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Value propositions of mHealth projects

Article in Journal of Medical Engineering & Technology August 2016

DOI: 10.1080/03091902.2016.1213907

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ORIGINAL RESEARCH ARTICLE

Value propositions of mHealth projects

Irena Gorskia, Joshua T. Brama, Staci Sutermastera, Molly Eckmana and Khanjan Mehtab
a
The Pennsylvania State University, University Park, PA, USA; bHumanitarian Engineering and Social Entrepreneurship (HESE) Program,
Engineering Design, The Pennsylvania State University, University Park, PA, USA

ABSTRACT ARTICLE HISTORY

While mHealth holds great potential for addressing global health disparities, a majority of the Received 1 March 2016
initiatives never proceed beyond the pilot stage. One fundamental concern is that mHealth proj- Revised 13 June 2016
ects are seldom designed from the customers perspective to address their specific problems Accepted 16 June 2016
and/or create appreciable value. A customer-centric view, where direct tangible benefits of inter- Published online 11 August
2016
ventions are identified and communicated effectively, can drive customer engagement and
advance projects toward self-sustaining business models. This article reviews the business mod- KEYWORDS
els of 234 mHealth projects to identify nine distinct value propositions that solve specific prob- mHealth; value proposition;
lems for customers. Each of these value propositions is discussed with real-world examples, healthcare; developing
analyses of their design approaches and business strategies, and common enablers as well as countries; meta-analysis
hurdles to surviving past the pilot stage. Furthermore, a deeper analysis of 42 mHealth ventures
that have achieved self-sustainability through project revenue provides a host of practical and
poignant insights into the design of systems that can fulfil mHealths promise to address health-
care challenges in the long term.

1. Introduction a phone to an intermediate station where it is sent at

Mobile health, also known as mHealth, refers to the
use of mobile devices to facilitate data and informa-
tion exchange between patients and medical profes-
sionals.[1] In recent years, mHealth projects have
become increasingly common in developing countries
due to improved global cellular infrastructure and
increased affordability of mobile devices. There is
ample evidence that mHealth initiatives can improve
the delivery and effectiveness of patient-centred care
in places where primary healthcare is limited or
unavailable.[2,3] Most mHealth systems rely on cell
phones, and with 90% of the worlds population
adopting this technology,[4] mHealth projects are a
promising solution to rising healthcare costs in the
developing world.[1]
Despite the potential of mHealth applications, the
majority of initiatives fail in the pilot stage, thus limit-
ing long-term impact. mHealth systems face six com-
mon failure modes that prevent them from growing
beyond the pilot phase, including technical, social and
economic barriers.[5] Sudden project failure can result
from advanced technology being constrained by poor
internet access, inability to recharge devices or store-
and-forward mechanisms (i.e. information is sent from
a later time to the final destination) not functioning
properly. Poor employee management often inhibits
progress beyond initial phases because of high turn-
over rates, minimal technical training and inadequate
employee incentives. In addition, social challenges,
such as context-specific gender roles (e.g. women trad-
itionally do not venture far from the household) and
social stigmas (e.g. people do not want others to
know they have HIV/AIDS), can cause project failure.
Most mHealth systems owe their genesis to research
and development grants and lack the sustainable rev-
enue models necessary to maintain and expand opera-
tions. Although offering free services attracts
customers, communities need to appreciate the value
of mHealth services to become paying customers [5]
and provide a pathway for long-term economic
viability.
Instead of overreliance on external funding, sustain-
able mHealth endeavours must offer strong value
propositions. When foreign entities donate to organi-
sations in developing countries, they separate the cus-
tomers (NGOs and governments) from the consumers
(end beneficiaries). When customers do not under-
stand, or do not articulate, the needs of the

