Ecosystem “Fertility” is a Rate-Limiting Factor Pathways to Scale: Ecosystem “Fertility” is a Rate-Limiting Factor Alain B. Labrique, PhD, MHS, MS Director JHU Global mHealth Initiative Associate Professor Dept. of International Health Johns Hopkins Bloomberg School of Public Health Good evening. It’s a pleasure to be here tonight as part of this discussion on how existing technologies and innovative approaches can help us improve health where it is needed the most. The public health community has a strong track record of identifying and testing innovations and working with program and policy partners to advocate for the scale-up of efficacious interventions. Today I hope to explore some of the landscape of maternal and neonatal health priorities, sharing some relevant data from rural Bangladesh, where our group has been working for over a decade. Throughout, we will hopefully see examples of opportunities and challenges for mHealth in this and similar resource-limited settings…

2016 http://www.itu.int/en/mediacentre/Pages/2016-PR30.aspx

October 2016: WHO Launches “Evidence-based Guidelines for Digital Health Strategies” Process.

Eras of Mobile / Digital Health Fragmented Experimentation II Uncoordinated Proliferation III Scrutiny and Consolidation IV Integration and Scale

Scalability = Intrinsic + Extrinsic Factors

http://tinyurl.com/WHO-MAPS

The M.A.P.S. Tool mHealth Assessment and Planning for Scale To assess scalability by reviewing key considerations and activities To plan for future activities after identifying areas of weakness To improve on progress through scale

Each axis has a scorecard Users add up the scores for each SAQ and calculate the “axis score”

Summary Scorecard Allow users to identify areas requiring attention Can be used to assess progress over time

http://tinyurl.com/jhufhw

A Country-level Readiness Assessment Toolkit for ICT Innovations

“Scaling” is a Battle on Many Fronts TECHNICAL DEVELOPMENT ENABLING ENVIRONMENT POLICY HUMAN RESOURCES INFRASTRUCTURE FUNDING MONITORING & EVALUATION PARTNER ENGAGEMENT, TRAINING

MAN MACHINE “SYSTEM” Deconstructing the Elephant: Inertia: Resistance to Change Threats to Status Quo “Dual Burden” Incentives Human Resource Training in IT Social Obstacles NOT addressed MACHINE “SYSTEM” Interoperability True “Scalability” & Redundancy Flexibility Extendability Service Delivery / HR Capacity Data Use Capacity Data Use Incentive Digital Infrastructure Support @ Scale

Engage Government from the beginning of the innovation cycle .

Train people NOW for the digital future. Data use, real-time decision-making for quality improvement.

Invest in Infrastructure. Optimize Network and Electrical Stability, Dependability, Speed, Cost

SCALE is not only about the digital innovation… but about the ecosystem in which it is trying to grow...

Market-driven scale is a function of: Utility (Meets a clear need) mPESA ? Market-driven scale is a function of: Utility (Meets a clear need) Desirability (Easier than status quo) Ease-of-use Affordability

Building for public-sector SCALE is not easy or cheap. Many “pilots” were not built to scale.

Coming Soon: The Global Digital Health Index

Degree to which the Digital Health strategy changes the status quo INSTITUTIONAL / HEALTH SYSTEM INERTIA COMPLEXITY OF ENGAGED ECOSYSTEM DIFFICULTY OF SCALING INCREMENTAL CHANGE DISRUPTIVE INNOVATION Degree to which the Digital Health strategy changes the status quo