Developing mHealth partnerships for Scale

SCALING UP MOBILE HEALTH:
H
DEVELOPING MHEALTH
PARTNERSHIPS FOR SCALE
Authored by Jeannine Lemaire
SECOND REPORT IN A SERIES OF SPECIAL REPORTS ON SCALING UP MOBILE HEALTH
Commissioned by Advanced Development for Africa

CASE STUDIES: CROSS-
COUNTRY SCALE UP
RECOMMENDATIONS:
CHALLENGES
CONCLUSION
REFERENCES
ABOUT ADA
ACKNOWLEDGEMENTS
ACRONYMS
FIRST REPORT
INTRODUCTION:
CASE STUDIES:
IN-COUNTRY SCALE UP
Scaling Up Mobile Health: Elements
Necessary for the Successful Scale Up
of mHealth in Developing Countries
Disease Surveillance & Mapping Project
KimMNCHip
mDiabetes
mHealth Tanzania Public-Private
Partnership
mTrac
CONTENTS
02 21
34
62
66
67
68
03
04
06
09
10
12
14
16
18
22
26
28
30
32
37
46
52
58
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36
Background: Mobile Health
Overview: Partnerships & Scale Up
Mobile Alliance for Maternal Action
Mobile Technology for Community Health
Programme Mwana
SMS for Life
Switchboard
PARTNERSHIP EXPERTS
OVERVIEW
Building the Partnership
Implementing the Partnership
Sustaining the Partnership
Ensuring Partnership-Driven Scale Up

02
I
would like to convey my deepest gratitude to Coumba Touré, the Founder and
President of Advanced Development for Africa, who commissioned this impor-
tant report. This report would not have been possible without her commitment to
addressing the challenges in applying ICTs for health in developing country contexts
through knowledge sharing, empowerment and capacity-building.
I would like to express my sincere thanks and appreciation to the experts who com-
mitted their time to sharing invaluable insights, perspectives and expertise from
different sectors through interviews: Sean Blaschke, Health Systems Strengthening
Coordinator at UNICEF Uganda; Awa Marie Coll-Seck, Minister of Health for Senegal;
Amir Dossal, Founder and Chairman of the Global Partnerships Forum; Sarah Em-
erson, Country Director of the mHealth Tanzania Public-Private Partnership; Kirsten
Gagnaire, Global Director of the Mobile Alliance for Maternal Action (MAMA); Patri-
cia Mechael, Executive Director of the mHealth Alliance; and Judy Njogu, Product
Manager for eHealth and eLearning at Safaricom.
I would like to extend my gratitude and appreciation to our Expert Review Panel
who provided careful, in-depth reviews and important feedback to the report,
ensuring realities and various experiences are reflected: Yunkap Kwankam, CEO of
Global eHealth Consultants; Chris Locke, Managing Director of GSMA Mobile for
Development; Carole Presern, Executive Director of The Partnership for Maternal,
Newborn and Child Health (PMNCH); Sandhya Rao, Senior Advisor for Private Sec-
tor Partnerships in the Office of Health, Infectious Diseases and Nutrition at USAID;
and Véronique Thouvenot, Head of the International Women and eHealth Working
Group at Millennia2015.
Special thanks to Soumya Alva, Senior Technical Specialist at the International
Health & Development Division of ICF International, and Vaibhav Gupta, Technical
Officer in the Private Sector and Innovation Division of the World Health Organi-
zation, who contributed important concepts and feedback to this report. Several
insights were also drawn from speakers at the 2012 mHealth Summit Global Health
Track convened by the mHealth Alliance. I would therefore like to convey acknowl-
edgement and appreciation to the individuals that put the Global Health track
together and the mHealth Alliance for its leadership in this space.
Jeannine Lemaire
Advanced Development for Africa
Lemaire.Jeannine@gmail.com
ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS&ACRONYMS
03
Advanced Development for Africa
Base of the Pyramid
Community Health Worker
Corporate Social Responsibility
District Health Information Software 2
Early Infant Diagnosis of HIV
GSM Association
Health Management Information System
Information and Communications Technology
Information Technology
International Telecommunication Union
Interactive Voice Response
Monitoring and Evaluation
USAID’s Maternal & Child Health Integrated Program
Millennium Development Goals
Mobile Network Operator
Maternal, Newborn and Child Health
Ministry of Health
Memorandum of Understanding
Non-Governmental Organization
Prevention of Mother to Child Transmission of HIV
Public-Private Partnership
Short Message Service
United Nations Children Fund
United States Agency for International Development
Unstructured Supplementary Service Data
World Health Organization
ADA
BOP
CHW
CSR
DHIS2
EID
GSMA
HMIS
ICT
IT
ITU
IVR
M&E
MCHIP
MDGs
MNO
MNCH
MOH
MOU
NGO
PMTCT
PPP
SMS
UNICEF
USAID
USSD
WHO
ACRONYMS

Scaling up Mobile Health
FIRST REPORT
04
Policy environments, business models and funding
schemes around mobile health (mHealth) have fueled the
proliferation of pilot projects. Therefore in 2011, Advanced
Development for Africa (ADA) commissioned the first
report in a series of special reports on scaling up mHealth
to assess various implementations of mHealth programs in
developing country contexts that were either scaled up or
in the process of achieving this. The objective was to iden-
tify the important elements necessary for achieving scale.
This report profiled select mHealth programs that had
been piloted and were in the scale up phase, having proven
enough success that they should be considered as potential
models for other initiatives. Using the identified success fac-
tors and interviews with experts in the field of mobile health,
the report generated a set of best practices and specific pro-
grammatic, operational, policy and global strategy recom-
mendations to create an enabling environment for mHealth
and support organizations in achieving scale.
Mobile health can directly support policy-making and plan-
ning within healthcare systems and improve the health of
local communities, particularly remote populations, through
the dissemination of health information, more accurate and
timely data for disease surveillance, decision support for
health workers and health information management. The
primary goal of ADA’s first report is to provide recommenda-
tions and best practices that will allow mHealth initiatives
to better plan their own scale up beyond successful pilot
phases. To download the first report, click on the image.
The following report is the second in a series of special
reports, focused specifically on partnership-driven scale up
of mHealth containing sets of recommendations for building
effective partnerships to achieve scale in mHealth.
FIRST REPORT:
Scaling Up Mobile Health: Elements
Necessary for the Successful Scale Up
of mHealth in Developing Countries
SCALING UP
MOBILE HEALTH
ELEMENTS NECESSARY FOR THE
SUCCESSFUL SCALE UP OF
mHEALTH IN DEVELOPING COUNTRIES
WHITE PAPER COMMISSIONED BY
ADVANCED DEVELOPMENT FOR AFRICA
Prepared by Actevis Consulting Group
Researched and Written by
Jeannine Lemaire
December 2011
First report in a series of special reports on scaling up mHealth.
To download the First Report, click on the image above.

Scaling up Mobile Health
FIRST REPORT
05
FIRSTREPORT
Image Credit: mTrac, Sean Blascke, UNICEF Uganda.

06
01 Background & Overview
INTRODUCTION
INTRODUCTION
In a world of 7 billion people and over 6 billion mobile phone
subscriptions, this remarkable adoption of mobile phones presents
concrete opportunities for increased access to health care, thanks
to the growing field of mobile health. Mobile health, or mHealth, is
the use of mobile technology in health and can be a powerful tool in
improving health, particularly in places where health care is unavail-
able or access is limited. According to the International Telecom-
munication Union (ITU), mobile phone networks cover 90% of the
world’s population today, with just over 75% of mobile subscriptions
held by nearly 80% of the population in low- and middle-income
countries.1
While there is still a need for a stronger evidence-base of
mHealth health impacts and cost-effectiveness, some studies have
already demonstrated the positive effects of mHealth. One study
showed that two daily text messages to health care workers in Kenya
improved pediatric malaria care by 24.5%.2
Another trial identified
significantly improved ART adherence and rates of viral suppression
thanks to weekly mobile text messaging and follow-up improving
HIV drug adherence.3
Interest from NGOs, companies, government institutions, and
donors in mHealth is rapidly expanding. To illustrate the current
global landscape:
• The mHealth Alliance’s HealthUnBound mobile health directory
lists over 300 mHealth programs around the world, while the
mHealth Working Group Inventory of Projects lists 400 mHealth
projects in 79 countries.
• The GSMA’s Mobile for Development Intelligence portal maps 376
organizations from a wide variety of sectors working on mHealth.
• USAID funds more than 100 mHealth activities across the globe.
Background:
Mobile Health
Overview:
Partnerships & Scale Up
1
ITU World Telecommunication, ICT Indicators Database 2011.
2
Zurovac D et al. (2011). “The effect of mobile phone text-message reminders on Kenyan health
workers’ adherence to malaria treatment guidelines: a cluster randomised trial.” The Lancet.
3
Lester, R. T., Ritvo, P., Mills, E. J., Kariri, A., Karanja, S., Chung, M. H., Jack, W., et al. (2010). “Effects
of a mobile phone short message service on antiretroviral treatment adherence in Kenya
(WelTel Kenya1): a randomised trial.” The Lancet.
4
Leon, N., Schneider, H., and Daviaud, E. (1 January 2012). “Applying a framework for assessing
the health system challenges to scaling up mHealth in South Africa.” BMC Medical Informatics
and Decision Making.
Scale up related to mHealth has been defined in various ways, in-
cluding technology replication in multiple contexts, or an expansion
or national scale of a project, platform or organization. Although
increasing organizational scale and scaling up the diffusion of
mHealth platforms and strategies is a great achievement for organ-
izations, such as Text to Change (which has delivered 70 mHealth
projects in 17 countries), this report focuses on program or project
scale at a national or cross-country level. Achieving scale may not
be required or appropriate for all projects, particularly those that
prove a particular concept does not work. However, governments in
developing countries are increasingly frustrated with the prolifera-
tion of pilots and fragmentation within their borders. This has re-
sulted in the South African National Department of Health and the
Ugandan Ministry of Health placing moratoriums on the implemen-
tation of new telemedicine and electronic health (eHealth) projects,
respectively, until national strategies are in place.4
The movement
away from pilots presents a common objective for mHealth initia-
tives today: scale up.
Players from the public, private and non-profit sectors are now ac-
tively seeking partners to collaborate with in order to increase the
capacity, reach and impact of their projects. A concrete example of
this was shared by Judy Njogu, Product Manager for eHealth and
eLearning at Kenya’s leading mobile network operator, Safaricom.
She identified partnerships with partners from different sectors as
a key factor for enabling Safaricom to go beyond their limits as a
mobile network operator. “Without partnering with organizations
from different sectors, Safaricom would just be focused on m-
vouchers and mobile money transfers in the healthcare space. Now
01

