GSMA mNutrition Agenda USAID mHealth Assessment Dissemination Workshop May 20-21, 2014

Restricted - Confidential Information © GSMA Background The Pan-African mHealth Initiative has been funded by the UK / Norwegian governments to support the scale-up of mHealth in nutrition and maternal / child health* in support of MDGs 4,5 & 6, over a 3 year period through developing commercially sustainable mHealth services that meet public health needs Côte d’Ivoire Ghana Kenya Rwanda Mozambique Nigeria Malawi Tanzania Uganda Zambia *Nutrition focus is across all 10 countries. MCH / Nutrition focus on Nigeria and Malawi only.

Restricted - Confidential Information © GSMA Justifying Our Priority Health Areas Nutrition and Maternal & Child Health have been selected as priority health areas Nutrition (across all 10 countries) Undernourished estimates in sub- Saharan Africa grown from 175m to 239m in last 20 years, with 20m added in last 2 years 36% of children in Africa under 5 are born stunted In May 2012, health leaders adopted the Maternal, Infant and Young Nutrition plan to reduce numbers of stunted children in the world by 40% by 2025 Maternal and Child Health (in Nigeria / Malawi) Africa has 12% of global population but accounts for 50% of maternal deaths and 50% of deaths of children under 5 Women living in poorest parts of Africa are 300 times more likely to die from complications in childbirth or pregnancy than in industrialised countries In 2010, UN Commission on Life Saving Commodities for Women and Children endorsed recommendations to implement at scale ICT solutions to increase demand for and utilization of health services by women

Restricted - Confidential Information © GSMA 2013 Vision 4 Our Vision By end of 2016, the Pan-African mHealth Initiative aims to have catalyzed a series of nationally-scaled implementations for a suite of commercially sustainable mHealth services which contribute meaningfully to national health objectives in nutrition as well as maternal / child health in 10 African countries, with 500,000 registered users (and 1m by 2018) The GSMA aims to play this catalytic role by: -Facilitating a collaborative product alignment and business case development process between public and private sector in the health and mobile industries, -Providing technical assistance to the mHealth industry during implementation and launch, and -Developing thought leadership and sharing of best practices between the projects in each country and globally -Facilitating the development of national health content frameworks and localized, validated health content which can be used by the health community

Restricted - Confidential Information © GSMA Issues to Address The project aims to address some of the issues preventing mHealth from realizing its potential Service fragmentation and lack of scale despite pilot successes  PAMI brings together existing high potential mHealth services and provides a framework to align them for higher collective impact and interoperability Difficulty engaging with mobile operators due to lack of sustainable business models  PAMI provides an engagement mechanism for aggregation of multiple business models to achieve greater commercial scale and viability for private sector investment Lack of success stories  PAMI focuses on creating quick wins together with supporting implementations to create momentum, and ensures that these successes are adequately communicated to the wider community Lack of consistent, validated sources of health content  PAMI aims to facilitate the development of national level content frameworks and demonstrate the value of these frameworks through the development of localized content for use by service providers

Restricted - Confidential Information © GSMA Our Workstreams Product and Business Framework Stakeholder Engagement Country Feasibility Assessment Consumer Research Health Economic Research Content Framework Localized Content Product Testing Monitoring & Evaluation Framework 4 MONTHS 5 MONTHS 4 MONTHS Nutrition priorities per country Consumer insights Existing services profiling Mobile ecosystem interest Overall feasibility and challenges Content Consumer insights Business model insights Alignment of M&E indicators

Restricted - Confidential Information © GSMA 2013 Scope 7 Priority mHealth Product Areas Demand generation and Registration are foundational areas in mHealth in developing countries Prevention Promotion Participation Drive demand for services Prevention Promotion Participation Drive demand for services Ensure supply meets demand Improve quality and efficiency Extend hospital services Improve quality and efficiency Extend hospital services Identify and track patients Extend hospital services Drive accountability Extend hospital services Drive accountability DEMAND GENERATION REGISTRATION COMMUNITY HEALTH WORKERS SUPPLY CHAIN ADHERENCE, MONITORING Service area Service function Example Behaviour change Incentives Awareness Behaviour change Incentives Awareness Stock outs Facility management Authentication Stock outs Facility management Authentication Quality assurance & reporting Best practices Job aids Quality assurance & reporting Best practices Job aids Mobile and health identity Patient records Data accessibility Mobile and health identity Patient records Data accessibility Reminders Surveillance Diagnostics Referrals Reminders Surveillance Diagnostics Referrals

Restricted - Confidential Information © GSMA mHealth Use cases in MCH and Nutrition Monitoring and providing real time updates on stock-outs and drug authentication e.g. SMS4Life; RapidSMS Targeted, stage-based, messaging for behaviour change communication e.g. MAMA in SA Mobile job aids, quizzes and training which can be updated on the fly e.g. Mobile Kunji in India; m4Change in Nigeria Mobile-enabled registration and data collection for community health workers e.g. D-Tree Supervisory (and incentive) systems providing real-time supervision and monitoring e.g. CommCare: Pathfinder Int. in Nigeria mHealth application direct linkages to DHIS2 systems e.g. CommCare and MOTECH Error-checking and protocols built into data collection applications on mobile e.g. CommCare

