officer proposes to buy laptops and Mircrosoft Office just to do M&E for one project in Excel.

Most people think about scale looks like this:

Many Many Users

Ministry of Health

Implementer

Program (e.g. MCH)

CHWs CHWs

Program (e.g. malaria)

CHWs

Implementer

When it’s usually more like this

Three paths to scale mHealth impact

USER EXPANSION: Adding more users (both CHWs

and supervisors)1


PROGRAM EXPANSION Adding new programs (e.g. a

new malaria app)2


and supervisors)1


and supervisors)


PROGRAM EXPANSION Adding new programs (e.g. a

new malaria app)2

1

VERTICAL EXPANSION:Adding value to existing programs. This leads to better control through systems integration, and

increased program effectiveness

3

Path 1: User ExpansionAdding more users to a program (be it CHWs, supervisors, etc.)

John Snow International in Tanzania

• USAID & MoH adopted ILSGateway

• Goal to improve supply chain decision making through mobile tools

• Grew from pilot to 4,600+ facilities; currently scaling nationally

• Able to scale because cost-effective to add users

Path 2: Program ExpansionLeveraging an existing mHealth platform to tackle another use case.

TulaSalud in Guatemala

• 200 CHWs adopted CommCare in 2012

• Application designed to help CHWs better manage high-risk pregnancies

• Expanded application to include malaria modules, and planning to add malnutrition modules

• Able to scale because org became very familiar with CommCare platform

Path 3: Vertical Expansion & SystemsIntegrationIntegrating an mHealth program into mHealth systems

at both the implementer and district/national partners levels, including the MoH.

CARE in Bihar, India

• Deployed MOTECH Suite for MNCH + nutrition in Bihar, India

• Successfully demonstrated CommCare integration with Mother and Child Tracking System (MCTS)

• Able to scale because program had vision of integration from Day 1

Economies of scale in mHealth expansion

User expansion

Program expansion2

1

Vertical expansion3

Fixed costs (= levers for economies of scale)

Variable costs (= increase with variable metric)

• Office equipment & facilities• Existing trained staff & managers• Programmatic content• Part of data management• Phone replacement policy• …

• Office equipment & facilities• Field & supervisors staff• Mobile phones• Voice & plan for phones• Some part of training• Field visit costs• Software & data hosting• …

• Initial upfront systems integration• Reporting build out and training• Management time to analyze data• …

• Incremental field & supervisors staff salaries• Mobile Phones • Voice & plan for phones• Initial & annual trainings• Field visit costs• Software & data hosting• …

• Programmatic content• Ongoing training• Incremental software & data hosting• Management time to analyze data• …

• Systems maintenance• …

Economies of scale in mHealth expansion

Total Cost per CHW

MOH CostsNGO Costs

Implementation Costs

Program expansion

100%

34%23% 17% 16%

Cost/CHW with increasing programs (500 CHWs)

2

0 0 0 0 0

5001

5002

5003

5004

5005

User expansion

100%

40% 36% 35% 33%

Cost/CHW with increasing users(500-1000 CHWs)

1

1 10

10

10

10

500 600 700 800 900# CHWs# programs# prog. integrated 0

Vertical + Program + User expansion

5001

5002

5003 4 5

0 1 2 3 4

1000 10000 0

# CHWs# programs# prog. integrated 10

Vertical expansion3

02

03

04

500 500 500 500 500

94%

2% 2% 2%

Cost per CHW for only vertical expansion

100%

127%

25% 18% 18%

Cost/CHW with Expansions

MOTECH Suite

User expansion Vertical expansionProgram Expansion

Frontline applications

Job aids for CHWs

Supply chain

Demand creation

Integration & Orchestration

Integrate mServices apps with national

information systems

Scheduling & workflow

Best practices for scale

Maturity Model

Economies of Scale Model

Data-driven Management

Blog post of this presentation: http://bit.ly/1yunJq2

Copy of the Total Cost of Ownership model: http://bit.ly/12G7r4q

[email protected]

Questions?

@dimagi

http://bit.ly/1yunJq2

http://bit.ly/1yunJq2

http://bit.ly/12G7r4q

http://bit.ly/12G7r4q

mailto:[email protected]

how much does mhealth really cost? december 2014

Documents

abt associates pg

dimagi slide

general slide

chws slide

budget shape

budget handout personday

case mission

decade of experience