07
INTRODUCTION
INTRODUCTION
5
Research by Dalberg Global Development Advisors. 2012.
6
Useem, A. (11 December 2012). “Mobile health initiatives look to service providers for
scale.” DevexImpact. Available: https://www.devex.com/en/news/mobile-health-intitia-
tives-look-to-service-providers-for-scale/79932 (Cited on 10 January 2013)
7
Sturchio, J. (8 January 2013). “The Evolving Role of the Private Sector in Global Health.”
The Huffington Post. Available: http://www.huffingtonpost.com/jeffrey-l-sturchio/the-
evolving-role-health_b_2432823.html (Cited on 10 January 2013)
that we’ve partnered with different organizations with different
expertise areas, we are able to go much further,” says Njogu as
she describes Safaricom’s partnership initiatives on mHealth
micro-insurance and maternal health messaging.
Historically, 85% of funding for mHealth was dedicated primar-
ily to early-stage R&D or pilot programs.5
Although funding for
pilots can be important for rationalizing the mHealth field, fund-
ing towards growth, coordination and scale up is also needed.
Dr. Esther Ogara, Head of eHealth at Kenya’s Ministry of Medical
Services, says there are many projects launched in Kenya with-
out an idea of who will fund them in the long run, highlighting
the fact that donors are reluctant to underwrite on-going pro-
grams, and that host governments cannot be a catch-all funding
mechanism for every pilot. Therefore, Ogara conveys that part-
nerships offer the best hope for bringing mHealth projects to
scale.”6
The landscape described by Ogara is a strong incentive
for the emergence of partnerships to bring together alternative
methods of financing projects.
Today, partnerships are employing new methods of cooperation,
new business models, and demonstrating greater measurable
results. A realization is emerging that the fragmentation of efforts
is a big barrier to achieving large-scale impact, and that the right
partnerships can bring about scale through joining distinct sets
of core capabilities and collaboration directed towards common
goals. Diversity in partners can bring together new ways of think-
ing, technology, methods, best practices, lessons learned, markets,
innovative ideas and more to support the scale up of a project.
The USAID alone has formed nearly 700 public-private partner-
ships (PPPs), a huge increase from the 50 PPPs that existed in
the 1980s.7
Partnerships with the private sector have evolved over
time — moving beyond simple philanthropic and charitable models
towards collaborations based on business models and sharing
risks, rewards, responsibilities and investment.
There is consensus that partnerships hold the key to scaling up
successful projects. Therefore, Advanced Development for Africa
(ADA) commissioned this report to determine how to best build
and sustain partnerships between public, private and non-profit
sector players, and how to ensure partnership-driven scale
up of mHealth, with three main objectives in mind. Through a
thorough examination of the landscape of partnerships in the
field of mHealth, the report’s first objective is to provide an as-
sessment of a set of partnerships that have demonstrated or are
in the process of achieving regional, national or cross-country
scale, through a series of case studies. The second objective is
GSMA Mobile for Development Intelligence map of 376 organizations working on mHealth
© www.mobiledevelopmentintelligence.com Mobile for Development Intelligence Organisations Map, 30/5/13

08
to determine how they have achieved this scale, by identifying key
success factors that other budding partnerships could draw from.
The final objective is to present the expertise and experiences of
brokers, stakeholders, and key decision-makers within large-scale
cross-sector partnerships through concise sets of recommendations
focused on the different phases of partnership development.
The intended audience for this report is the international develop-
ment sector in emerging markets and stakeholders working with
this sector on mHealth. Our goal is to amalgamate and share the
knowledge and perspectives of experts from various sectors in
order to support the international development sector in devel-
oping partnership initiatives geared towards greater impact and
scale. In-depth research and interviews, as well as a full review
of the report by an Expert Review Panel, was performed with
stakeholders and representatives from different partnerships that
demonstrate strong cross-sector collaborations. As partnerships
typically bring together individuals and organizations from differ-
ent sectors and fields, this report will carefully present the varying
needs, challenges and recommendations from various sectors.
We hope this report will be valuable to organizations from all sec-
tors seeking to partner with others as it presents diverse perspec-
tives that are critical to understanding how to build successful,
scalable and sustainable partnerships.
Our goal is to amalgamate and share the knowledge and perspectives
of experts from various sectors in order to support the international
development sector in developing partnership initiatives geared
towards greater impact and scale.
”
“
INTRODUCTION

09
CASESTUDIES:IN-COUNTRYSCALEUP
IN-COUNTRY SCALE UP
8
The information presented in these case studies, including project data, is sourced from online research, project docu-
ments, communications, and interviews with personnel involved in the management of these initiatives.
02
CASE STUDIES
1. DISEASE SURVEILLANCE & MAPPING PROJECT
2. KimMNCHip
3. mDIABETES
4. mHEALTH TANZANIA PUBLIC-PRIVATE PARTNERSHIP
5. mTRAC
The following set of case studies present mHealth partner-
ship initiatives that have achieved or are working towards
scale within a country and present concrete elements of
success that can be incorporated in other partnership
initiatives looking to achieve regional or national scale.8
02 In-country scale up
CASE STUDIES

10
Disease Surveillance & Mapping Project
� LOCATION: BOTSWANA, KENYA (PLANNED), MOZAMBIQUE (PLANNED) � STATUS: SCALING UP
1
The Disease Surveillance and Mapping Project is an initia-
tive of the public-private partnership formed between HP,
Clinton Health Access Initiative (CHAI), Botswana Ministry
of Health (MOH), CDC Botswana, mobile network operator
Mascom, and Positive Innovation for the Next Generation
(PING), a local Botswana non-profit organization. It covers
the implementation of a mobile disease surveillance and
mapping project to aid Botswana’s fight against malaria with
the use of mobile phone technology. The program equips
health workers with mobile devices that collect malaria data
and can be viewed in a geographic map of disease trans-
mission to generate more context-aware information about
outbreaks in order for workers to respond accordingly. This
allows health workers to report real-time disease outbreak
data, tag the data with GPS coordinates, and send out SMS
disease outbreak alerts to all other healthcare workers in the
district, and allows facilities to submit regular reports back
to the MOH. The data is then aggregated in real-time on the
backend and graphs and reports are generated in a matter
of seconds. This enables MOH officials to promptly collect
and analyze context-aware data on malarial outbreaks, track
developments in real-time and quickly dispatch medicines
and mosquito nets, and monitor treatments using GPS
coordinates.
Results since the program rolled out in June 2011 in
Botswana’s Chobe region:
• Improved response times to notify authorities of malaria
outbreaks from four weeks to three minutes in the first
year of the program.
• 1,068 real-time notifications and updates on disease pat-
terns to MOH officials and health workers.
• 93% of facilities now reporting on time, compared to
20% previously.
OBJECTIVES & GOALS
The long-term vision of this project is to move away from
paper-based reports by equipping health workers at clinics
across Botswana with mobile phones, enabling them to sub-
mit real-time reports to the MOH. The objective is to shorten
the outbreak identification process and improve response
times of medical intervention to outbreaks using mobile-
based disease surveillance solutions.
SCALE UP ACHIEVED
The project expanded its scope to cover tuberculosis and
was rolled out to an additional 100 facilities in Botswana.
FURTHER SCALE UP PLANNED
The Botswana MOH, PING, HP and Mascom are currently
planning a full national scale up of the current system (cover-
ing malaria and tuberculosis) that will cover 100% of all
health districts across the country. Botswana’s government
aims to add another 16 diseases to the project, and increas-
ing the scope to all notifiable diseases. PING is also looking
to adapt the program to improve the broader health system,
including the National Cancer Registry and blood supply
logistics.
HP and CHAI have started working with Kenya’s MOH and
are in talks with Mozambique’s government to expand the
program to these countries. Kenya’s government is already
using the platform to track the spread of 11 diseases, includ-
ing malaria.
CASE STUDY
PARTNERS ROLES
Botswana MOH, CDC Botswana,
Clinton Health Access Initiative (CHAI)
Implementers
HP, Mascom (leading MNO in Botswana) Providing technology, funding, and technical expertise
(HP provided smartphones and cloud solutions, MASCOM
provided free data transmission)
Positive Innovation Next Generation (PING) Initially only technology provider (mobile application
platform), now directly supporting implementation
In-country scale up
CASE STUDIES
02

11
CASESTUDY:DISEASESURVEILLANCE&MAPPINGPROJECT
The objective is to shorten the outbreak identification process
and improve response times of medical intervention to out-
breaks using mobile-based disease surveillance solutions.
”
“
Technology partners play an active role in implementation:
• PING was initially a technology partner, but has since evolved into a hands-on implementation partner by leading train-
ings, support and maintenance, as well as interacting regularly with health worker end-users and performing site visits
with the MOH.
• HP and Mascom, who are private sector partners, were actively engaged in the program by sharing skills and expertise
in project implementation, instead of simply donating technology and resources.
The partnership project presented strong value propositions to its private sector partners. For example, by providing free data
transmission for the project, Mascom sees an opportunity to build market share while fulfilling its strong commitment to social
responsibility.
The MOH was directly involved in project design and implementation from the beginning, ensuring country ownership of
the program and, based on the success of the pilot, is now supporting scale up of the program.
Success factors
93% of facilities now reporting on
time, compared to 20% previously.
CASE STUDIES

