Mhealth

Using low-end technology for high-end gains

“In trying to solve the

public health

challenges of our

time, technology is a

compelling answer...”

Particularly if you’re trying to deliver life-saving

information about maternal and child health to millions of

poor people in the north India

104 million people,

including 27 million women

of child bearing age.

82% of 15-49 year old

men and women in Bihar

have access to a mobile

phone.

63% of men and 32% of

women own their own

phone.

200,000 grassroots

community health workers

in the state.

Each responsible for a

catchment area of 1,000

people.

100% of community health

workers has access to a

phone.

The scale of opportunity is huge...

But there are also huge

challenges to overcome...

80% of people

may have access

to a mobile phone,

but their handsets

look like this....

Old, used,

damaged,

basic....

The majority of

these ‘gray

market’ copycat

handsets do not

support local

language fonts

They don’t own smart phones

The majority can’t read

Even if local language fonts

were supported, the fact

remains that nearly 70% of

women in rural India are

not educated.

They don’t know how to send SMS

The majority of low-

income subscribers in

have owned a mobile

phone for less than a year.

Low literacy and very

recent adoption of mobile

technology mean that

technical literacy is very

low.

91% have never sent an

SMS

All the majority know how

to do is make and receive

phone calls.

They have very little money

A large percentage of rural

population has very limited

disposable income

• Almost 100% are pre-

paid customers

• More than 60% spend

less than USD 1 per month

on telephony

• The average balance is

approximately 10 cents

So how do we design sustainable, effective

mHealth solutions

for millions of people?

mHealth

Too much focus on technology

mHealth

As opposed to people

Technology Centric Design

• Mhealth text services…for largely illiterate

populations

• Algorithm based apps for health workers

on old Nokia phones

• Handset distribution schemes

• Over 100,000 mHealth pilots

• 97% maternal mHealth projects have

failed

Human Centric Design

Human solutions require a confluence of technology and art

Design

• Insight – Understanding people

• Innovation – Making people’s life easier

• Interface – Making the interaction with

technology simpler

mHealth Innovations

• Identify the problem that technology can

solve

• Identify the technology that can solve that

problem

• Design an interface that “works”

Innovations

2 Examples

Mobile Academy

Use IVR technology that is handset

independent, audio based and accessed

via a simple voice call to train Bihar’s

200,000 community health workers to

deliver life-saving information to millions of

families • Mobile Academy is a training course on maternal

and child health

• Covers 33 months - from pregnancy until the child

is 2 years of age

• Designed to expand CHWs’ knowledge of life

saving preventative health and enhance their

communication skills

• Divided into chapters, lessons and quizzes

• Accumulative pass/fail score

• Printed certificate for all those who pass

• Mobile Academy is billed to CHWs at 50 paise per

minute (less than US 1 cent)

• 90% reduction in the standard commercial IVR tariff

• The total cost of taking the course is Rs 80 or $1.50

• This tariff covers the mobile operators’ cost of

delivering Mobile Academy, including government

taxes, and generates revenue

• Operators share revenue with BBC Media action

and its technology platform provider, OnMobile

Global Ltd, to help cover operational costs

• Additional revenue streams including advertising

will make the services commercially attractive in the

longer term

• Strategic partnerships with FMCGs that recognise

that health behaviour change in rural markets will

benefit their products – will enable long term

ownership

& sustainability

Make it cheap, share revenue to cover costs and

create value for advertisers

Equip health workers with an audio

visual job aid that is lightweight and

makes use of the technology they

already own. • Designed to be used by CHWs during their

counselling sessions with families

• Mobile Kunji brings together an IVR-based

mobile service

• And a virtually indestructible deck of 40

illustrated cards on a ring

• Each card communicates life-saving messages

about maternal and child health

• A unique shortcode at the bottom of each card

plays the related audio health message to rural

families

Mobile Kunji

• Designed to be used by CHWs every day, Mobile Kunji is Toll Free

• Exceptionally low rates were agreed with the mobile operators for calls billed to BBC Media Action

• The Government has agreed to cover call costs on an ongoing basis

• Government willing to cover call costs because Mobile Kunji enables high quality, standardized counseling of millions of people, which will save lives and money

Demonstrate value to the public sector

Develop partnerships for scale

• BBC Media Action launched Mobile Kunji and Academy in

Bihar in May 2012

• A partnership with six of the biggest mobile operators in India,

accounting for 90% of the market in Bihar: Airtel, BSNL, Idea,

Reliance, TATA and Vodafone

• Leverages an existing, proven mobile technology platform

provided by OnMobile Global Ltd, integrated with the

networks of all participating operators not just in Bihar – but

pan India

• Means the services can be used on any handset, and are

available on common shortcodes and common tariffs

across all participating operators

• Developed with funding from the Bill & Melinda Gates

Foundation and with the support of the Government of Bihar

– as part of the Ananya Programme

•

Prove demand and scale

• 85,000 people have begun using Mobile Kunji during the last 10 months, playing 2.3 million minutes of life-saving health content via their mobile phones

• 27,000 people have begun the Mobile Academy training course, accessing 2.8 million minutes of health education content via their mobile phones. More than 8,000 have already completed the course.

• They are now being scaled to the state of Odisha, with funding from the UK Department for International Development and with the support of the Government of Odisha

• We are in discussion with the central Indian government to scale the services to all the north Indian states, including Utter Pradesh, which has a population of 200 million people

Thank you

Siddhartha Swarup,

Director of Family Health Programmes

Siddhartha.Swarup@bbcwst.org