mHealth and Local Ownership: Reflections from the Global mHealth Forum
What does local ownership of an electronic health (eHealth) or mobile health (mHealth) service look like? Depending on who you ask, you could probably get a thousand different answers. As a member of the mHealth Working Group Advisory Board and one of the organizers of the inaugural Global mHealth Forum, I hoped we could foster meaningful discussion about this very topic—and I think we succeeded.
All of us working in eHealth and mHealth in low- and middle-income countries (LMICs) understand that it is crucial to foster a sense of local ownership in order for a digital health solution to become sustainable. And yet, it can be difficult to reach agreement on what “local ownership” means. To one person, it could mean that you presented your mHealth concept to a group of stakeholders in-country and they signed off. To someone else, it could refer to an idea that was born in-country and realized with external project resources. Or it could refer to a scenario where an entire service was developed, implemented, and funded with local resources—both human and financial. I went to the Forum hoping to hear fewer examples of the former and more of the latter.
Happily, I got my wish—or at least a flavor of more things to come—starting at the beginning of the Forum. In the opening plenary, Dr. Adetokunbo Oshin of Nigeria recalled how he successfully convinced the government to invest its own resources in an mHealth initiative by demonstrating cost savings that the mHealth application provided. He now co-chairs a Mobile Conditional Cash Transfer Working Group and leads a different maternal and child health project funded solely by the Federal Government of Nigeria. Another speaker, Dr. Ousmane Ly of Mali, recounted how government leadership enabled a dramatic drop in service prices charged by a mobile network operator, thereby facilitating the scale-up of various mHealth initiatives. Finally, Dr. Alvin Marcelo of the Philippines explained how the government enacted a governance structure that permits coordinated implementation of eHealth initiatives. Across their examples, governments took the initiative to express a need, identify an appropriate e- or mHealth solution, coordinate among those who could implement the solution, and provide financial resources to do so.
I was also inspired by examples of government taking the lead in coordinating and sharing knowledge about e- and mHealth within a country and across a region. In Tanzania, the government chairs a very vibrant mHealth Community of Practice. It provides a space to share best practices and lessons learned, to match needs with mHealth solutions, and to mobilize and manage the efficient use of resources. The Asia eHealth Information Network and the African Network for Digital Health provide similar peer-to-peer learning opportunities at regional levels.
Over the two days of the conference, I still heard a fair amount of presentations that involved an external implementing partner (usually a donor-funded NGO) talking about how they engaged local stakeholders in discussion of a proposed mHealth solution, or how they eventually handed over a service to an indigenous technology firm. And the truth is, these are not bad things. They represent moves in the right direction. But it is my hope that at subsequent gatherings, I will hear even more concrete examples of how government is sitting in the driver’s seat, demonstrating leadership, coordination, and investment in e- and mHealth.