12
KimMNCHip
� LOCATION: KENYA � STATUS: ONGOING, WITH NATIONAL SCALE AS A TARGET
2
The Kenyan integrated mobile Maternal and Newborn Child
Health (MNCH) information platform, or KimMNCHip, is
a national-scale mHealth initiative for maternal and child
health run by a cross-sector partnership between the Gov-
ernment of Kenya, Safaricom, World Vision, Care, AMREF,
and NetHope.
KimMNCHip aims to support Kenya’s efforts in meeting
MDGs 4 and 5 focusing on reducing child mortality and
improving maternal health by offering three complementary
services:
1. Public information via an mHealth advisory service
for pregnant women who register and provide their due
date. They receive a mix of “push” SMS and voice messag-
es, and access to call-in advisory hotlines and information
databases for MNCH issues. These messages provide the
women with timely health information scheduled in ac-
cordance with the national MNCH plan. SMS/voice charges
are being covered by private partners (funded via text or
voice message advertising).
2. Mobile financial (mFinancial) services for health that
provide pregnant women with electronic vouchers to
redeem in a collaborating clinic of their choice. The vouch-
ers act as an incentive for clinics to enhance the quality of
their services and attract more pregnant women, through
a results-based payment system. The voucher also
includes a social protection cash transfer to support the
women with the costs of delivery. KimMNCHip is exploring
other uses of mPayments to support maternal and new-
born care. Funding of the vouchers is being sourced from
social protection funds and contributions from donors and
the private sector.
3. Primary care via mobile support (mSupport) services
along the continuum of care, for mothers and for primary
health care workers. These will be based on access to
electronic medical records, appointments, reminders, and
checklists to deliver better community health services, and
monitor and respond to MNCH indicators.
OBJECTIVES & GOALS
KimMNCHip aims to support Kenya’s commitment to the
UN Global Strategy for Women’s and Children’s Health
through one integrated system, providing women with
mHealth support along the continuum of care from pre-
pregnancy to post-natal stages.
CASE STUDY
PARTNERS ROLES
World Vision Partnership broker
Safaricom, Mezzanine Private sector partners providing the technology (cloud-
based application and technical architectures), mServices
and business models
CARE International, Aga Khan University Hospital, AMREF Non-profit implementing partners
NetHope, mHealth Alliance Global platform partners providing expertise
and supporting information sharing
Ministry of Public Health and Sanitation (MOPHS) Supporting implementation and scale up
In-country scale up
CASE STUDIES
02

13
CASESTUDY:KIMMNCHIP
KimMNCHip is designed from the beginning to be implemented at national scale.
KimMNCHip focuses on the brokering and partnership processes necessary to develop a national service through implement-
ing a partner brokering monitoring framework.
Safaricom, World Vision, Care, AMREF, the Ministry of Medical Services, and the MOPHS have formed a taskforce to define
KimMNCHip’s requirements. This taskforce includes representatives from the Division of Reproductive Health, the Divi-
sion of Child and Adolescent Health, the Division of E-health, the Division of Community Promotional Services, and other
NGOs. KimMNCHip members also actively engage in key committees responsible for family planning, maternal and child
health, and community health indicators. Efforts are ongoing to form focus groups of mothers to provide feedback on
KimMNCHip.
High-level commitment from the partners was secured, resulting in the initiative being recently endorsed as the principal
Maternal Newborn and Child Health initiative in the country at an mHealth and eHealth Stakeholders Conference hosted
by the MOPHS.
Success factors
KimMNCHip will be implemented at all health facilities across the
country (over 8,000). The initiative plans to achieve national scale
to reach 6-10 million mothers and 200,000 community health
workers in 200 districts.
Its objectives are to:
1. Strengthen Kenya’s community health system/referral
services by linking households, community health workers,
and health facilities in a real-time health information system
that tracks pregnancies, births, and maternal deaths and
provides updates and reminders for timely interventions;
2. Provide push and pull target-based health messaging for
mothers and household members; and
3. Promote and popularize mSavings and eVouchers for mothers
and related family members. KimMNCHip will link the end-to-
end process from mother, community health worker, health
facility and back with data aggregation at a national level.
SCALE UP ACHIEVED
KimMNCHip is in the process of national roll out. Initially, there
was a CHW component through which Safaricom equipped
CHWs with 650 mobile devices. Now KimMNCHip is being
scaled to a national level covering all health facilities, at the
request of the MOPHS.
KimMNCHip will be implemented at all health facilities coun-
trywide (over 8,000). The initiative plans to achieve national
scale to reach 6-10 million mothers and 200,000 community
health workers in 200 districts.
”
“
CASE STUDIES

14
mDiabetes
� LOCATION: INDIA � STATUS: ONGOING, WITH PROJECT TARGET SCALE OF ONE MILLION REACHED ONE YEAR EARLY.
3
mDiabetes is a large-scale diabetes prevention mHealth
initiative being implemented in India using text messaging
to increase awareness and prevention of diabetes among
the Indian population. This nationwide mHealth project is
implemented by the US non-profit Arogya World in partner-
ship with Nokia, and supported by a consortium of partners
in the US and India.
Arogya World is providing free access to mDiabetes content
for an initial period of six months to both current and new
Nokia customers in India who have the Nokia Life applica-
tion on their mobile phones and subscribe to Nokia’s health
channels. Their business model is based on user fees - once
the six-month trial is over, customers will have the opportu-
nity to opt-in to receive the diabetes awareness and preven-
tion messages at a nominal fee.
The content of the project was developed in partnership
with Emory University and consists of 56 diabetes aware-
ness and prevention text messages in 12 regional languages.
The messages have been reviewed for cultural relevancy
and technical accuracy, and potential for behavior change,
through Arogya World’s Behavior Change Task Force made
up of medical, health promotion and consumer communica-
tions experts.
mDiabetes implementation activities were launched in
January 2012. The project considers measurement and
evaluation critical to project success, and therefore is im-
plementing a rigorous effectiveness evaluation plan. Initial
consumer testing of messages with 750 consumers and
analysis of feedback was performed; the results revealed
that the messages were found to be clear, useful and com-
pelling. Effectiveness studies and evaluation of behavior
change is currently underway.
OBJECTIVES & GOALS
The goal of mDiabetes is to educate Indians on diabetes
prevention and to bring about behavior changes proven to
prevent diabetes in 50,000 people in India. The initial aim
was to enroll one million consumers in the program over
a period of two years. This initial enrollment target has
already been met, one year ahead of time.
SCALE UP ACHIEVED
Between January 2012 and January 2013, 1.05 million
consumers from across India opted in and were enrolled
in mDiabetes through the Nokia Life platform. As of April
2013, mDiabetes has sent out over 45.9 million text mes-
sages through the program, with over 185,000 people hav-
ing already completed the initial six-month program.9
CASE STUDY
9
Data is not available on what percentage of the 185,000+ have continued to subscribe to mDiabetes by paying a nominal fee.
In-country scale up
CASE STUDIES
02

15
CASESTUDY:MDIABETESmDiabetes creates a value-added service for Nokia presenting a strong investment case, and uses their existing large-scale
network of consumers on the Nokia Life platform to deliver diabetes awareness and prevention messaging. Over 95 million
consumers in India, China, Indonesia and Nigeria have experienced Nokia Life services, which also recently launched in
Kenya in March 2013.
mDiabetes launched with a business model built into the project, whereby consumers can access the content for free for the
first six months, after which they have to pay a nominal fee to continue receiving diabetes messaging. According to Arogya
World, the marginal cost of enrollment is about 40 cents per person, thereby presenting a potentially cost-effective model for
chronic disease prevention.
Arogya World is employing a strong monitoring and evaluation strategy with multiple phases, particularly to evaluate the
effectiveness of the intervention in changing behavior in both urban and rural areas. Coupled with this, Arogya World is
maintaining a flexible and adaptable approach to mDiabetes, allowing for corrective changes informed by interim results
to be applied to improve program effectiveness throughout the implementation period.
Success factors
PARTNERS ROLES
Arogya World Implementer and evaluator providing strategic leadership
Nokia Implementer and technology provider: providing Nokia Life
platform, translation and transmission infrastructure, and ac-
cess to consumer network. Nokia is also providing funding by
subsidizing program costs.
Synovate (now Ipsos) Providing market research
Biocon, Johnson & Johnson (LifeScan Inc.) and Aetna Providing financial support for the program and measurement
and evaluation insights
Emory University Providing support on content development
mDiabetes aims to send 58 million text messages over a two-
year implementation of the program and scale up the program
to reach more of India’s mobile subscribers, depending on re-
sults. Through a rigorous effectiveness evaluation of mDiabe-
tes, Arogya World aims to establish a scalable, cost-effective
model for chronic disease prevention to be replicated in
other countries.
CASE STUDIES

16
mHealth Tanzania
Public-Private Partnership
� LOCATION: TANZANIA � STATUS: SCALING UP
4
The Ministry of Health and Social Welfare of Tanzania
(MOHSW) leads the mHealth Tanzania Public-Private
Partnership (PPP), with support from the US Government
Center for Disease Control and Prevention (CDC), as well as
numerous Tanzanian and international public and private
sector partners. The PPP focuses on addressing ministry-
defined public health priorities by convening partners and
supporting national-scale solutions that work in concert
with initiatives underway at the Ministry.
The PPP supports several active mHealth programs includ-
ing the Blood Donor SMS Messaging Service (led by the
MOHSW National Blood Transfusion Services), as well as
the scale-up of the Electronic Integrated Disease Surveil-
lance and Response system (led by the Epidemiology and
HMIS sections). This case study focuses on the national
launch of the ‘healthy pregnancy’ free text messaging
service of the ‘Wazazi Nipendeni’ campaign.
A key commitment of the PPP and the MOHSW is to
improve maternal and child health during pregnancy,
delivery, and newborn babies’ first part of life. This com-
mitment is part of the Campaign on Accelerated Reduc-
tion of Maternal Mortality in Africa in Tanzania (CARM-
MAT).10
Therefore, the MOHSW launched the “Wazazi
Nipendeni”, or “Parents Love Me”, countrywide multi-
media campaign in late November 2012 with the support
of several key partners, to operationalize CARMMAT.
The campaign is supported by providing free healthy
pregnancy SMS messages in Swahili to pregnant women
and mothers of newborn babies (up to 16 weeks of age),
as well as her supporters, including the husband, friends
and family. The PPP and MOHSW developed official
Government of Tanzania-sanctioned SMS messages,
in close collaboration with several departments at the
MOHSW, and leveraging ‘fetal development’ messages
from the global MAMA program. Wazazi Nipendeni
involves a multi-media campaign that includes promo-
tion of the free (reverse-billed) SMS messaging service
by listing the short-code 15001 on campaign materials
and instructs anyone interested in more information on
healthy pregnancy for free to text the word ‘MTOTO’
(‘baby’) to the short-code.
OBJECTIVES & GOALS
The objectives of the PPP are to improve the flow of infor-
mation across and between levels of the health system and
community, reduce the response time of providing critical ser-
vices, increase evidence-based planning and decision-mak-
ing, and improve public awareness on key health priorities.
The PPP works on leveraging the rapid expansion of mobile
networks and technologies by exploring numerous applica-
tions of mHealth technology, such as increasing direct patient
care, rapid lab results communication, health worker training,
and drug supply-level information management. The PPP
aims to strengthen Tanzania’s public health systems by sup-
porting a scalable, cost-effective and sustainable foundation
for enhanced national health information systems. This will
CASE STUDY
10
Campaign on Accelerated Reduction in Maternal, Child and Newborn Mortality: http://www.carmma.org
In-country scale up
CASE STUDIES
02

