Avoiding mHealth “Pilotitis” Doesn’t Mean You Shouldn’t Start Small

Within mHealth, pilots have earned a bad name, and for good reason. But avoiding “pilotitis” does not mean you should not start small. It means starting small in a way that is built to go big.

This piece by Dimagi’s Chief Strategy Officer, Neal Lesh, was originally featured on the Maternal Health Task Force’s Tech4MH blog.

Making it easy to start small

Since 2008, Dimagi has helped organizations in 30 countries set up mobile projects with CommCare, an open-source mobile platform that supports frontline workers (FLWs). CommCare is actively used by over 130 frontline programs across numerous development sectors. One of the most common and compelling uses is to support FLWs delivering vital maternal health services: registering clients, tracking antenatal care visits, counseling on the importance of facility delivery, and calculating due dates. Thanks to support from USAID’s Development Innovation Ventures, Dimagi will launch at least 40 new frontline programs in 2013 to use CommCare in India alone, a majority of them focused on maternal health.

Technology is never the whole answer, but it can be an essential component of empowering FLWs and improving the maternal health services they offer. Our goal is to help frontline programs reach sustained impact at scale by making it as easy as possible to start small while being able to go big. Why start small? Within mHealth, pilots have gotten a bad name, given the many projects declared a success only because they started, regardless of whether they can or do continue. Indeed, many of our partners will tell us we can start with a small number of FLWs as long as we do not call it a pilot.

Why iteration matters

mHealth applications, like most technology, take time and field iteration to develop. mHealth is still a young field, and iteration is necessary to develop usable systems. Organizational capacity to use mHealth takes time to develop too. Most organizations we work with do not fully appreciate what they are getting into until they have used CommCare for a while.

Proof-of-Concept packages

One way we make it easy to start small is by offering Proof of Concept (POC) packages, where funding allows, that include 10 free phones and about a month of remote and on-site support from Dimagi’s experienced team. One thing that initially surprised us is how popular the POC packages are. To date, over 68 organizations in 18 countries have started using CommCare through POC packages. We receive a large number of applications when we put out requests for them, even from huge development organizations with budgets over 100 million dollars. We have come to realize that POC packages are popular because they remove much of the perceived risk for someone within an organization to initiate an mHealth project.

One platform, built to scale

The key thing that allows us to start small but go big is that we offer CommCare as a Software-as-a-Service product hosted on our cloud server. All 130 frontline programs using CommCare run on the same platform. Anyone can create an account, develop their own CommCare application, or customize a pre-existing application from CommCare Exchange, the first open-source mHealth app store.

One example is the Reducing Maternal and Newborn Deaths (ReMiND) pregnancy app developed by Catholic Relief Services (CRS) in partnership with Dimagi to support prenatal and postnatal care in the northern Indian state of Uttar Pradesh. Following initial testing and refining with 10 government-selected FLWs, the app scaled up to 271 FLWs, who use audio and visual prompts to systematically counsel and assess women and babies for danger signs. Supervisors are alerted when visits are missed, and the latest edition adds customized SMS reminders triggered by computer-detected newborn danger signs. The CRS site has become a strong innovation test bed and an increasingly well-known global example of mHealth as a supportive supervision tool.

Over the following year, we expected to support CommCare and MOTECH Suite in several maternal health programs at large scale in India, Haiti, and other countries. In every case, we started small, and were very excited to go big.