CONTACT Khanjan Mehta khanjan@engr.psu.edu Humanitarian Engineering and Social Entrepreneurship (HESE) Program, Engineering Design,
The Pennsylvania State University, 213U Hammond Building, University Park, PA 16802, USA
2016 Informa UK Limited, trading as Taylor & Francis Group
2 I. GORSKI ET AL.
population correctly, the resulting solutions are likely
to fail. This phenomenon is less likely in revenue-
driven mHealth ventures, where the customer and
consumer are the same and the feedback systems are
effective. A strong value proposition is thus the funda-
mental building block of a financially and socially sus-
tainable mHealth endeavour. For example, an mHealth
project that provides videoconferencing between
patients at a kiosk and doctors at a remote location
offers multiple value propositions: the patient saves
time and money because they do not need to travel
to a clinic or hospital and they also receive more
highly trained care than they would from just visiting
the community health worker or nurse that operates
the kiosk. Meanwhile, the doctor has the opportunity
to reach out to patients that they would not be able
to otherwise while potentially generating additional
income.
A better understanding of context-specific value
propositions can inform future mHealth endeavours
on how to offer value that will draw more customers.
Based on a comprehensive review, this article analyses
patterns across 234 mHealth projects related to project
leadership, geographical regions, project stages, health
foci and demographic concentrations. In addition, this
article presents a typology of the nine most common
value propositions related to access to healthcare. For
each type of value proposition, projects are categor-
ised by the value provided rather than specific health-
care needs, e.g. a project focussed on preventing HIV/
AIDS through educational workshops would be classi-
fied here as Education instead of HIV/AIDS. The art- champion mHealth projects (n 7), although some
icle then provides a deeper analysis of revenue-driven
projects (n 42) to identify trends and commonalities
that can inform the design of future mHealth projects
to achieve self-sustainability.
2. Methods
mHealth projects (Appendix A) were identified by (1)
searching the Center for Health Market Innovations
database for projects in mobile health and/or that uti-
lised mobile technology, and (2) searching articles
from the Stanford Social Innovation Review between
January 2006 and April 2015 for the key terms grass-
roots innovation and mobile health. Any project that
solely focussed on utilisation of computers or eHealth
rather than mobile technology was not included. For
each mHealth project, data was collected on the pro-
ject leaders, geographical region (region of world;
rural, urban and/or peri-urban), stage of project (start-
up, short-term, post-pilot or inactive), health focus,
demographic and value proposition. Although
comprehensive, the data collected may be limited by
web-based information gathering. Potential caveats
include projects not surviving past the pilot stage and
therefore have incomplete project data, outdated web-
sites or lack of individual contact with mHealth project
leads.
3. Meta-analysis of mHealth projects
3.1. Project leaders
mHealth projects are championed by organisations
ranging from for-profit companies to academic institu-
tions and nonprofits, to government agencies and
multilateral organisations (Figure 1). Nonprofits oper-
ate more projects than any other type of organisation.
However, for-profits are the second most common
type of organisation operating mHealth endeavours,
highlighting an emerging trend of social businesses
that target a triple bottom line of social, environmen-
tal and economic impact. Fifty-three mHealth projects
identified in this study are jointly managed by a part-
nership between two and four different types of
organisations. The most common partnership is
between nonprofits and for-profits. Nonprofits bring
experience in delivering social value, while for-profits
bring the mind-set, skillset and toolset to the partner-
ship which facilitates economic stability. In addition,
for-profit companies may strengthen their brand visi-
bility through partnerships with nonprofits striving to
improve public health. Academic institutions rarely
institutions partner with the other types of organisa-
tions (n 11). Similarly, governments rarely operate
mHealth projects alone (n 3), but 25 projects are in
partnership with governments. Multilateral organisa-
tions, such as the World Health Organisation and the
World Bank, are international bodies that coordinate
actions among multiple countries. Despite the commit-
ment of many of these organisations to global devel-
opment, multilaterals have relatively low participation
in these 234 mHealth projects. The overall indication is
that mHealth endeavours are driven by non-profit and
for-profit enterprises with academic, governmental and
multilateral organisations often acting as supporters
that facilitate, connect, fund and/or advise them.
3.2. Geographical region
All projects advertised a primary region of focus or
specified that they operated globally. The majority of
mHealth endeavours are situated in sub-Saharan Africa
(n 108), with a large proportion also located in