17
CASESTUDY:MHEALTHTANZANIAPUBLIC-PRIVATEPARTNERSHIP
All projects are performed through major partnerships, including Wazazi Nipendeni. The PPP convenes multiple partners
from different sectors, combining expertise and resources to implement sustainable and scalable public health programs
that leverage the rapidly expanding mobile phone and network infrastructure in Tanzania and existing activities of local
partners. These partners were selected based on their core strengths and complementary abilities that could be leveraged
for the campaign. For example, EGPAF contributed their technical expertise in PMTCT to support the development of SMS
content on this topic, as well as utilized their extensive on-the-ground experience in supporting over 1,300 health facilities
in Tanzania to help orient health facility workers to assist women enrolling in Wazazi Nipendeni.
The Wazazi Nipendeni free SMS service utilizes the multi-media campaign to reinforce awareness of the service and the
shortcode, while employing a reverse-billing approach to enable pregnant women and their supporters to access the SMS
service for free.
The PPP works across departments, sections, units, programs and projects at the Ministry, under the leadership of the Ministry’s
mHealth Coordinator who is in the Department of Policy and Planning. The PPP supports the Ministry in developing a national
mHealth Strategy that will link with the eHealth Strategy and other Government of Tanzania and MOHSW strategic plans. It
also works in concert with initiatives underway in the MOHSW, including integration with the national enterprise architecture.
Success factors
PARTNERS ROLES
Tanzania Ministry of Health and Social Welfare Strategic leadership
US Government Centers for Disease Control
and Prevention (CDC)
Funding and technical assistance support
CDC Foundation Partnership Administration and Management Support
Text to Change Provider of technical assistance and SMS Text Messaging
Technology Platform
Johns Hopkins Bloomberg School of Public Health, USAID,
Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Aga
Khan Health Services
Technical, implementation and financial support
involve leveraging private sector interest in mHealth and related
areas of ICT to develop long-term public-private partnerships,
while continuing collaboration with other governmental and non-
governmental implementing partners.
SCALE UP ACHIEVED
Wazazi Nipendeni was launched as the MOHSW’s national
healthy pregnancy campaign in late November 2012. The SMS
component of the multi-media campaign has proven to be the
most successful (measured by volume) national-scale mHealth
program in Tanzania to date, with 100,000 active, unique sub-
scribers within the first 15 weeks of the campaign.
National scale of the Wazazi Nipendeni healthy
pregnancy campaign.
CASE STUDIES

18
mTrac
� LOCATION: UGANDA � STATUS: SCALING UP, WITH NATIONAL SCALE PROJECTED WITHIN 2013
5
mTrac11
is part of a nationwide health systems strengthen-
ing initiative launched by the Ugandan Ministry of Health
(MOH), the National Medical Stores and the President’s
Monitoring Unit, with support from UNICEF, WHO and
DFID. It consists of a mobile-based disease surveillance
and medicine tracking system that provides real-time
data for response while monitoring health service deliv-
ery performance.
mTrac achieves this by digitizing the transfer of Health
Management Information System (HMIS) data via mobile
phones. The initial focus of mTrac is to speed up the
transfer of HMIS Weekly Surveillance Reports (covering
disease outbreaks and medicines). Powered by Rap-
idSMS, mTrac collects the weekly surveillance reports
from Health Facility workers who use their own basic
handsets to send the data using SMS and USSD. This data
is then amassed and presented on an online dashboard
for MOH officials to observe the data in real-time. All
mTrac data is also automatically fed into the national
District Health Information Software 2 (DHIS2) database.
Using mTrac, the Ministry of Health is receiving real-time
information on medicine stocks, and district health of-
fices are able to successfully lobby the National Medical
Stores for resupply based on their ability to present reli-
able and timely data.
mTrac also focuses on providing a mechanism for commu-
nity members to report on service delivery challenges by
implementing a toll-free SMS Anonymous Health Service
Delivery Complaints Hotline, supported by an initiative called
uReport - UNICEF’s social monitoring network with almost
200,000 registered reporters in Uganda alone. Data from
CASE STUDY
In-country scale up
CASE STUDIES
02
11
mTrac was featured in the first ADA report on mHealth focused on scale up. It has been included again here, with significant updates, given the national scale up of the
program as of the first quarter of 2013.
PARTNERS ROLES
UNICEF Technical partner focusing on community management,
negotiations brokering with private sector, and providing
technical assistance to the MOH
WHO Technical partner focusing on national training curriculum,
national data usage and analysis, and providing technical
assistance to facilities
DFID Funder
USAID and local Implementing Partners Supporting implementation by requiring USAID implementing
partners to include DHIS2 and mTrac in program plans
Local NGOs and Community Service Organizations Supporting implementation, advocacy and community
mobilization

19
CASESTUDY:MTRAC
CASE STUDIES
both Health Facilities and community members is available on
mTrac’s web-based dashboard, where District Health Teams are
expected to follow up on incoming reports (such as drug stock-
outs and health worker absenteeism). The aim is to empower
District Health Teams by providing timely information for action.
National level government stakeholders also monitor this, ensur-
ing accountability and action.
OBJECTIVES & GOALS
The goal of mTrac is to tackle the challenge of access to disag-
gregated health data, identification of bottlenecks and timely
follow-up, by strengthening Uganda’s health management
information systems. The objective of mTrac is to avoid unneces-
sary stock-outs and to improve transparency and accountability
within the healthcare system.
SCALE UP ACHIEVED
Following an 18-month pilot program, mTrac is now taken over
and operated by the MOH and has sustained a 90% response
rate for weekly reports via SMS. At district-level, mTrac is
fully rolled out. mTrac is also serving as the MOH’s national
communications tool, with over 15,000 registered and trained
CHWs already in the database. mTrac was used to send out
alerts and refresher training information during the 2012 Ebola
outbreaks. UNICEF Uganda’s related initiative, uReport, has
190,000 people registered, while their anonymous hotline
receives 1,200 to 1,500 reports per month. As part of the
mTrac roll-out, UNICEF has put in place computers and access
to the Internet at all 112 district offices and set up an online
dashboard to allow them to validate and review the official
data that comes in, as well as receive SMS alerts when certain
notifiable diseases are identified.
mTrac is being scaled up nationally in Uganda, with all 5,000
government Health Facilities expected to be using the system by
May 2013 (as of March 2013, mTrac is already being used in 70%
of all Health Facilities).
Ownership and operation of mTrac has shifted to the MOH.
mTrac has secured high-level government involvement through the appointment of an inclusive steering committee by the
Permanent Secretary, which comprised the MOH, the National Medical Stores (in charge of distribution of all drugs to govern-
ment facilities and includes state houses monitoring unit for accountability issues, transparency and corruption), along with a
number of other external stakeholders. A technical working group has also been put in place by the Permanent Secretary with
representatives from each of the program divisions, including the users of the National Malaria Control Program, surveillance
division, pharmacy unit and MOH resource center.
mTrac employs strategies, such as avoiding heavy hardware or software costs, that enable the initiative to both scale very
quickly as well as put in place a system that the government is comfortable taking on by not imposing a huge hardware burden
that other systems may have required. For example, Health Workers use their personal mobile phones to send in the data,
addressing issues of sustainability by eliminating the need for the government to manage and support tens of thousands of
electronic devices while keeping recurrent costs at a minimum.
Success factors
Sustainability and scale up of mTrac has been achieved thanks to several factors:

21
CASESTUDIES:CROSS-COUNTRYSCALEUP
03 Cross-country scale up
CASE STUDIES
CROSS-COUNTRY SCALE UP
12
The information presented in these case studies, including project data, is sourced from online research, project documents, communications,
and interviews with personnel involved in the management of these initiatives.
03
CASE STUDIES
1. MOBILE ALLIANCE FOR MATERNAL ACTION
2. MOBILE TECHNOLOGY FOR COMMUNITY HEALTH
3. PROGRAMME MWANA
4. SMS FOR LIFE
5. SWITCHBOARD
The follow set of case studies present mHealth partnership
initiatives that have achieved or are working towards scale
across different countries and present concrete elements of
success that can be incorporated in other partnership initia-
tives looking to achieve cross-country or global scale.12

22
Mobile Alliance for Maternal Action
� LOCATION: BANGLADESH, SOUTH AFRICA, INDIA � STATUS: MAMA BANGLADESH: SCALING UP.
MAMA SOUTH AFRICA: SCALING UP. MAMA INDIA: PLANNING PHASE.
The Mobile Alliance for Maternal Action (MAMA) is a
global mHealth public-private partnership that is initially
mobilizing US$10 million over the course of three years to
improve maternal and child health. The partnership will
implement and support mHealth projects in three initial
countries - Bangladesh, India and South Africa - that will
deliver culturally-sensitive, evidence-based health informa-
tion to pregnant women and new mothers. Subscribers to
the service register by indicating their expected due date or
the birthday of their recently born child and receive weekly
messages and reminders during the pregnancy and up to
the child’s first birthday. Messages include everything from
proper nutrition, breastfeeding, vaccinations and referrals to
local health resources.
Each country program is different as they are tailored to
local contexts. For example, in Bangladesh a high percent-
age of the target beneficiary group is illiterate, therefore
voice messaging via Interactive Voice Response (IVR) is a
major delivery method. A smaller percentage of the popula-
tion receives push SMS. In South Africa, literacy rates are
much higher but SMS messages are very expensive at scale.
Thanks to the high penetration of data-enabled feature
phones, this then allowed the use of mobile web (mo-
bisites). The program also uses USSD, a text-based interac-
tive platform that works on the lowest-end phones but is
cheaper than SMS. MAMA South Africa offers specialized
support to mothers enrolled in prevention of mother-to-
child transmission of HIV (PMTCT) programs. MAMA India
is currently performing a landscape analysis and mapping
effort using cross-sectoral partners to assess how to best
design the program.
MAMA also provides a library of free, adaptable mHealth
messages for programs that are using mobile phones to
inform and empower new and expectant mothers. These
health messages and reminders are comprehensive,
stage-based and available for use in SMS and audio (IVR)
programs. The messages are based on WHO and UNICEF
guidelines and can be adapted to different languages, cul-
tures, regions, and to address specific needs.
OBJECTIVES & GOALS
MAMA is a global partnership that seeks to accelerate the
use of mobile technology to improve the lives of expect-
ant and new mothers in developing nations by engaging an
innovative global community to deliver vital health informa-
tion through mobile phones. MAMA’s objectives are to help
coordinate and increase the impact of existing mHealth mes-
saging programs, provide resources and technical assistance
to promising new business models, and build the evidence
base on the effective application of mobile technology to im-
prove maternal health. Lessons learned from these and other
initiatives will be shared globally in a coordinated exchange
of information.
SCALE UP ACHIEVED
MAMA Bangladesh was the first country program to launch
a national mHealth service, called Aponjon, after complet-
ing an 11-month pilot phase. Aponjon is delivering critical
stage-based information to new and expectant mothers and
their families. Since launching, Aponjon already has 40,000
CASE STUDY
03Cross-country scale up
CASE STUDIES
1

