The World Bank December 16, 2010 ICTD 2010 London

1. Mobile Applications Initiatives The World Bank December 16, 2010 ICTD 2010 London

2. Panel • Christine ZhenweiQiang, Lead Economist, ICT Sector Unit, The World Bank • Vicky Hausman, Associate Partner, Dalberg Global Development Advisors • Tim Kelly, Lead ICT Specialist, infoDev, The World Bank • MajaAndjelkovic, Researcher, Oxford Internet Institute

3. Agenda • Overview of the World Bank Mobile Flagship Program • Sectoral Mobile Applications Analysis • Health • Rural Development • M-applications Labs Initiative • Social Networking: Open Innovation in the Mobile Industry

4. Economic Rationale: Why Mobile? • Key infrastructure: driver of economic growth and the competitiveness of nations • General Purpose Technology (GPT) with pervasive impact on other sectors • Increasingly the primary means for accessing information, a public good that is essential for all types of economic activity and governance • Increasingly an important platform to deliver public and social services, especially to remote areas

5. World Bank Mobile Flagship Program • Summarize trends and usage in m-applications for development • Provide case studies and analyses of how mobile can be used to improve sector specific outcomes • Analyze the mobile “ecosystem” in developing countries, and how incentives might be optimized to develop viable sectoral m-applications • Identify innovative business/implementation models for scaling-up and replication

6. Mobile Applications for Health

7. Context: What is the mHealth ecosystem? Government Legislators Regulators Legal system Ministries Health Health system Health care workers Medical supply chains Patients Health funding mHealth applications mHealth Service delivery Technology Software developers Mobile operators Handset makers Finance Banks Insurance companies Private investors Philanthropists Donors Mobile platforms Source: Dalberg research and analysis

8. Better health How does mHealth produce impact? Outcomes Intermediate outcomes Multipliers Outputs Inputs Access, affordability, quality, matching of resources, behavioral norms ICT literacy Health literacy Health training M&E Complementary mServices Complementary capital investments ICT maintenance and repair capacity mHealth service delivery Financing Health system needs Health care best practices Procurement & Supply chains Cultural attitudes Network installations Distribution channels Research & Development Policies & Strategies Related Infrastructure Regulation & Standards Leadership & Governance Communication & Education

9. M-applications for health are being used for a range of health service delivery Health services Example Case Description of mHealth usage and applications 1 Treatment Compliance Utilization of messages and voice to communicate treatment and procedural reminders to patients (e.g., automated SMS reminders to patients on chronic medication) 2 Data Collection and Disease Surveillance Usage of mobile handheld devices to collect data remotely (e.g., by community health workers); additionally, use of remote diagnostic tools for disease surveillance and treatment; includes civic participation in reporting outbreaks and disease information 3 Health Information Systems & Support Tools for Health Workers Collection and analysis of patient data, particularly at clinics or related to call centers that are used to triage services and treatment; information to help health worker prioritization 4 Disease Prevention and Health Promotion Use of mobile and SMS-based health information and education to inform individual patients of preventive care and treatment 5 Emergency Medical Response Systems Emergency response tools , including creation of EMR via mobile phones, and ambulance services whose reach is extended with mobile usage in remote areas 6 Supply Chain Management Management of inventory and supply chain steps by mobile tracking and communication; includes advocacy informed by supply chain information 7 Health Financing Use of smart-cards, vouchers, insurance and lending for health services linked to mobile platforms (e.g., m-Pesa) Source: Dalberg research and analysis

10. 9 Catalogued apps. are fairly young, NGO-led, and focus on HIS/data collection Type of mHealth service Additional observations 21 • Majority of models are pilots • Many applications continue to be supply-driven • Various degrees of indigenous developer capacity and innovation; home-grown models in both Kenya and India; limited capacity and training 12 10 6 <1 year 2 years 3-5 years 5+ years Time horizon / track record • Sector is very nascent and dynamic • Health system value chains are changing –growing use of mobile health workers and clinics • Growing focus on platforms and enablers, but limited existing interoperability and standardization • Acute challenges in rural settings, including scarcity of HR, data on health needs, and finance 19 15 10 5 5 4 3 Data collection Health Promotion Emergency Response Health Financing Health information systems Supply Chain Treatment compliance Lead implementer business model • ecosystems giving rise to diverse new business models; cost of experimentation primarily borne by aid organizations • Increasing amount of attention and funding to both e- and mHealth at a global and national level; majority of funding remains philanthropic / ODA oriented • Limited commercial viability, and limited linkage with large scale funders • Shortfalls in implementation, (e.g., development of mHealth components of eHealth strategies; training of field workers) 32 11 7 Nonprofit Hybrid (1) For-profit Kenya Haiti India • Hybrid is defined as any intervention which includes both for profit and non-profit partners and/or generates revenue and receives subsidies. Examples include PPP and tiered pricing models. • Note: The total number of initiatives and applications observed is 61, not including an additional 17 platform initiatives identified in India. however, as our team does not have complete data on each model, the total number across several dimensions captured here is less than 32.; Source: Dalberg interviews and analysis.

