Diverse Teams Improve the Quality of mHealth Solutions


Nandini Jayarajan

CCP | Co-Manager, Global Health eLearning

Before the 2014 Global mHealth Forum, if you’d asked me to draft a budget for developing and deploying a mHealth solution, I’d have shrugged and thought, “Sure. Piece of cake.”  As a program manager and someone with a fair amount of experience in mHealth, I would have felt confident mapping out a process and assigning a budget to each step. Then, at the Forum, I had the opportunity to attend an interactive session in the Finance Track that made me consider how my personal perspective could affect budgeting. The session, titled “What Does mHealth Really Cost? Understanding the Question,” was presented by Eric Couper of Abt Associates and Jonathan Jackson of Dimagi, Inc. and intended to teach people the importance of preparing a reasonable budget for a mHealth solution. My biggest takeaway was how necessary it is to include many roles and perspectives in the decision-making process.

We were broken up into groups, given a case study of an mHealth intervention in Guatemala, and told to determine a budget for a one-year intervention that moved through the steps of design, development, test, train, and deploy. The staff roles they identified for the activity were an expat project manager, an expat lead designer, a local IT manager, a local trainer, and an expat trainer.

Our professional backgrounds were diverse. My group mostly consisted of program managers, including myself. We tended to advocate for more time and resources dedicated toward testing and training. Participants who identified more closely with one of the technology positions (lead designer or IT manager) leaned toward allocating more funds to developing the technology. The session also included participants who identified as either local or expat staff; as such, they had differing opinions on how many trips for external technical assistance were needed, at what stage local staff should be included in the process, and how many local or expat trainers should be recruited. Halfway through the session, our group budgets were entered into a dashboard and the results gave a good visual of the different perspectives present in the room. 

Graph of group work from "What Does mHealth Really Cost? Understanding the Question"

Graph of group work from "What Does mHealth Really Cost? Understanding the Question"

Looking at the Total Costs by Project Phase chart, the only thing people seemed to agree on was that the testing phase should be the least expensive. Then, looking at the Total LOE by Role chart, you can imagine there was a lot of debate on which roles were more critical to the project. Unsurprisingly, my Team 2 army of program managers allocated the most LOE to the expat program manager role. Team 5 allocated the most LOE to the lead designer and very little to the other roles. Team 1 seemed to be the most fair, having distributed LOE more evenly amongst the staff roles. Interestingly, Team 3 didn’t feel an expat trainer was even needed for the project.

Some of the considerations that contributed to the wide range of decisions included whether a group decided on building software from scratch to fit their needs or chose something off-the-shelf and adapted the program to the software. Custom builds resulted in allocating more funds to a lead designer, while off-the-shelf meant more training and greater need for a program manager to coordinate that effort.

Hearing people argue for one solution over another based on their professional experience not only furthered my understanding of what technologies work best in different settings, it widened my perspective and forced me to think outside of my normal responsibilities. Thirty minutes sitting next to two trainers from India and listening to them list out the things they’d need given the activity parameters helped me understand the process and challenges of deploying a product to community health workers in India faster than reading any program brief or report ever could have.

There’s a lot of really good evidence, gray literature, and guidance available to help you through the mHealth solution process. But when you read these documents alone, you tend to only see things from your point of view. In my experience, it’s rare to have a project team that includes the programming, technology, and local perspectives—especially at the beginning, when having all viewpoints represented is probably most critical. This session, and the Global mHealth Forum overall, reminded me how important discussion, debate, and multiple perspectives are to developing successful mHealth solutions. 


Excellent post about measuring the true cost of any ICT4D project. The long term sustainability of an effort has to include maintenance and tech support for the software.