23
CASESTUDY:MOBILEALLIANCEFORMATERNALACTION
CASE STUDIES
PARTNERS ROLES
USAID Providing funding, strategic leadership, access to local USAID
missions and expertise through MCHIP
Johnson & Johnson Providing funding, technical expertise in communications and
branding
UN Foundation Providing support for communications, advocacy and public
outreach, and linkages to UN organizations
mHealth Alliance Serving as MAMA Secretariat, and providing technical mHealth
expertise and a forum to exchange knowledge and share best
practices
BabyCenter LLC Providing adaptable messages library (both text and audio
messages) and expertise
MAMA BANGLADESH113
D.Net MAMA Bangladesh partnership coordinator and primary implement-
ing agency, with its own consortium of partners, including BRAC
Bangladesh Ministry of Health and Family Welfare
(MOHFW)
Providing health content review and approval; leadership of the
MAMA Bangladesh Advisory Board; promotion through state media
and public sector health system
Local partners Providing in-cash and in-kind support
MAMA SOUTH AFRICA
Praekelt Foundation, Main local implementation and service design
Cell-Life, WRHI partners
Vodacom Foundation Provision and promotion of free access to MAMA South Africa for
Vodacom subscribers
13
There are over 30 partners in Bangladesh, including five mobile network operators, over five outreach (NGO) partners including BRAC, Smiling Sun Franchises, and
Mamoni (Save the Children), as well as the MOHFW and corporate sponsors such as Multimode and Beximco.

24
CASE STUDIES
subscribers registered for the service thanks to the 1,500
community health workers coordinating this process, trained
by key local partner D.Net, a social enterprise in Bangladesh
and lead project implementer. Aponjon is a service where
most (about 80%) of the subscribers opt-in and pay for the
service at a subsidized rate. Only about 20% of the sub-
scribers who meet the criteria for being the poorest get the
service entirely for free.
MAMA South Africa was launched nationally in May 2013
and announced its first partnership with a mobile network
operator, Vodacom (via the Vodacom Foundation), one of
the country’s leading telecommunications companies. The
partnership will give all 25 million Vodacom subscribers
free access to MAMA’s mobile website (askmama.mobi)
and will support a free SMS program offered through two
inner-city clinics in Hillbrow, one of the lowest-income
areas of Johannesburg.
MAMA’s adaptive messaging library has been accessed by
more than 120 organizations in 50 countries14
. The library
is constantly being expanded with new content, including
messages on PMTCT, post-partum family planning, breast-
feeding, immunization, as well as messages for husbands
and mothers-in-law. These adaptable messages have
reached 200,000 new and expectant mothers and have
been translated in 10 languages.
MAMA Bangladesh aims to reach two million new and
expectant mothers, as well as household decision-makers,
by 2015.
MAMA South Africa aims to reach 500,000 women and
household decision-makers over two years. The program
uses multiple channels of message delivery: they are cur-
rently rolling out SMS, USSD, and mobisite services and aim
to add voice and MXit services in 2013.
Aponjon is a service where most (about 80%) of the subscrib-
ers opt-in and pay for the service at a subsidized rate. Only
about 20% of the subscribers who meet the criteria for being
the poorest get the service entirely for free.
”
“
14
To request access to use MAMA’s adaptable mobile messages library, visit this page: http://www.mobilemamaalliance.org/mobile-messages.

25
CASE STUDIES
MAMA carefully selected its partners based on their added value. Engaging and working closely with diverse global,
regional and local partners enabled MAMA to tailor each country program to local contexts and use different mechanisms
for message delivery that best suit local market structures and target populations to ensure uptake.
MAMA identified different types of business models, such as variable pricing, to ensure sustainability of the service. For exam-
ple, Aponjon engages local community health agents from different partner organizations in order to assess eligibility of users
for different price tiers, thereby targeting different segments of the BOP. Aponjon is available for free for the poorest, while the
other 80% pay a small user fee, consistent with prices charged for other mobile information services. A benefit of applying user
charges is that implementers can assess whether users value the content, as they would unsubscribe if not. MAMA Bangladesh
is currently exploring the use of sponsorship tags on IVR services to generate an additional revenue stream to ensure long-
term sustainability.
MAMA country programs are employing a comprehensive approach in program design and implementation. MAMA is working
with a wide variety of local partners in each country, including NGOs, mobile network operators and government institutions,
to inform the program design, perform direct implementation and drive scale up.
Success factors
CASESTUDY:MOBILEALLIANCEFORMATERNALACTION

26
Mobile Technology for Community Health
� LOCATION: GHANA, INDIA � STATUS: SCALING UP IN GHANA AND ROLLING OUT TO NEW A GEOGRAPHIC
AREA IN INDIA.
The Mobile Technology for Community Health, or MOTECH,
project is a joint initiative between the Grameen Foundation,
the Ghana Health Service, and Columbia’s Mailman School of
Public Health, that addresses maternal and neonatal health
and mortality among the rural poor using mobile technology.
Through its “Mobile Midwife” information service, MOTECH
sends targeted, time-specific, evidence-based voice and
text messages with vital health care information to pregnant
women and new parents in their local language throughout
the pregnancy and during the first year of their child’s life.
These messages contain advice on pregnancy-related issues,
important facts about fetal development and reminders
about upcoming clinic check-ups and care visits.
A complimentary service called Mobile Nurse enables rural
community health workers to record and track the care pro-
vided to women and newborns in their area. Using a basic
mobile phone, community health workers enter data from
patients’ clinic visits and upload the records to MOTECH
servers for authentication. Patient records are analyzed to
establish personalized care schedules, and notifications
are sent to nurses about care visits. This information is also
used to personalize the Mobile Midwife alerts, reminders
and information sent to the pregnant woman. The system
also sends weekly notifications to nurses on various patient
updates, such as new defaulters (patients who miss appoint-
ments) and upcoming and recent deliveries. Mobile Nurse
enables nurses to automate the generation of their monthly
reports, which used to take 4-6 days per month of their
CASE STUDY
CASE STUDIES
2
time, thereby helping the nurses save valuable time as well
as improve the accuracy of their reports. Mobile Nurse also
facilitates the identification of patients who have missed
certain care visits. The system also sends detailed data on
health service delivery and outcomes to the Ghana Health
Service, giving policymakers an accurate and detailed pic-
ture of health conditions in the country.
OBJECTIVES & GOALS
The objectives are to enable the delivery of maternal health
information over mobile phones to pregnant women in rural
areas, while helping nurses record and track care delivered
to women and newborns in their area. MOTECH aims to use
mobile phones to increase the quantity and quality of an-
tenatal, postnatal and neonatal care in rural Ghana, as well
as the demand for such services, with a goal of improving
health outcomes for mothers and their newborns.
SCALE UP ACHIEVED
In Ghana, there are now over 25,000 people registered for
the service and almost 300 community health workers us-
ing mobile phones to track their patients. The Ghana Health
Service is expanding the service to additional districts to

27
CASESTUDY:MOBILETECHNOLOGYFORCOMMUNITYHEALTH
CASE STUDIES
15
Available at: http://www.grameenfoundation.org/sites/default/files/MOTECH-Lessons-Learned-Sept-2012.pdf
Grameen Foundation designed MOTECH for long-term scale and replication from the outset by building components that
could be reused in other geographies and other health domains.
Grameen Foundation worked with organizations such as Dimagi and InSTEDD that had complimentary technologies to make
their services interoperable, resulting in the MOTECH Suite.
Much value is placed by the Grameen Foundation in developing strong partnerships and working collaboratively to address the
myriad operational details required to build a successful mHealth intervention.
Grameen Foundation employs a strong monitoring and evaluation approach, and has publicly shared their documented their
lessons learned and experiences from Ghana in documents available online.15
Success factors
PARTNERS ROLES
Grameen Foundation Program implementer and manager
Columbia Mailman School of Public Health Providing program support
Bill & Melinda Gates Foundation (for Ghana), Johnson &
Johnson (for India)
Funders
Ghana Health Services Supporting scale up and implementation
help meet its top-priority goals: increasing the number of women who
receive four antenatal care visits, the number of deliveries that happen
with a skilled birth attendant, and the number of newborns who are
seen by a health worker within the first 48 hours of life.
MOTECH is now being expanded to a new geography and health prior-
ity with Grameen Foundation’s HIV/AIDS program in India. MOTECH
is enabling organizations to send messages to HIV-positive patients
reminding them to take their antiretroviral medication. It is working
to provide tools and training to 200,000 health workers reaching the
poorest communities in Bihar, India. MOTECH is also helping health
workers track their clients in World Vision programs in seven countries,
such as Afghanistan and Zambia.

