1. How much does mHealth really cost? December 2014

2. Abt Associates | pg 2 Outline Summary of Activity Case Review Explanation of the budget handout Compiling the prices Discussing the variations

3. Abt Associates | pg 3 The big questions How good are we at estimating what projects will cost? What influences our estimates? Does the project shape the budget or the budget shape the project?

4. Abt Associates | pg 4 What you can expect FROM THIS SESSION  Open environment to share  Hands-on activity  Participant driven insights

5. Abt Associates | pg 5 Timing 15 min 30 min 10 min 20 min Introduction/Case Review Group Activity Compiling the prices Discussing the variations

6. Abt Associates | pg 6 Outline Summary of Activity Case Review Explanation of the budget handout Compiling the prices Discussing the variations

7. Abt Associates | pg 7 Case MISSION  Improve maternal care  Address extremely high rates of malnutri­tion and malaria About YOU  NGO with more than decade of experience in Guatemala  Office in DC as well

8. Abt Associates | pg 8 By the numbers 78% Below the Poverty Line ~333,000 Population 54% Pregnancies with 1 or more risk factor 200 CHWs

9. Abt Associates | pg 9 Staff Profiles Project Manager (expat)  Sets overall strategy  Ensures “the trains run on time”  Handles all admin tasks (budgeting, communications, etc.)  Stakeholder management Lead Designer (expat)  Leads IT procurement tasks (developing SoW, selecting solution provider)  Develops SWOT analysis and ensures system addresses risks and various stakeholders’ needs IT Manager (LCN)  Generally manages the office’s computers and internet connection  Is eager to learn, but doesn’t have web development or mobile experience Trainer (LCN/expat)  Designs and leads training activities, including refreshes  Expat has experience with something similar in another country. LCN does not

10. Abt Associates | pg 10 Outline Summary of Activity Case Review Explanation of the budget handout Compiling the prices Discussing the variations

11. Abt Associates | pg 11 Budget Handout Design Development Test Train Deploy & Sustain General

12. Abt Associates | pg 12 Budget Handout  Person-day = Total days for everyone in that position  You should account for all staff required for this effort  All non-Guatemalan employees are based in DC.  No need to account for: –In-country travel or lodging –Data plans –CHW salaries

13. Abt Associates | pg 13 Outline Summary of Activity Case Review Explanation of the budget handout Compiling the prices Discussing the variations

14. Abt Associates | pg 14 Submit your prices www.bit.ly/mhbudget

15. Abt Associates | pg 15 Outline Summary of Activity Case Review Explanation of the budget handout Compiling the prices Discussing the variations

16. For more information, please contact: clienttechnologycenter@abtassoc.com

17. 17 Developing Economies of Scale in mHealth Jonathan Jackson, Dimagi CEO December 10 th, 2014 @dimagi

18. Why do I care about this?  Dimagi: 12 years experience implementing 300+ ICT projects in over 40 countries  Partnership: Dimagi and Grameen Foundation to create MOTECH Suite for achieving economies of scale  Me: Still one of the biggest technology skeptics out there

19. Big question is why isn’t most mHealth scaling… ….we say that most mHealth shouldn’t scale.

20. Good or Bad Idea? Your M&E Program Officer proposes to buy laptops and Mircrosoft Office just to do M&E for one project in Excel.

21. Most people think about scale looks like this: Many Many Users

22. Ministry of Health Implementer Program (e.g. MCH) CHWs Program (e.g. malaria) CHWs Implementer When it’s usually more like this

23. Three paths to scale mHealth impact USER EXPANSION: Adding more users (both CHWs and supervisors) 1

24. Three paths to scale mHealth impact PROGRAM EXPANSION Adding new programs (e.g. a new malaria app) 2 USER EXPANSION: Adding more users (both CHWs and supervisors) 1

25. USER EXPANSION: Adding more users (both CHWs and supervisors) Three paths to scale mHealth impact PROGRAM EXPANSION Adding new programs (e.g. a new malaria app) 2 1 VERTICAL EXPANSION: Adding value to existing programs. This leads to better control through systems integration, and increased program effectiveness 3

26. Path 1: User Expansion Adding more users to a program (be it CHWs, supervisors, etc.) John Snow International in Tanzania USAID & MoH adopted ILSGateway Goal to improve supply chain decision making through mobile tools Grew from pilot to 4,600+ facilities; currently scaling nationally Able to scale because cost- effective to add users

27. Path 2: Program Expansion Leveraging an existing mHealth platform to tackle another use case. TulaSalud in Guatemala 200 CHWs adopted CommCare in 2012 Application designed to help CHWs better manage high-risk pregnancies Expanded application to include malaria modules, and planning to add malnutrition modules Able to scale because org became very familiar with CommCare platform

28. Path 3: Vertical Expansion & Systems Integration Integrating an mHealth program into mHealth systems at both the implementer and district/national partners levels, including the MoH. CARE in Bihar, India Deployed MOTECH Suite for MNCH + nutrition in Bihar, India Successfully demonstrated CommCare integration with Mother and Child Tracking System (MCTS) Able to scale because program had vision of integration from Day 1

29. Economies of scale in mHealth expansion User expansion Program expansion 2 1 Vertical expansion 3 Fixed costs (= levers for economies of scale) Variable costs (= increase with variable metric) Office equipment & facilities Existing trained staff & managers Programmatic content Part of data management Phone replacement policy … Office equipment & facilities Field & supervisors staff Mobile phones Voice & plan for phones Some part of training Field visit costs Software & data hosting … Initial upfront systems integration Reporting build out and training Management time to analyze data … Incremental field & supervisors staff salaries Mobile Phones Voice & plan for phones Initial & annual trainings Field visit costs Software & data hosting … Programmatic content Ongoing training Incremental software & data hosting Management time to analyze data … Systems maintenance …

30. Economies of scale in mHealth expansion Total Cost per CHW MOH Costs NGO Costs Implementation Costs Program expansion 2 00000 500 1 2 3 4 5 User expansion 1 11 0 1 0 1 0 1 0 500600700800900 # CHWs # programs # prog. integrated0 Vertical + Program + User expansion 500 1 2 345 01234 1000 00 # CHWs # programs # prog. integrated10 Vertical expansion 3 0 2 0 3 0 4 500

31. MOTECH Suite User expansion Vertical expansion Program Expansion Frontline applications Job aids for CHWsSupply chainDemand creation Integration & Orchestration Integrate mServices apps with national information systems Scheduling & workflow Best practices for scale Maturity Model Economies of Scale Model Data-driven Management

32. Blog post of this presentation: http://bit.ly/1yunJq2http://bit.ly/1yunJq2 Copy of the Total Cost of Ownership model: http://bit.ly/12G7r4qhttp://bit.ly/12G7r4q jjackson@dimagi.com Questions? @dimagi