Ten lessons learnt: scaling and transitioning one of the largest mobile health communication programmes in the world to a national government

Abstract

There has been exponential growth in the numbers of ‘digital development’ programmes seeking to leverage technology to solve systemic challenges. However, despite promising results and a shift from pilots to scale-ups, many have failed to realise their full potential. This paper reflects on lessons learnt from scaling and transitioning one of the largest mobile health programmes in the world to the Indian government. The complementary suite of services was designed by BBC Media Action to strengthen families’ reproductive, maternal, neonatal and child health behaviours. Mobile Academy was a training course to refresh frontline health workers’ (FLHWs) knowledge and improve their interpersonal communication skills. Mobile Kunji was a job aid to support FLHWs’ interactions with families. Kilkari delivered weekly audio information to families’ phones to reinforce FLHWs’ counselling. As of April 2019, when Mobile Academy and Kilkari were transitioned to the government, 206 000 FLHWs had graduated and Kilkari had reached 10 million subscribers. Lessons learnt include the following: (1) private sector business models are challenging in low-resource settings; (2) you may pilot ‘apples’ but scale ‘oranges’; (3) trade-offs are required between ideal solution design and affordability; (4) programme components should be reassessed before scaling; (5) operational viability at scale is a prerequisite for sustainability; (6) consider the true cost of open-source software; (7) taking informed consent in low-resource settings is challenging; (8) big data offer promise, but social norms and SIM change constrain use; (9) successful government engagements require significant capacity; (10) define governance structures and roadmaps up front.

At the frontlines of digitisation: a qualitative study on the challenges and opportunities in maintaining accurate, complete and timely digital health records in India’s government health system

“…Health workers require training on the value of maintaining an up-to-date mobile number in their data registries, so that they are motivated to ensure that these numbers are correct. Furthermore, in light of research findings that ‘SIM churn’ (changing SIM cards, and as a result getting a new mobile number) is as high as 44% per year among rural families, 10 frontline workers need to regularly confirm beneficiary mobile numbers and have access to user-friendly mechanisms to update numbers whenever they change.…”

“…Developed and scaled by BBC Media Action in collaboration with the Indian Ministry of Health and Family Welfare, Kilkari is the world’s largest maternal mobile messaging initiative, having reached 10 million subscribers in 13 states by December 2018. 10 It delivers maternal, child and reproductive health information content through up to 72 once-weekly outgoing prerecorded calls. Beneficiaries (pregnant or postpartum women and their husbands) 11 are subscribed to Kilkari based on the mobile number captured in governmental HIS registries called, depending on the state, the Maternal and Child Health Tracking System (MCTS) or Reproductive and Child Health (RCH) system.…”

“…The Government of India’s Kilkari programme is one example of an mHealth service that relies on the quality and timeliness of mobile phone numbers and other data collected in the government’s health registries in order to reach beneficiaries. Developed and scaled by BBC Media Action in collaboration with the Indian Ministry of Health and Family Welfare, Kilkari is the world’s largest maternal mobile messaging initiative, having reached 10 million subscribers in 13 states by December 2018 10. It delivers maternal, child and reproductive health information content through up to 72 once-weekly outgoing prerecorded calls.…”

“…It delivers maternal, child and reproductive health information content through up to 72 once-weekly outgoing prerecorded calls. Beneficiaries (pregnant or postpartum women and their husbands)11 are subscribed to Kilkari based on the mobile number captured in governmental HIS registries called, depending on the state, the Maternal and Child Health Tracking System (MCTS) or Reproductive and Child Health (RCH) system 10. The gestational age estimate or child’s date of birth is used to determine the appropriate Kilkari messages to send based on the stage in pregnancy or child’s age.…”

Methods and Lessons From Costing a Large mHealth Intervention at Scale in India

“…Relatedly, these components should be reassessed before scaling, with an emphasis on effectively responding to government procurement and distribution challenges, which should be costed for. Third, sustainability strategies tend to focus on initial capital investment rather than ongoing recurring costs ( 31 ).…”