28
Programme Mwana
� LOCATION: ZAMBIA, MALAWI � STATUS: SCALING UP
Programme Mwana is a mobile health initiative implemented
by the Zambian MOH with support from UNICEF and col-
laborating partners to strengthen health services for moth-
ers and infants in rural health clinics, with particular focus on
improving Early Infant Diagnosis (EID) of HIV and improving
post-natal care for mothers and their children.
In Zambia, delivery of paper-based infant HIV test results
typically averages 6.2 weeks given poor road infrastruc-
ture and far distances between clinics and labs processing
the results, thereby presenting long delays for EID. Such
delays contribute to loss of follow-up and possible death of
30% of affected children if no interventions are provided.
Programme Mwana launched a pilot in April 2010 to reduce
these delays in results transmission from the HIV test labo-
ratories to rural health facilities via SMS message. The pilot
had two main SMS components: Results160 and RemindMi.
Results160 was used by staff to securely deliver infant HIV
results from the lab to the health clinics, while RemindMi was
used by CHWs to remind the mothers to return to the clinics
to receive their infant’s results.
The following results were identified through
a program evaluation:
• Over 5,000 infant HIV test results have been delivered (as
of September 2012).
• The time between when the samples were collected and
when the mother received the results was reduced by 56%.
• 30% more results were successfully delivered to mothers
thanks to the digitization of the results (as the paper cop-
ies were often getting lost).
A national scale-up plan was developed and is now being
implemented, which commenced with a preparation phase
and followed by shifting to an iterative phase where clinics
are trained and added to the system and problems and suc-
cesses are evaluated. Throughout the scale-up process, the
project will be closely monitored to ensure the systems are
having a positive effect on the targeted health challenges.
OBJECTIVES & GOALS
The primary goal of Programme Mwana is to use mobile
technology to strengthen health services for mothers and
infants in rural clinics, particularly EID as it is a significant
problem for countries trying to improve prevention of
maternal to child transmission of HIV (PMTCT). The limited
amount of technology available to perform infant HIV
diagnosis combined with very poor road infrastructure
for delivery of results present major bottlenecks for EID.
Programme Mwana was designed to reduce infant mortality
by addressing these particular bottlenecks using mHealth,
SMS-based interventions.
SCALE UP ACHIEVED
Programme Mwana was first piloted by the Zambia MOH in
13 districts in six provinces from 2010 with a goal of reaching
nationwide coverage by 2014. Programme Mwana is now
currently in more than 364 facilities and full national scale up
is underway in Zambia.
In Malawi, the program was adopted at national level in 2012
and RapidSMS has been rolled out to tackle other issues
as well, including pre- and post-natal care, immunization,
growth monitoring and nutrition promotion.
In 2011, the Zambian MOH officially decided to scale Pro-
gramme Mwana to 414 health facilities that provide EID ser-
vices. The scale-up is taking place over three years, assisted
by a wide range of government and NGO partners.
CASE STUDY
CASE STUDIES
3
PARTNERS ROLES
Zambia MOH / Malawi MOH Implementer providing strategic leadership
UNICEF Innovation, UNICEF Zambia / UNICEF Malawi Providing implementation support, technical expertise
and technology/systems development.
Boston University affiliate the Zambia Centre for Applied
Heath Research and Development (ZCHARD), Clinton
Health Access Initiative (CHAI), and other implementing
and technical partners
Implementing partners

29
CASESTUDY:PROGRAMMEMWANA
CASE STUDIES
16
For more information on the project design of Programme Mwana, see the Case Example on page 59.
Success factors
The mobile solutions developed for Programme Mwana were designed with specific health objectives that were aligned
with the national health strategies of Zambia.16
Upon completion of the pilot, all computer hardware, system software, partnerships with telecom companies and software
developers were in place to simplify the scaling up of the system to a matter of training.
The entire system and supporting processes and materials were designed in a way to make a single package that can be easily
replicated in other countries.
The team invested significant effort and time in understanding and strengthening the existing health interventions, rather than
replace them with a new intervention. This was done in close partnership with the government and partner NGOs.
MWANA INITIATIVE, ZAMBIA & MALAWI
MOTHER
CHILD 1ST
TRIMESTER
2ND
& 3RD
TRIMESTERS
CHW
RURAL CLINIC
DISTRICT
COUNTRY
CHW registers birth
6/6/6 visit reminder 6/6/6 visit reminder 6/6/6 visit reminder
DBS sample registered
Mother asked to visit clinic
Mother receives results
at clinic
Results registered at national lab
SMS results
received
Sample shipped
and tracked
KEY SYSTEM
COMPONENTS
PREGNANCY
BIRTH &
POSTPARTUM
BIRTH &
POSTNATAL
MATERNAL
HEALTH
INFANCY CHILDHOOD
USER REGISTRATION PATIENT REGISTRATION LOGISTICAL TRACKING REMINDER
LOGISTICAL TRACKING RESULTS NOTIFICATION CONFIRMATION
CONFIRMATION REQUEST FOR ACTION
CONFIRMATION
A national scale-up plan was developed and is now being
implemented, which commenced with a preparation phase
and followed by shifting to an iterative phase where clinics
are trained and added to the system and problems and
successes are evaluated.
”
“
Programme Mwana mapped on the continuum of care. Credit: UNICEF Innovation

30
SMS for Life is an innovative public-private partnership ini-
tially led by Novartis and supported by the Tanzanian Minis-
try of Health and Social Welfare (MOHSW), IBM, Medicines
for Malaria Venture (MMV), the Swiss Agency for Develop-
ment and Cooperation (SDC), Vodacom and Vodafone. The
project comes under the umbrella of the global Roll Back
Malaria Partnership.
SMS for Life harnesses everyday technology to improve ac-
cess to essential malaria medicines in rural areas of devel-
oping countries. It uses a combination of mobile phones,
SMS messages and electronic mapping technology to track
weekly stock levels at public health facilities in order to:
eliminate stock-outs, increase access to essential medicines,
and reduce the number of deaths from malaria.
Every Thursday, the system sends a stock request message
to the mobile phones of all registered health facility work-
ers. They then count how much stock they have and send
the information back to the system via a free text message.
If they have not done this by Friday, the system sends them
a reminder. On Monday the system would send information
about stock levels and non-reports to the district manage-
ment officer, who can then monitor stock levels and order or
redistribute medicine between sites accordingly.
OBJECTIVES & GOALS
The SMS for Life project was originally conceived to harness
mobile resource management technology in eliminating stock-
outs and improve access to malarial medicines in Tanzania. The
partnership’s objectives are to bring weekly visibility to medi-
cine stock levels at the remote Health Facility level, improve
access to life saving medicines at the point of care by eliminat-
ing medicine stock-outs at the health facility level, and provide
an infrastructure to allow weekly collection of surveillance
information. It tackles these by enabling real-time reporting of
stocks using mobile phones and two-way text messaging.
SCALE UP ACHIEVED
SMS for Life has been rolled out nationally across Tanzania,
with the staff of over 5,000 facilities trained and reporting on
a weekly basis. Ownership of the initiative has been officially
transferred to the Tanzanian MOHSW. The post-pilot partner-
ship includes the Tanzanian Ministry of Health, the Medicines
for Malaria Venture (NGO), Novartis Foundation, Vodacom, and
the Swiss Agency for Development and Cooperation.
Novartis is now planning to expand SMS for Life to several
African countries. In Ghana, following a successful pilot
in six districts sponsored by the Swiss Tropical and Public
Health Institute (Swiss TPH), Novartis is working with the
Ghana Health Service on planning a full country scale up.
In Kenya, another successful and extensive pilot has been
completed and Novartis is working with the National Malaria
Control Program (NMCP) on a plan for a full country scale
up. In Cameroon, with support from the Norwegian Agency
for Development Cooperation (NORAD), Novartis and its
partners are in the planning phase for a full country scale up
of malaria medicine tracking, in addition to collecting patient
surveillance data on the use of rapid diagnostic tests.
In addition to Tanzania, Kenya, Ghana and Cameroon, there
is interest in exploring SMS for Life integration in Zimbabwe,
Madagascar, Chad and the Democratic Republic of Congo.
SMS for Life
� LOCATION: TANZANIA, KENYA, GHANA, CAMEROON � STATUS: TANZANIA: National scale achieved.
Additional African Countries: Scale up and implementation ongoing or planned.
CASE STUDY
CASE STUDIES
4
Extract from SMS for Life Poster. Credit: RBM Partnership

31
CASESTUDY:SMSFORLIFE
CASE STUDIES
Sustainability has been achieved through securing government buy-in and ensuring ownership of SMS for Life programs
by country governments, as well as sustainable funding as partners fund the initial systems cost associated with the pro-
ject while the in-country training and implementation costs are typically covered by the country government itself.
SMS for Life brings together a broad consortium of partners from a variety of sectors. A strong steering committee has
been set up to manage the partnership and the initiative via the Roll Back Malaria partnership, including representatives
from government, the private sector and non-profit partners (including Vodafone, Novartis and the Swiss Tropical Institute).
Success factors
PARTNERS ROLES
Novartis Providing funding, technical expertise and strategic leadership
Roll Back Malaria partnership (RBM) Providing strategic support and guidance by facilitating a
steering committee and advocacy efforts
Swiss Agency for Development and Cooperation, Medicines
for Malaria Venture
Initial funders
IBM, Google, Vodacom, Vodafone Technical supporting partners providing technology and other
support
Country Governments Supporting implementation and national scale

32
In partnership with mobile network operators Vodafone
and MTN, Switchboard has created a free calling network
for every doctor in Ghana and Liberia, and is now creating a
free calling network for all health workers in Tanzania. Since
2008, physicians have been collaborating using the Switch-
board network to improve patient care with over four million
calls made.
Physicians in Ghana were spending upwards of US$70
per month on calls to colleagues. With the development
of Switchboard, physicians in Ghana and Liberia gained a
nationwide support network, while telecoms gained valuable
customers. As physicians in Ghana and Liberia registered for
the Switchboard networks, Switchboard was able to create
the first-ever doctor directories in 2010 and 2011. Every
physician received a print directory, allowing them to expand
their support network nationwide, consult with new col-
leagues, and refer patients more effectively.
OBJECTIVES & GOALS
Using even the simplest mobile phones, Switchboard aims to
make nationwide networks of health workers enabling them
to seek medical advice and make referrals free of charge.
Switchboard works to achieve this by: (1) creating free call-
ing networks between health workers enabling them to call
or text each other for free; (2) building nationwide phone
registries; and (3) implementing a bulk SMS messaging plat-
form. This platform will enable bi-directional communication
between health workers and MOH officials to relay disease
outbreak information, drug supply levels and receive lab
results in real-time.
SCALE UP ACHIEVED
Free calling networks have been established between all 181
doctors in Liberia and all 2,200 physicians in Ghana – gener-
ating four million calls since 2008.
Switchboard is expanding into Tanzania with the aim of creat-
ing a network between all 34,000 health workers in Tanzania.
Out of these 34,000, only 6,505 medical and clinical officers
manage all rural health centers in Tanzania – acting as the
main points of care for a population of 45 million. These
isolated health workers are currently unable to seek advice
from almost 2,500 urban doctors or receive government
support. To allow health workers to freely seek advice
nationwide, Switchboard is initially creating a free calling
network for the 9,000 doctors, medical and clinical officers
in Tanzania through local telecom partner, Vodacom.
For every isolated health worker in Tanzania to receive best
practices or disease outbreak alerts instantly on their mobile
phone, Switchboard will work with the Ministry of Health to
utilize their Bulk SMS platform, enabling them to send critical
information to large groups of health workers, and allowing
practitioners in the field to also reply to vital questions or
report medical supply levels.
Switchboard
�LOCATION: GHANA, LIBERIA, TANZANIA (ROLLING OUT) �STATUS: GHANA, LIBERIA: National scale achieved (reach-
ing 100% of doctors). TANZANIA: Ongoing, with the target of national scale (reaching all health workers).
CASE STUDY
CASE STUDIES
PARTNERS ROLES
Switchboard Lead implementer and partnership broker
MTN (Liberia), Vodafone (Ghana), Vodacom (Tanzania) Technology providers: providing free calling networks
Ghana Medical Association (GMA), Ghana Medical & Dental
Council
Liberia Medical & Dental Association, Liberia Medical &
Dental Council
Local implementers
Ghana MOH, Ghana Health Service; Liberia MOH; Tanzania
MOH
Supporting and implementing scale up
Google.org Providing strategic funding for scale up in Tanzania
5

