Sustainable cost models for mHealth at scale: Modeling program data from m4RH Tanzania

Emily R. Mangone, Smisha Kaysin, Kelly L'Engle, Christine Lasway, Trinity Zan, Hajo Van Beijma, Jennifer Orkis, Robert Karam

Research output: Contribution to journalArticle

Abstract

Background: There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, lowaccess settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. Methods: We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. Results: In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. Conclusions: These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program's reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact.

Original languageEnglish (US)
Article number0148011
JournalPloS one
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Tanzania
Telemedicine
Costs and Cost Analysis
income
Costs
Health
health information
uncertainty analysis
profits and margins
developing countries
Recovery
uncertainty
mHealth
Sustainable development
Uncertainty
Text Messaging
Health Communication
Uncertainty analysis
Gift Giving
Cell Phones

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Mangone, E. R., Kaysin, S., L'Engle, K., Lasway, C., Zan, T., Van Beijma, H., ... Karam, R. (2016). Sustainable cost models for mHealth at scale: Modeling program data from m4RH Tanzania. PloS one, 11(1), [0148011]. https://doi.org/10.1371/journal.pone.0148011

Sustainable cost models for mHealth at scale : Modeling program data from m4RH Tanzania. / Mangone, Emily R.; Kaysin, Smisha; L'Engle, Kelly; Lasway, Christine; Zan, Trinity; Van Beijma, Hajo; Orkis, Jennifer; Karam, Robert.

In: PloS one, Vol. 11, No. 1, 0148011, 01.01.2016.

Research output: Contribution to journalArticle

Mangone, ER, Kaysin, S, L'Engle, K, Lasway, C, Zan, T, Van Beijma, H, Orkis, J & Karam, R 2016, 'Sustainable cost models for mHealth at scale: Modeling program data from m4RH Tanzania', PloS one, vol. 11, no. 1, 0148011. https://doi.org/10.1371/journal.pone.0148011
Mangone, Emily R. ; Kaysin, Smisha ; L'Engle, Kelly ; Lasway, Christine ; Zan, Trinity ; Van Beijma, Hajo ; Orkis, Jennifer ; Karam, Robert. / Sustainable cost models for mHealth at scale : Modeling program data from m4RH Tanzania. In: PloS one. 2016 ; Vol. 11, No. 1.
@article{5c5b612247ef49a783d6e5d3789aa53f,
title = "Sustainable cost models for mHealth at scale: Modeling program data from m4RH Tanzania",
abstract = "Background: There is increasing evidence that mobile phone health interventions ({"}mHealth{"}) can improve health behaviors and outcomes and are critically important in low-resource, lowaccess settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. Methods: We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. Results: In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54{\%}, 83{\%}, and 58{\%}, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. Conclusions: These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program's reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact.",
author = "Mangone, {Emily R.} and Smisha Kaysin and Kelly L'Engle and Christine Lasway and Trinity Zan and {Van Beijma}, Hajo and Jennifer Orkis and Robert Karam",
year = "2016",
month = "1",
day = "1",
doi = "10.1371/journal.pone.0148011",
language = "English (US)",
volume = "11",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "1",

}

TY - JOUR

T1 - Sustainable cost models for mHealth at scale

T2 - Modeling program data from m4RH Tanzania

AU - Mangone, Emily R.

AU - Kaysin, Smisha

AU - L'Engle, Kelly

AU - Lasway, Christine

AU - Zan, Trinity

AU - Van Beijma, Hajo

AU - Orkis, Jennifer

AU - Karam, Robert

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, lowaccess settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. Methods: We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. Results: In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. Conclusions: These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program's reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact.

AB - Background: There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, lowaccess settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. Methods: We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. Results: In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. Conclusions: These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program's reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact.

UR - http://www.scopus.com/inward/record.url?scp=84958214720&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958214720&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0148011

DO - 10.1371/journal.pone.0148011

M3 - Article

C2 - 26824747

AN - SCOPUS:84958214720

VL - 11

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 1

M1 - 0148011

ER -