Restricted - Confidential Information © GSMA Countries have been categorized utilizing three key drivers Profiling the Countries

Restricted - Confidential Information © GSMA Country Profile Countries with larger health burden, higher ability to pay and larger reach relatively easier to launch services (all other things remaining equal) Size of bubble denotes relative scale of health burden

DRAFT FOR DISCUSSION – NOT FOR CIRCULATION Restricted - Confidential Information © GSMA Barriers to scale and how different stakeholders can support Challenge/BarriersmHealth Service Provider Commercial aggregator Mobile operator GovernmentGSMA Availability of validated, localized, relevant, mobile content Play a part in the development of field tested content Help test content with their users Help test content with their subscribers Support processes for content validation Support development of local content Lack of credibility in the health sector Provide operational and sector credibility --Endorse partnerships which meet criteria Support development of criteria for pubic endorsement Lack of clarity around mHealth regulations and standards Provide input as to what regulations and standards need to be adopted --Support in endorsement of standards Help develop commonly adopted mHealth standards Lack of common short codes which limit reach & ease of use Help their commercial partners with differentiating their product Help work with operators to obtain codes Explore the possibility of common codes Provide support through the regulator Provide the business case for common short codes Connectivity costs which reduce affordability and access Provide accurate costing and impact information Help identify areas for pricing flexibility Explore mutually beneficial pricing terms Provide public justification and support Help develop business models which show ROI

Restricted - Confidential Information © GSMA What worked: the Nigerian experience 1.Alignment with national priority on MCH and leveraging on the existing SOML initiative 2.A vibrant mHealth Community of Practice with members from both public and private sector with several successful partnerships and learning/sharing on best practices 3.Solid partnership between GSMA and the largest private sector stakeholder investment in health to impact the MNCH week 4.Facilitated the formation of seven good partnerships 5.Facilitated the linkage of mHealth service providers to VAS providers and mobile operators culminating in some successful business partnerships 6.Documenting of best practices using case studies and interactions on replicable mHealth services through the monthly GSMA mHealth Africa Working Group

Restricted - Confidential Information © GSMA Lessons Learnt Bundling of mHealth service with other value added services can create investment interest for mobile operators and mHealth content owners/Service providers Engagement with players from both public and private sectors can help sustain Govt. led mHealth initiatives Private sector investment in mHealth is critical in achieving impact and greater reach Better to approach mobile operators when your mHealth concepts are concretised with good business model Leverage existing systems–think national, work with the Ministries of Health to empower local resources in driving implementation. Leave room for scaling while implementing the pilot phase Service design should support a range of mobile devices and be network agnostic Partnership is crucial: leverage others strengths and positions. It balances the ecosystem

Restricted - Confidential Information © GSMA Partnerships facilitated by GSMA in Nigeria mHealth areaHealth partnerAlignment to health area? Participation from commercial aggregator? Involvement from operator? Government support? Coverage? Demand creationWell Being Foundation, MAMA MCHVAS2Nets, Starfish Mobile MTN, AirTel, Etisalat SOMLNational Demand creationMAMAMCHStarfish Mobile, VAS2Nets MTN, AirTel, Etisalat SOMLNational Demand creation. registration VAS2Nets/GSMAMCHVAS2NetsMTN, AirTel, Etisalat Lagos / Ikeja LGA State level Registration, data collection Pathfinder International, SURE- P MCH MCHVAS2Nets, StarfishMTN, AirTel, Etisalat, Globacom SOMLNational Demand creation, registration, data collection GrameenMCHVAS2NetsAirTelSOMLNational Job aids, logistics, immunization tracker, mobile lab results CHAIMCH, PMTCT, HIV VAS2NetsMTN, AirTel, Etisalat FMOH, SOML, NACA 6 States Demand creation, registration, job aids, mobile lab results MSHMCH, PMTCT, HIV Starfish Mobile, VAS2Nets MTN, AirTel, Globacom SOML1 State Registration and data collection SURE-P MCH, Instrat MCHNONEEtisalatSOMLNational

Restricted - Confidential Information © GSMA Opportunities for Stakeholders Help to broker partnerships and funding for innovative partnership solutions Replication of high potential programmes/services in country by development partners and mobile operators Participate in opportunities like the Zero Mothers Die (ZMD) which have potential for scaling across multiple countries USAID Mission, MoH and Operators can leverage on outputs of existing stakeholders’ groups and Communities of Practice Share best practices on easily adaptable use cases in resource-poor settings

GSMA mHealth Resources mHealth Tracker mHealth Service Maturity Tool defined-stakeholders-and-value-propositions mHealth Publications Mobile for Development Impact Victor Ohuruogu, mHealth Regional Project Manager GSMA Mobile for Development Mobile:

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