33
CASESTUDY:SWITCHBOARD
CASE STUDIES
Switchboard designed their program for scale from the beginning and incorporated strong incentives for each partner to
participate, with a particularly strong commercial incentive for the mobile network operator.
Switchboard designs and employs creative business models to engage private sector partners. For example, Switch-
board’s free calling networks save doctors money on calls to colleagues to seek advice or refer patients, so they provide
a significant incentive to switch carriers. Vodafone has only 18% market share in Ghana, yet they have all 2,200 physicians
as subscribers. While practitioners make free calls to seek advice, they also make paid calls to friends and family – already
generating $1.5 million in revenue for Vodafone and MTN. Switchboard believes these creative business models are the key
to nationwide mHealth scale and expansion to new markets.
Switchboard sought partnership agreements with Ministries of Health and the MNOs to ensure the type of monitoring and
evaluation they needed internally to collect the data necessary to build their business cases.
Success factors
Liberia
Doctors 181
People 4 million
Ghana
Doctors 2,200
People 24 million
Tanzania
Health Workers 9,000
People 45 million
- 9,000 health workers in Tanzania
- All 2,200 doctors in Ghana
- All 181 doctors in Liberia
The Ghana Doctor Directory in use at Korle Bu Teaching Hospital, Accra, Ghana. Credit: Dania Maxwell

34
04 RECOMMENDATIONS
Introduction
RECOMMENDATIONS
04
Introduction
Strategic partnerships combine the distinct core competencies, knowledge, exper-
tise, resources, market access and networks of each partner in order to achieve scale
and impact of an initiative that, if pursued as individuals, may not be possible. It pro-
vides a unique opportunity to share risks, rewards, responsibilities and investments
to achieve common goals. This section delivers recommendations on how to best
proceed through different phases of partnership development for mHealth projects
with a constant focus on achieving scale up.
1
2
3
4
Building
the Partnership
Implementing
the Partnership
Sustaining
the Partnership
Ensuring Partnership
Driven Scale Up
What are key success factors for build-
ing and sustaining partnerships that can
achieve scale of a mobile health initia-
tive? How can partnership-driven scale
up be ensured? These questions are an-
swered through interviews with various
major partnership brokers, stakeholders
and decision-makers, with the content
organized into sets of recommendations
according to partnership development
phases. The recommendations were
then evaluated by an Expert Review
Panel in order to ensure the perspec-
tives of diverse fields were represented.
The recommendations were crafted
according to the following partnership
development phases →

35
RECOMMENDATIONS:BUILDINGTHEPARTNERSHIP
04 Partnership experts
RECOMMENDATIONS
RECOMMENDATIONS:INTRODUCTION&PARTNERSHIPEXPERTS
Partnership experts
EXPERT INTERVIEWEES
EXPERT REVIEW PANEL
Sean Blaschke Health Systems Strengthening Coordinator, UNICEF Uganda
Awa Marie Coll-Seck Minister of Health, Senegal | Former Executive Director, Roll Back Malaria
Amir Dossal Founder & Chairman, Global Partnership Forum
Sarah Emerson Country Manager, mHealth Tanzania Public-Private Partnership, CDC Foundation
Kirsten Gagnaire Global Director, Mobile Alliance for Maternal Action (MAMA)
Patricia Mechael Executive Director, mHealth Alliance
Judy Njogu Product Manager for eHealth & eLearning, Safaricom
Yunkap Kwankam
CEO, Global eHealth Consultants | Executive Director, International Society for
Telemedicine & eHealth
Chris Locke Managing Director, GSMA Mobile for Development
Carole Presern Executive Director, The Partnership for Maternal, Newborn & Child Health (PMNCH)
Sandhya Rao
Senior Advisor, Private Sector Partnerships, Office of Health, Infectious Diseases and
Nutrition, USAID
Véronique Thouvenot Head of International Women and eHealth Working Group, Millennia 2015
These recommendations were drawn from partnership experts with experience
from a variety of sectors (non-profit, government, donor, and private sectors),
and present a diverse set of perspectives and insights for a comprehensive view
on what are the key elements for successful strategic partnerships to drive the
scale up of mHealth.

36
04 RECOMMENDATIONS
Recommendations Overview
Perform a
thorough
landscape
analysis of
local
contexts
Employ an
inclusive
multi-
stakeholder
approach
Partner with
government &
private sectors
Ensure
strategic
alignment &
commitment
Create a
compelling
partnership
proposal
Understand
differing
organizational
cultures &
how to work
together
Establish a
formal partner-
ship agreement
& governance
structures
Employ a
collaborative
approach on pro-
ject design
for scale
Agree on goals
and targets;
set realistic
and flexible
expectations
Be aware
of risks
& rewards
of partnering
Establish
a strong
communication
strategy
Build trust
& minimize
human resource
obstacles
Implement
a broad
monitoring
& evaluation
strategy
Maintain
flexibility
& adaptability
Start small,
think big, &
design a smart
model for scale
Ensure
government
ownership &
involvement
Establish a
cross-agency
committee to
steer scale up
Avoid high
human
resource &
technology costs
Recommendations Overview
Build
Implement
Sustain
Scale

37
4.1 Building the Partnership
RECOMMENDATIONS
BUILDING THE
PARTNERSHIP
Building the partnership covers an in-depth exploration of
the target issue, contexts, stakeholders, potential partners
and possibility for alignment, and finally creating a win-win
proposal to secure partners to form the desired core part-
nership. This initial phase of partnership development can
last from a few months to more than a year, depending on
the scope and context. The following recommendations
cover strategies for successfully building a partnership.
1
PERFORM A THOROUGH LANDSCAPE ANALYSIS
OF LOCAL CONTEXTS
EMPLOY AN INCLUSIVE MULTI-STAKEHOLDER APPROACH
PARTNER WITH GOVERNMENT & PRIVATE SECTORS
ENSURE STRATEGIC ALIGNMENT & COMMITMENT
CREATE COMPELLING PARTNERSHIP PROPOSAL
RECOMMENDATIONS:

38
4.1 RECOMMENDATIONS
The first step is to perform a landscape analysis to develop a thor-
ough understanding of the problem to be tackled, the existing solu-
tions, the potential major stakeholders, and the national information
and health infrastructures and systems in the area of implementation.
Dr. Awa Marie Coll-Seck, current Minister of Health of Senegal and
former Executive Director of the major public-private partnership
Roll Back Malaria, advises having a clear and strong identification
of the problem the proposed partnership wishes to tackle. She
recommends analyzing the problem and the different ways in which
to resolve the problem, as well as identifying what are the different
sectors needed to participate in solving the problem.
Once this is done, Sean Blaschke, Health Systems Strengthening Co-
ordinator of UNICEF Uganda, recommends mapping what solutions
already exist and what is being implemented, as well as what is
working and what isn’t. Without such information, an initiative could
easily run into trouble. One example is unknowingly investing a
great amount of time and energy in proposing and getting funding
for a duplication of an existing project, which would likely not get
accepted or approved by the Ministry of Health (MOH).
Another important element is ensuring there is an enabling environ-
ment for electronic and mobile health (e/mHealth) in the country
of implementation. “You really need to know what the existing laws
and policies are. I’ve seen a number of projects fail where a donor
gave money to an NGO who then hired a technology company to
create a solution which, once presented to the Ministry, was rejected
because certain things – like patient privacy – weren’t taken into
consideration,” says Blaschke. For this reason, Blaschke says it is de-
cidedly important to use the landscape analysis to determine what
current government structures, policies and legislation are in place
that can impact the project and to develop an understanding of the
local ecosystem. If the partnership is lacking local knowledge of how
the government works, and of the policies, legislation and frame-
works in place, it is crucial to involve individuals with this knowledge
as navigating the government can be quite complex and difficult.
Seek out local communities of practice, such as the mHealth Com-
munity of Practice in Tanzania, co-led by the Tanzanian Ministry of
Health and Social Welfare and rotating co-chairs.17
Sarah Emerson,
Country Director of the mHealth Tanzania Public-Private Partner-
ship, shared how this community of practice provides a forum for
sharing experiences, challenges and advice, as well as identifying
potential collaborations within the Tanzanian ecosystem for mobile
health. Blaschke says that Uganda, like many other countries,
provides additional challenges because the government has not
yet officially endorsed its eHealth strategy. There is also an eHealth
moratorium in place since December 2011, meaning the Ministry is
currently not considering new projects until the eHealth strategy
has been completed. Ideally, with these strategies governments
should be able to outline what their priorities are, where they are
currently investing and where there is need for investment. While
more than 80 countries have eHealth strategies in place, unfortu-
nately very few countries in Africa have such a framework in place.18
The landscape analysis should also identify major potential stake-
holders that can play a role in the partnership.
After performing the landscape analysis, Blaschke identifies the
next step as understanding how different information systems fit
together in the country or area of implementation. This is something
that many organizations don’t do in the early phases, even those
looking to broadly strengthen health management information sys-
tems (HMIS). What is not taken into account, according to Blaschke,
is that “an eHealth enterprise-level architecture typically includes
many domains, including logistic management information systems,
patient records, and health insurance systems, all of which must
work together.” As such, there usually are other information systems
that overlap with the tools and systems being developed. Blaschke
notes that UNICEF is working with the Ugandan MOH to identify
what these areas of overlap are and to ensure that existing tools and
those being developed can actually work together in a coherent and
cohesive way.
Perform a thorough landscape analysis in the
local context(s) of implementation.
• Clearly identify the problem, existing solutions, major stakeholders & local infrastructure and systems.
• Ensure there is an enabling environment for e/mHealth & understand how information systems work together.
1
17
The Tanzania mHealth Community of Practice is currently co-chaired by the Tanzania
MOHSW and D-Tree International, and has over 90 members from 30 organizations across
government, industry and NGO sectors. The community can be accessed here: https://groups.
google.com/forum/?fromgroups-!forum/tanzania-mhealth#!forum/tanzania-mhealth
18
A directory of national eHealth policies can be found in the WHO’s Global Observatory for
eHealth: http://www.who.int/goe/policies/countries/en/index.html