Figure 1. Types of organisations leading mHealth projects (n 234).
Figure 2. Geographic region of mHealth projects (n 234).
Southeast Asia (n 79) (Figure 2). There is likely a fun-
damental sampling bias towards projects located in
developing countries because of the nature of organi-
sations that are listed on the Center for Health Market
Innovations website as well as organisations reported
on by the Stanford Social Innovation Review. However,
the broader trends toward mHealth projects in sub-
Saharan Africa and Southeast Asia are likely still valid
due to underdeveloped healthcare infrastructure in
these regions.
Most mHealth projects are not specialised for popu-
lations in rural, urban and/or peri-urban areas
(Figure 3). By utilising computers and/or phones, most
projects do not require project personnel in a specific
location, enabling a variety of populations to access
products and services. However, rural, peri-urban and
urban populations have very different healthcare chal-
lenges due to differential allocation of resources,
such as locations of hospitals and access to electricity.
JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 3
Figure 3. Urban versus peri-urban versus rural focus (n 234;
14 unspecified).
With these large differences, it is surprising that proj-
ects lack a specific population focus. Projects may tar-
get all three areas to increase patient base, but may
lack knowledge of specific local contexts. However,
ventures focussed on primary care may not need to
understand local contexts to be successful.
3.3. Stage of mHealth projects
Overall, two-thirds of projects in this study have con-
tinued to operate beyond the pilot stage (Figure 4).
There is likely a sampling bias at play because projects
in the pilot stage have not been active long enough
to be featured in an article or database. However,
since earlier data indicates that most mHealth projects
fail,[5] it is encouraging that 154 out of 234 of the
projects reviewed in this study are post-pilot. More
data on the lifespan of each project would be
4 I. GORSKI ET AL.
necessary to understand the long-term impact of these
endeavours.
3.4. Health focus
The most popular health foci for mHealth projects in
descending order are: primary care; HIV/AIDS; family
planning and reproductive health; and maternal, new-
born and child health (Table 1). These main health foci
are common across most geographic regions. Less
common health foci are only popular in some regions;
for example, anti-malaria projects only operate in sub-
Saharan Africa where the disease is most prevalent.
While treatment of disease is the most common
mHealth service, many provide preventive healthcare
as well (including family planning and nutrition). The
gradual eradication of tuberculosis and current rise in
non-communicable diseases are trends potentially
reflected by mHealth projects within these foci.
3.5. Demographics
The large majority of mHealth endeavours serve the
general population. Significant percentages of endeav-
ours also specifically target women, children under
Figure 4. Stage of mHealth projects (n 234).
Table 1. Health foci and corresponding geographic regions.
Health focus Number of projects
Primary care
HIV/AIDS
Family planning and reproductive health
Maternal, newborn, and child health
Secondary/tertiary care
Non-communicable diseases
Tuberculosis
Emergency care
Nutrition
Malaria and other vector borne diseases
Dentistry
Mental health
Eye care
Pharmacy services
Other
five and young adults (Table 2). These demographics
are common across most geographical regions while
less popular demographics are only common in some
regions (e.g. projects targeting the elderly only operate
in China and India).
A potential explanation for this demographic pat-
tern is the availability of funding for certain groups.
For example, a large number of grants target projects
that improve maternal and child health, hence the
large proportion of projects focussing on women. In
addition, cultural standards may make it easier for
men to travel to healthcare facilities, and as a result,
women more often need healthcare access locally.
4. mHealth project typology by value
proposition
The value proposition for each mHealth project was
identified and verified by three separate individuals
(JTB, ME, SS) (Figure 5). For projects offering more
than one type of value, only the most prominent value
proposition was included. This section discusses each
value proposition with the help of representative
examples and provides a cursory analysis of how
mHealth projects vary in the delivery of each value
proposition.
The majority of mHealth projects focus on earlier
and easier access to care, a trend likely due the limita-
tions and expense of travelling, poor doctor to patient
ratios, and limiting characteristics of mobile technol-
ogy such as difficult access to charging and internet.
When seeking care in resource-constrained settings,
physical, financial and social barriers can compromise
health-seeking behaviour.[6] With populations increas-
ing and the rates of communicable and chronic dis-
ease climbing, mHealth projects offering earlier and
faster access to medical care are the most common in
the study (n 59). On the other side, the fewest num-
ber of mHealth projects focus on quality control
Primary geographic region(s)
74 All
36 All
34 All
32 All
23 All
19 All
16 South & Southeast Asia, Sub-Saharan Africa, Global
11 North America, South & Southeast Asia, Sub-Saharan Africa
9 South Asia, Sub-Saharan Africa, Global
7 Sub-Saharan Africa
4 South Asia, Sub-Saharan Africa
3 Southeast Asia, Sub-Saharan Africa
3 South Asia
3 Sub-Saharan Africa
35 All
 JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 5

Table 2. Demographics and corresponding geographic regions.

Demographic Number of projects Primary geographic region(s)
General population 151 All
Women 71 All
Children under 5 42 All
Young adults (1324) 24 All
Men 18 Sub-Saharan Africa, South & Central Asia, South America, Global
Children 5 and older 14 South & Central Asia, Sub-Saharan Africa
Informal sector workers 10 South & Southeast Asia, South America, Sub-Saharan Africa
Formal sector workers 9
Elderly 4 India, China
Ethnic minority 2 Vietnam, Nigeria
Military 3 India, Peru, Bolivia

Figure 5. mHealth project value propositions.

