By Maganizo Monawe, Tyler Smith, and Andrea Fletcher

As the team that worked on the Malawi mHealth Landscape Analysis, we want to respond to the recent ICTWorks post about the cost of mHealth.

The purpose of our mHealth 360 analysis is to develop an inventory of mobile health technology systems currently implemented in Malawi, and provide concrete recommendations for Malawi’s Ministry of Health to assess and evaluate the evidence when formulating policies, standards, and strategies in mhealth.

There is indeed insufficient literature guiding the costing of mHealth applications. Our study produced an estimated cost of mHealth interventions by generating a financial indicator based on a ballpark estimate of resources used for mHealth in Malawi. We understand the limitations of this approach and intend to refine it moving forward. We hope these numbers can move us closer to understanding how much mhealth costs, demonstrate how we can conduct better costing studies, and uncover methods for reducing inefficiencies and demonstrating the return on investment of mhealth.

While this data is insufficiently precise to allow for future budgeting, it offers a snapshot of the situation in the field. As a first step, there is value in identifying how partners are spending in various categories in order to understand the order of magnitude of funding necessary for mHealth as we plan and strategize in the future.

31 different mobile applications under implementation to support health service delivery in Malawi with some of the geographical locations having as many as half of these applications being implemented in the same district reflects a fundamental challenge in the implementation of mHealth in developing countries. It is a clear demonstration of lack of harmonization among implementing partners resulting in duplicate efforts and inefficiencies in use of investments.
— Malawi ministerial statement at the 2018 World Health Assemby

The analysis reveals a project’s average lifespan to be 5 years, coincidentally, most donor funding is on a 5-year timeline. Just as projects are starting to ramp up, the funding dies down. For governments to absorb projects, realistic planning and budgeting for scale must begin from the onset of the project with a clear return on investment demonstrated. We need consistent, timely financial data to make that happen.

We believe there needs to be a strong methodology upfront to understand how plans and expenditures are used and on what inputs they are based. In the current status quo, we don’t validate the total cost of ownership and the budgets, we just know that the money is spent. Currently, the global mHealth community also does not compare actual resource use with actual scope and scale achieved by each project over time, which precludes us from having quality empirical data for making future funding decisions. We need to change that.

While we agree that the value of mHealth interventions are not only monetary, it is challenging to get partners to share their expenditure data. Only 12 of the 31 projects who responded to the national registration were willing to provide cost data and much of what was provided was incomplete. Moving toward a global standard around how best to document true cost for mHealth, then getting everyone to share this information so it can be used to improve how we’re actually paying for services in mHealth --  that is the end state that we hope to achieve.

In-depth after-the-fact costing studies are not the way to track costing for mHealth. We need something that is more routine and lightweight. It requires relentless coordination, lots of elbow grease, and consistent openness with data. Using the project data that already exists, expenditure analysis can lead us to the answers of how much mHealth cost.