11. M While the evidence base is limited, there are early indications of impact Speed of information delivery Number of people reached Volume of data captured Patient adherence and health impact 37 600 # of days # people reached(K) # of new patients per day # of patients -75% -91% -90% 150 4 With SMS Without SMS Mobile phone Paper-based Existing process SMS based printer Suppress viral loads Treatment Adherent patients Patients NOT receiving SMS Patients receiving SMS Source: Dalberg research and analysis, including Voila, International Red Cross; CHAI ArogyaRaksha, Technopak, and HMRI WelTel data published in the Lancet, 2010.

12. High-level requirements across the ecosystem to realize the potential for mHealth Creation of mHealth services Scaling up and replication Enhancing impact on health outcomes Fostering an mHealth ecosystem • Create linkages to encourage innovation • Support for business models and financing • Understand costs • Monitor and evaluate to create an evidence base for decisions • Support capacity and training across the ICT industry • Customize content • Invest in health and ICT literacy • Document outcomes • Prioritize successful models • Support for critical inputs (e.g., entrepreneurship, incentives for mobile operators to partner, etc) • Investment in multipliers (e.g., creation of eHealth strategies; support for mobile money, etc)

13. Fostering an mHealth ecosystem: A range of financing and implementation vehicles are appropriate – and being tried – across the application lifecycle Stage 1: R&D Stage 2: Demonstration Stage 3: Deployment Stage 4: Diffusion Stage 5: Maturity Stage 6: Decline • Develop technology prototype • Establish evidence base (M&E) • Refine technology and model • Achieve scale of users • Further optimize product (e.g., lower costs) • Replace / refine with 2nd gen. tech.) Objectives R&D grants (including competitive subsidy, cost sharing Cost-sharing / subsidies from large scale funders (e.g., PEPFAR, Global Fund, WB) Types of financing vehicles Debt or equity guarantees “Pull” incentives (e.g., challenge funds – Gates Foundation’s Grand Challenges Explorations) Incubator funds Type of funding Public/private venture capital = Public / philanthropic Insurance / payers = Blended (public/private) Angel investors Venture capital = Private Industry investment (including equity, debt) Corporate R&D investment Tax credits

14. Fostering an mHealth ecosystem: Ministry of Health Prioritization Framework Key questions Desired outcomes 1 • What are health needs / priorities? • What is the current state of / dynamics in the ecosystem (e.g., infrastructure, regulation, technology, applications)? • Understand the key priorities, needs, opportunities and constraints in the ecosystem Review of local ecosystem and context • In which areas could mHealth/ICT play a role? • What are broader ICT and e-Gov priorities and initiatives that might complement mHealth? • What are core regulatory and implementation requirements (e.g., incentives, financing) 2 eHealth strategy development • Define strategic approach to eHealth that recognizes broader ICT/e-Gov priorities and integrates mHealth 3 • What is the most efficient and appropriate means to implement (e.g., grants for R&D? Tender to select partner? Challenge fund?) • What is the roadmap for implementation (e.g., expected activities, timeline and resourcing?) Implementation planning and tactics • Outline core requirements and tactics for implementation 4 • What has been the success and impact of the selected mHealth applications and interventions in the context of the broader eHealth strategy? • What are lessons learned via M&E? • What refinements need to be made to achieve desired impact? Evaluate and refine strategy and tactics • Identify lessons learned and understand impact to refine strategy and tactics

15. Mobile Applications for Rural Development

16. Mobile applications aim to address targeted development challenges, Targeted Sectoroutcomes

17. Many m-apps do not go beyond pilot stage. Peak of Inflated Expectations: 71% of mobile apps reliant on gov’t or donor funding Plateau of Productivity: 15% of apps are sustainable Viability Slope of Enlightenment: 48% of apps in the commercialization phase Trough of Disillusionment: 37% of apps don’t go past the pilot stage Technology Trigger = mobile penetration Time

18. M-applications for are being used for various subsectors under rural development.

19. Existing business/implementation models face various issues.

20. M Some m-apps start to see real development impact

21. Preliminary Findings • Defining success and the government’s role in financing • Mobile money as a foundation for many m-applications in other sectors • Rigorous financing planning • Telecom operators’ incentives to be aligned to contribute • Awareness raising and training • More analysis required for scaling up / replication