Author: Dr. Sherri Bucher, December 13 2016 - Launched in August 2014, MomConnect, a stage-based text messaging platform which connects women in South Africa with targeted, evidence-based information regarding pregnancy, childbirth, and child health, recently reached 1 million subscribers. In just 2 years, MomConnect has evolved from a vision on paper to a vibrant digital health tool which educates mothers and families, empowers health care workers, improves health service delivery, and provides tools by which key metrics and indicators for maternal health are collected.

Within the landscape of mHealth “pilotitis,” MomConnect in South Africa appears to be one example of a truly “scaled-up” digital health solution. Other examples of scaled digital health solutions include cStock in Malawi, and Kilkari in India. A closer look at each of these initiatives reveals that there are 5 key factors, which one could dub “the 5 C’s,” which underpin digital health scale-up success stories.

A Common Vision

cStock in Malawi, MomConnect in South Africa, and Kilkari in India are underpinned by a strong, shared vision among supporting partners and stakeholders. Whether it is uniting around the mission of creating a feasible, acceptable, and affordable platform by which to deliver evidence-based health information to pregnant mothers, or that of tracking life-saving commodities and identifying gaps in the supply chain for essential medicines, building a digital health tool for scale requires coordinated action around a common vision.

Collaboration and Cooperation

Initiatives of the breadth and depth of cStock in Malawi, MomConnect in South Africa, and Kilkari in India would collapse under their own weight without collaboration and cooperation among a wide range of donors, technical partners, and public-private stakeholders. Crucially, for each of these initiatives, national-level engagement and leadership are the lynchpin of the successful collaborative effort. The active involvement demonstrated by government partners in Malawi (pp. 72–73), South Africa, and India serves as a role model for how bold engagement and visionary leadership can be a catalyzing force by which to successfully support the evolution of digital health solutions through all stages of development.

Connection

In order to grow a digital health solution from the pilot phase to scale-up, each of the technical, implementing, and funding partners needs to be connected to various aspects of the public health landscape within which the digital solution is designed to operate  -  including having a deep understanding of key behavioral and cultural dimensions. Partners must also be knowledgeable about various aspects of the Information Communication Technology (ICT) ecosystem within which the digital health solution will be deployed. This includes knowledge about existing technological solutions and system tools which can be utilized through digital integration and harmonization, thus, avoiding the dreaded “reinvention of the wheel syndrome.” cStock in Malawi, MomConnect in South Africa and Kilkari in India each leverage various digital health solutions to address public health challenges in diverse geographical locations: what the underlying partnerships for each of these successfully scaled initiatives appear to have in common is a broad and deep knowledge of, and connection to, the ICT and public health system ecosystems within the settings where each program operates.

Currency

“Currency” has multiple meanings in the English language, including “the quality or state of being used or accepted by many people.” Collaborative partners and key stakeholders must build trust and good working relationships among themselves, and maintain the currency of these relationships over time, in order to achieve project milestones and produce the necessary deliverables to reach scale-up. In turn, end users need to have faith in the digital solution that is being offered, and believe that the digital health intervention adds value to their lives. In South Africa, over 1 million end users demonstrate that the MomConnect platform has currency for pregnant women, health workers, and communities. Additionally, developing a digital health intervention for scale also requires currency in the form of money and things that are used as money: whether that comes in the form of dollars (or pounds or shillings…), in-kind services, or expert technical assistance. Typically, bringing digital health solutions to scale requires all of these categories of investment.

“The Path to Greatness is Along With Others” –Baltasar Gracian y Morales (1601–1658)

Recently, I attended a symposium in which the keynote speaker suggested that competition is the key to success within the spheres of technology, digital health, and the life sciences. With all due respect to the distinguished professor, I believe that a Common vision, Collaboration and Cooperation, Connection, and Currency are the 5 Cs which create the catalytic synergy that is necessary to propel digital health initiatives beyond the dreaded stage of mHealth “pilotitis.” Rather than competition, other promising digital health projects which may be poised for scale-up within the global health landscape, such as those for newborn care in Kenya (pp. 46–47) or family planning in Tanzania (pp. 86–87), would do well to emulate the 5 C’s of scale-up success embodied by MomConnect, cStock, and Kilkari.

Dr. Sherri Bucher is Assistant Professor of Research at Indiana University School of Medicine & Country Mentor for Helping Babies Survive programs on behalf of the American Academy of Pediatrics. She can be reached at shbucher@iu.edu.

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