The case for nutritional health delivered over mobile in Tanzania
The GSMA Mobile for Development mHealth team has recently completed some in-depth analysis on the market feasibility of launching mHealth services in Tanzania from the perspective of child and maternal nutritional health.
The summary findings make insightful reading as they provide a guide to some of the most pressing issues currently facing stakeholders involved in launching, developing and scaling existing mHealth solutions in the 10 Sub-Saharan African countries that the mHealth team is considering with its nutrition initiative.
From the start, the remit has been to consider mobile from an efficacy standpoint, by considering what problems mHealth can actually help solve.
This approach was considered the most fitting as it provides a defined need and consequently a defined demand. Historically analysis in this area, particularly with mobile health services, has taken the view that a service should be developed and tested in the market to define demand. This approach has met with varying degrees of success.
Tanzania’s health ecosystem
From a pure health burden perspective Tanzania exhibits the third highest indicator for maternal mortality of the mNutrition target countries and the fifth highest indicator for stunting in children under five.
These statistics combine with a number of factors conducive to mHealth service development. These include a high percentage of the population above the poverty line (the third highest of the target countries), a high female literacy rate (fifth highest) which is encouraging for messaging based mHealth solutions, and one of the best distributions of wealth (first place) which is potentially conducive to becoming a market where mHealth services might be purchased privately.
Obstacles in Tanzania include the ongoing challenge to tackle the lack of centralised information sharing systems, data collection and collation and the dissemination of data across health provision infrastructure. Fortunately mobile is well positioned to tackle these particular challenges.
Inadequate, patchy and non-standardised health personnel training and ongoing development within the Tanzanian health sector is an obstacle, particularly in rural and Northern regions of the country. In this region handset ownership remains an issue but initiatives are underway to penetrate both rural and urban user segments while providing support to health personnel servicing these segments.
Developments conducive to mHealth
In addition to considering the health problems that mobile can assist with the GSMA mHealth team also considered developments that are conducive to mHealth development in Tanzania.One of the most encouraging features was the government’s acceptance of ICT and its role to improve the socio-economic position of its populace. This conviction is explicitly defined in its plans to exploit mobile for health creating a favourable environment for mHealth stakeholders to develop services.
The government of Tanzania understands that to successfully leverage mobile into healthcare there is a need for a consortium led approach, with each partner in the consortium bringing their unique skills, assets and capabilities. This understanding in approach has been augmented by the country’s ICT and eHealth strategy planning activities, where multiple stakeholder groups have been encouraged to formulate strategies and work collaboratively in the overall planning process.
Infrastructure investment in Tanzania is also a boon to mobile health service development. The government has invested in a fibre core network, the National ICT Broadband Backbone. One of the major outcome targets for its construction is the improvement of the nation’s health. This ideal has been explicitly defined in the national plan laid out for the rollout and crystallised in the provision of subsidised access for health facilities.
From a commercial and sustainability perspective there is an established mode of use with mobile money in Tanzania that associates itself with mobile health (saving for emergencies), providing a launch point from which mobile health services might develop.
The readiness of stakeholders to support mHealth
As we have seen there is both a role and a number of features conducive to mobile health development in Tanzania but what of the position of the various players normally involved in facilitating mobile health?
An integral part of successful mHealth is securing mobile operator buy-in. In Tanzania there is a good understanding of the opportunities that mHealth provides, both as a feature of mobile operator corporate social responsibility (CSR) and as a stand-alone commercial proposition in the longer term. There is some reticence to invest in costly mHealth service rollout without a solid business proposition and some fatigue in zero rating requests from NGO and government sectors. However as mobile operators begin to launch initiatives first mover dynamics will motivate other Tanzanian mobile operators to follow suit.
There is a well-established NGO infrastructure in Tanzania, with mHealth initiatives backed by internationally recognised funding bodies. This creates an opportunity for mobile players and other stakeholders to support these players in commercial and CSR-orientated relationships. This situation is amplified by the existing and established public-private strategy working framework with the country that comprises key stakeholders within government, NGOs and other facilitating stakeholder parties. This framework simplifies the processes and removes a number of the obstacles to facilitating mHealth service development and deployment.
The mHealth Tanzania Partnership shows great promise in addressing ministry-defined public health priorities through the support of nationally-scaled solutions. This collaborative approach has borne fruit in the free Wazazi Nipendeni SMS service. Beyond this the government’s monitoring of mHealth initiatives, in order to redirect resources and so avoid duplication and waste, provides a strong efficiency motivation while creating a resource for collaborative learning.
Tanzania is also advantaged in having a centrally defined nutrition strategy managed through its Food and Nutrition Centre (TFNC). The central placement of the TFNC and its broad membership, with ministries from across the government sitting on its governing board, provides evidence that the pivotal role nutrition plays in health is well understood. This acceptance of the role of nutrition in health provides an advantage at the outset for mobile health services concentrating on these features.
General Tanzania ICT market view SWOT
In summary, Tanzania is well placed from a mHealth service feasibility perspective although it faces a number of challenges. At the GSMA and within the Mobile for Development mHealth team we are committed to assisting in tackling these challenges and ensuring the opportunities present within Tanzania will be realised.
For more-depth analysis of Tanzania and other mHealth nutrition countries see the GSMA mHealth Country Feasibility suite of reports. The next tranche of reports to be published will be Tanzania and Ghana, which join the previously published Nigeria and Malawi reports, and which are expected to be available in finalised format in October 2014.
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