1. 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…

2. 2016

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

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

5. Scalability = Intrinsic + Extrinsic Factors

8. 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

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

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

16. A Country-level Readiness Assessment Toolkit for ICT Innovations

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

19. 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 Scale

20. Engage Government from the beginning of the innovation cycle .

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

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

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

24. 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

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

27. Coming Soon: The Global Digital Health Index

29. 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