© Palladium February 2016 Financial forecasting for mHealth partnerships for behavior change

© Palladium 2015 mHealth – “mobile health;” applying mobile technology to achieve or assist health goals; a subset of eHealth SMS – “short message service;” text messaging IVR – “interactive voice response;” automated voice messaging system with the ability to respond to voice commands USSD – “unstructured supplementary service data;” interactive way to communicate with mobile users via text; does not save to phone Financial forecasting for mHealth partnerships 2 Definitions

© Palladium 2015 BACKGROUND mHealth and the GSMA initiative Financial forecasting for mHealth partnerships 3

© Palladium 2015 Global trade association representing over 800 mobile network operators worldwide Mobile for Development Foundation  Partnering with African mobile network operators  Trying to create a sustainable, scalable mHealth program  Targeting vulnerable women and children with nutrition BCC messages Financial forecasting for mHealth partnerships 4 The GSM Association

© Palladium 2015 In the eight target countries, there are over 250 mHealth initiatives in operation 1 Few operate at the national scale Few are financially sustainable Most stakeholders in the health sector recognize the potential of mHealth for SBCC and other health interventions Financial forecasting for mHealth partnerships 5 Ghana, Malawi, Mozambique, Nigeria, Rwanda, Tanzania, Uganda, Zambia mHealth pilots are widespread 1 GSMA mHealth Tracker

© Palladium 2015 GSMA is collaborating with DfID and research partners to promote “mNutrition,” a model of using mobile messaging for health (nutrition) BCC messages Creating a model that is sustainable  Involving mobile network operators from the beginning  Developing a business case for delivering free or reduced cost health BCC messages via mobile  Free messages serve as a lead-in for other products and services and improves user satisfaction Scalable to the national level 6 Developing a model for sustainability Financial forecasting for mHealth partnerships $

© Palladium mNutrition model Voluntary registration Dial or SMS a dedicated shortcode to subscribe to mNutrition messages Provide basic information, including expected date of delivery or age of the child Indicate preference for text or voice *123# SMS or IVR Nutrition information and tips Stage-based messaging Receive regular (e.g. weekly) SMS or IVR BCC messages Tailored to gestational or child age (until child is two years old) Free (or very reduced cost ) to end user Financial forecasting for mHealth partnerships

© Palladium 2015 Government Legitimacy Validation of content Interface with health system Mobile network operators Communication channel CSR or other funds Brand recognition Non- governmental organizations On-the-ground experience Expansion of existing programs International funders Convening power Start-up funding Sharing of best practices 8 Potential partners for mNutrition Financial forecasting for mHealth partnerships

© Palladium 2015 PALLADIUM’S ROLE IN mNUTRITION Financial forecasting for mHealth partnerships 9

© Palladium 2015 Industry Engagement Research Technical Assistance Content development and localization Product concept AdvocacyMEL 10 Engage stakeholders in the 8 countries, assessing attitudes, buy-in, and opportunities Provide “health and economic proof points” in support of mNutrition launch and product concept development Goal is to achieve long-term sustainability of a free mNutrition product at scale through a combination of contributions from for-profit and not-for-profit stakeholders Palladium’s role in GSMA mNutrition activities Financial forecasting for mHealth partnerships

© Palladium Conversation between sectors for mHealth partnerships Key stakeholder interviews mHealth Decision Tree model Financial Forecast Model Stakeholder engagement Palladium’s approach Financial forecasting for mHealth partnerships

© Palladium 2015 METHODS Estimating program reach and cost 12 Financial forecasting for mHealth partnerships

© Palladium 2015 Draws on a combination of DHS data, Spectrum projections, and literature review Considers demographic factors such as access to mobile, literacy, and maternal status Estimates program reach 13 Estimating program reach in Zambia mHealth Decision Tree model Financial forecasting for mHealth partnerships Register 2% Women of reproductive age (15-49 years) 100% Eligible 32%

© Palladium 2015 Cost inputs include:Calculates: New registrants Active subscribers Message volume Annual cost of service Total cost of service Costs per user All of the above for SMS, IVR, and USSD 14 Palladium developed the Financial Forecast Model (FFM) to estimate the annual costs of stage-based messaging mNutrition Financial Forecast Model Content development Software development Infrastructure costs (startup) Capital Expenditure (CAPEX) Infrastructure costs (ongoing) Mobile advertising Connectivity Operating Expenditure (OPEX) Financial forecasting for mHealth partnerships

© Palladium 2015 RESULTS 15 Financial forecasting for mHealth partnerships

© Palladium 2015 Estimating cost: annual cost (USD) in Zambia 16 Financial forecasting for mHealth partnerships

© Palladium 2015 Estimating cost: five-year total cost in Zambia 17 Financial forecasting for mHealth partnerships

© Palladium 2015 Financial forecasting for mHealth partnerships 18 Country comparison: cost per subscriber (USD)

© Palladium 2015 DISCUSSION Facilitating sustainability of mHealth programs through public-private partnerships 19 Financial forecasting for mHealth partnerships

© Palladium 2015 The Financial Forecast Model: Allows program managers and donors to think critically about mHealth for BCC and other interventions, and make evidence-based decisions Provides the primary element to support a business case for a scalable, sustainable mobile BCC program Can be adapted to other health areas  Mobile BCC messaging for MNCH, HIV/AIDS, TB, etc. 20 A tool for planning and advocacy Financial forecasting for mHealth partnerships

© Palladium 2015 Financial Forecast Models or other tools to facilitate dialogue and catalyze partnerships 21 Sustainability through public-private partnerships Financial forecasting for mHealth partnerships Government Mobile network operators Non-governmental organizations International funders Sustainable, scalable, mobile BCC programs

© Palladium 2015 Financial forecasting for mHealth partnerships 22

© Palladium 2015 Sindri Kinnier, MBA, MPH Palladium, Senior Associate—Innovations & Technology Joseph Ichter, DrPH, MHA Palladium, Senior Technical Advisor 23 Correspondence Financial forecasting for mHealth partnerships