39
Amir Dossal, Founder and Chairman of the Global Partnerships
Forum, advises employing a multi-stakeholder partnership
approach by engaging a variety of actors to address social
problems in a cohesive way. Partners from different sectors and
fields can offer different sets of assets and strengths to benefit
the project. Consider not only their core competencies, but also
their history, networks and reputation in the area of implemen-
tation. Partners’ assets should be identified in early discus-
sions to determine areas of expertise and knowledge, existing
relationships, access to markets, etc. Dossal highlights specific
competencies from different sectors that can support the part-
nership, including: management skills of the private sector, nor-
mative leadership of the public sector, and successful delivery
mechanisms of NGOs and civil society who understand how to
deliver programs on the ground. Emerson further recommends
focusing on the complementary abilities of each partner that
can leverage the project and carefully determining where each
partner can and should play a role. According to Minister Coll-
Seck, it is important to identify which partners are the best fit
– based on what is needed for the project, where each partner
adds value and how they fit with the other partners.
Be inclusive and consider all stakeholders when building the
partnership; always keeping scale up in mind. Local stakehold-
ers, particularly community and traditional leaders, community
health workers (CHWs) and local populations, should also be
engaged as partners in the development and roll out of mHealth
solutions. Blaschke suggests that partnering with local com-
munity service organizations can be key to ensuring uptake
of the initiative by the target beneficiaries. UNICEF’s uReport
and mTrac’s Anonymous Hotline were able to leverage existing
grass roots organizations to mobilize their communities around
community monitoring. UNICEF identified various organizations
including the Church of Uganda, Islamic Supreme Council and
the Uganda Scouts Association who already have huge net-
works that they could tap into to make people aware of these
community-monitoring programs. “As an organization, a few
years back UNICEF started looking at signing strategic partner-
ship agreements with more local organizations,” says Blaschke,
and this has certainly been beneficial for them.
Kirsten Gagnaire, Global Director of the Mobile Alliance for
Maternal Action (MAMA), recommends identifying what assets
are specifically needed to scale the initiative: Access to a new
market or demographic? Subsidized mobile services such as
bulk SMS rates? In-depth local knowledge of a particular health
issue and target population? Tailored content and delivery
mechanisms for a specific demographic? Gagnaire advises
organizations to use this information to carefully determine
which partners are needed based on what is needed to support
scale up. Choose partners with the strongest competencies
based on the needs of the project and strive for the optimal
combination of added value to support its success and be
conducive to scale up.
The idea for and formation of MAMA started at USAID
headquarters in Washington D.C. USAID was interested
in creating a model that was built for scale, by catalyzing
country-based public-private coalitions to support the
development and scale-up of sustainable mHealth services
for maternal and child health, beginning in Bangladesh.
USAID was keen to leverage and build local capacity, and
decided to partner with a Bangladeshi social enterprise
that would serve as the coalition coordinator. This enter-
prise would “own” the service, created with initial catalytic
funding from USAID, and it would create and maintain
the relationships with mobile operators, outreach part-
ners, corporate sponsors, government entities and others.
Building on the model developed in Bangladesh, USAID
worked with Johnson & Johnson, who had created a
similar model in the U.S. with Text4Baby, to join forces and
form the Mobile Alliance for Maternal Action, to scale this
model to other countries, in partnership with the mHealth
Alliance, the United Nations Foundation and BabyCenter.
continued on the next page
CASE EXAMPLE: FORMATION OF GLOBAL PUBLIC-PRIVATE PARTNERSHIP MAMA
Employ an inclusive multi-stakeholder partnership
approach when selecting the partners.
• Carefully select each partner based on core competencies, strengths, areas of expertise, resources & networks.
• Focus on complementarity & strive for the optimal combination of added value to scale the project.
2
RECOMMENDATIONS

40
Developing partnerships with local government officials and
institutions can be a key success factor to ensuring the scala-
bility and long-term sustainability of the initiative. Judy Njogu,
Product Manager for eHealth and eLearning at Kenya’s leading
Mobile Network Operator (MNO) Safaricom, explains: “You cannot
achieve scale unless you are working with the government,” while
describing Safaricom’s relationships with local Kenyan govern-
ment leaders, including the Director of Public Health. Minister
Coll-Seck specifically advises partnering with government bodies
at the beginning of the project, and involving them in the entire
planning and development processes to generate government
ownership of the project, which can strongly impact the likelihood
of sustaining and scaling the project. Once ownership is secured,
this government body, such as the MOH, can then promote the
project within the government itself at ministerial meetings and
across the Ministeries. Therefore, the initiative would get present-
ed within the government by a government official, driving the
uptake and possibility for scale from within. The government’s
perception of being part of the partnership, rather than having
their country as a location for piloting the intiative, can be a key
factor in securing buy-in for the project.
Partnering and working with the government is critical for many
other reasons. If the mHealth initiative involves the delivery of con-
tent through mobile phones, this content may have to be reviewed,
approved, and in some cases, endorsed by the Ministry of Health,
according to Sandhya Rao, Senior Advisor for Private Sector Part-
nerships in the Office of Health, Infectious Diseases and Nutrition at
the United States Agency for International Development (USAID).
Blaschke emphasizes the importance of partnering with the gov-
ernment to ensure the initiative is aligned with their national strat-
egies and vision, or plans for such national policies or strategies
in contexts where they don’t yet formally exist. This is particularly
true in contexts where national policies and laws related to eHealth,
such as privacy and security of electronic health records, don’t
yet exist. In the context of Uganda, the lack of a national policy,
strategy and vision with regards to e/mHealth has been one of the
main barriers to getting private sector investment in the health
field. “For some risk averse companies, it is just too dangerous and
people are too wary of investing at this stage,” says Blaschke. Links
to the government are critical in this case because if a partnership
is formed that the government is not involved in, and new legis-
lation or policies are put in place that conflict with what has been
developed or is being deployed, the partnership is then suddenly at
a huge disadvantage. “You’d have to stop the project and change
everything,” warns Blaschke. In order to build awareness of and be
able to advocate to the government for supportive policies and
laws related to eHealth to create an enabling environment for the
scale up of mHealth, it is also important that the government be
engaged in the partnership’s activities.
Successfully getting government partners on board and ensuring
uptake of the initiative is not always easy and may require differ-
ent approaches. Blaschke recommends helping the government
see the initiative from a systems point of view. For UNICEF Ugan-
da to secure buy-in and uptake from the government for mTrac,
they developed and positioned mTrac not as a project, but rather
as a tool to strengthen and extend the local district health and
information software (DHIS2) and health management informa-
tion system (HMIS) by building an SMS transaction layer and an
SMS communications engine that could then be used for supply
tracking campaigns and for extending electronic medical records
to the community level. This meant building an SMS tool for a
wide range of government purposes that fit into the larger MOH
strategy for how the government was going to deploy eHealth in
the country. “This actually fit in with where the Ministry of Health
Partner with the government.
• Partner with government institutions in the local area of implementation to generate buy-in and drive local
ownership, scale and sustainability of the project.
3
MAMA was initially formed as a three-year initiative with
the founding partners, USAID and Johnson & Johnson, each
committing US$5 million to the initiative in three country
programs: Bangladesh, South Africa and India. Now MAMA is
evolving beyond a three-year initiative to a longer-term entity.
MAMA is also looking to embody a repository of tools, infor-
mation, lessons learned and best practices, in addition to the
existing mobile messaging library, that can be accessed and
used by any program in the field looking to scale these kinds
of MNCH programs.
4.1 RECOMMENDATIONS

41
Partner with the private sector.
• Partnering with private sector players can provide important know-how and technology to scale
the initiative.
4
PATRICIA MECHAEL, EXECUTIVE DIRECTOR OF THE
MHEALTH ALLIANCE, SHARES HOW THIS PUBLIC-
PRIVATE PARTNERSHIP CAME TOGETHER.
The mHealth Alliance joined a new partnership with the
Nigerian Federal Ministry of Health and Intel to leverage
mobile computing and telecommunications technologies
to support Nigeria’s Saving One Million Lives Initiative.
The partnership is now developing an interagency adviso-
ry group that cuts across Ministry of ICT, Federal Ministry
of Health, National Primary Health Care Development
Agency, and various different public agencies. It is now
also engaging the private sector such as MNOs and
multinational corporations through the business
council to see how they can leverage the expertise
of a diverse range of stakeholders.
How was the partnership formed?
All partners were present in Nigeria for the launch of Saving
One Million Lives and there was a special session on the use
of ICTs in this initiative where several commitments were
made. Intel made a commitment to the Federal MOH to lev-
erage their technology to train 10,000 health workers, while
the mHealth Alliance proposed studying the enabling envi-
ronment issues and helping facilitate the development of an
ICT framework. The Federal MOH guided the partnership,
requesting that each partner come up with a joint proposal
that would link all these pieces together under the umbrella
of Save One Million Lives. Patricia Mechael highlights that
an important success factor is “thinking pragmatically and
tactically about where different technologies are going to
accelerate the achievement of the targets set under the
initiative as well as enable the partners to systematically
track progress against the goals being set.”
CASE EXAMPLE: NEW PUBLIC-PRIVATE PARTNERSHIP LEVERAGING MOBILE
TECHNOLOGIES TO SAVE ONE MILLION LIVES IN NIGERIA
Engaging the private sector as partners can harness their tech-
nical core competencies, technology, know-how and resources.
These benefits are immediately obvious for mHealth programs
looking for technology providers or mobile network
operators as partners. However, consider also the ability to
expand the scope of the program based on integrating partners
with diverse products and services, such as partnering with an
insurance provider and mobile money service to deliver mi-
wanted to go with their emerging [eHealth] strategy,” says
Blaschke. From the initial phases, UNICEF started working
on integrating mTrac with DHIS2 so it wouldn’t be a parallel
project, but rather a way for health workers who didn’t have
access to computers to enter their data into DHIS2 via their
mobile phones using the mTrac tool.
In order to secure government buy-in, it is really useful for organ-
izations to look at government plans and policies, for example
a five-year health strategy. Blaschke recommends looking at
these first, and seeing if the initiative can be aligned with these
government priorities. Using the same language, and prioritizing
the same areas they and the donors have prioritized, will result in
higher chances of success.
Emerson also highlights the importance of government owner-
ship or buy-in, coupled with the need to have realistic expec-
tations of the amount of time that may be involved in securing
government support. It may be possible to avoid protracted
timelines associated with garnering government sponsorship;
however, it is highly beneficial for the partnership in the long-
run to invest time in securing this buy-in as early as possible.
RECOMMENDATIONS

Developing mHealth partnerships for Scale

Developing mHealth partnerships for Scale

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