(n 11) and increased institutional efficiency (n 7).
Healthcare professionals are often unwilling to adopt
new technology,[1] and strict regulations can prevent
people not formally affiliated with the hospital from
accessing hospital settings.
4.1. Earlier and faster access to medical care
Major barriers to healthcare in the developing world
are the significant distance to a healthcare facility and
the high cost of transportation. In 59 instances, the
mHealth value proposition is to reduce costs by offer-
ing an alternative to costly travel to clinics or hospitals.
Instead of face-to-face appointments, mHealth ven-
tures offer patient care through (1) doctor hotlines, (2)
local medical professionals relaying information to a
doctor electronically and (3) self-screening technolo-
gies. The most common model for mHealth projects
with this value proposition is offering hotlines that
people can call for medical advice. In India,
6 I. GORSKI ET AL.
NationWide Primary Healthcare Services offers 24/7
access to a doctor through their On-Call Hotline in
return for a subscription fee.[7] mHealth projects utilis-
ing the second model employ a nurse, trained com-
munity health worker, or clinical officer to collect and
send health information from patients to physicians.
Information may be transmitted via phone call, video
conference, text message, email, instant messaging or
photo messaging. One example is the mHealth ven-
ture, World Health Partners (WHP), in which users con-
sult a local entrepreneur who connects them via
telephone or videoconference to a remote physician.
After the consultation, the physician can send a pre-
scription to a clinic via SMS. WHP maintains laborato-
ries for blood work, X-rays, and ultrasound tests, and
runs WHP-branded pharmacies as well. Patients pay
less than $1 per visit, of which 60% goes to the fran-
chisee and 40% goes to WHP.[8]
Self-screening technologies allow patients to guide
themselves through a screening process on a phone
app, website or other tool. In Kenya, Baby Monitor
offers interactive voice response technology to detect
complications during pregnancy. Women may call the
Baby Monitor phone number and answer a series of
questions which screens them for pregnancy issues. If
necessary, Baby Monitor may send information to
healthcare providers and make referrals.
Common target audiences for the easier and faster
access to care value proposition include expectant
mothers, children, women and people with specific
diseases such as HIV, tuberculosis or skin conditions.
One project that specifically targets children is
Djantoli, whose community agents visit children at
home to collect health data and educate parents
about illness prevention and nutrition.[9] The informa-
tion is collected on the agents phones and delivered
to a doctor who identifies children that are at-risk and
encourages them to see a local doctor, with associated
medical fees covered by the subscription to Djantolis
services. Overall, mHealth projects with this value
proposition reduce wait time to see a medical profes-
sional and/or reduce the distance to a health clinic.
This distance could be a physical distance (i.e. miles)
or a social distance (i.e. people stay away from health-
care treatment because they do not know how to
navigate it).
4.1.1. Adherence to drug treatment regimens
Poor adherence to drug treatments poses both an
individual and public health risk. Improper drug regi-
mens can be especially concerning in developing
countries, where failure to take the proper
medications can cause the spread of major diseases
such as tuberculosis and HIV/AIDS. Nineteen of the
234 mHealth projects improve adherence to drug
treatment regimens and can be found across Africa,
Asia and Latin America. The primary model for
these projects is text or phone call reminders to take
medication. Reminders vary from automated
reminders without any follow-up or additional texts
and personalised calls in response to non-compliance.
Some services offer encouraging tips and resources
via SMS.
Two projects, SIMpill and Vitality GlowCap, provide
an additional level of engagement with patients. Pill
bottles with SIM cards notify a central server when
they are opened, and patients receive texts from the
server if they do not open the bottle at their desig-
nated times.[10,11] Another project, X out TB, requires
their patients to text photos of urinalysis strips to con-
firm adherence to medication.[12]
Some projects also include workshops, support
groups and home visits as a part of their services.
These mHealth projects target mostly HIV/AIDS
patients but also include people with tuberculosis,
diabetes, thyroid diseases, pregnant women, parents
of sick children and parents who want reminders for
when their children should receive vaccinations.
mHealth projects focussed on adherence to drug
treatment regimens can encourage the proper
usage of medication, decrease the number of cases of
resistant disease and keep patients on track toward
longer lives.
4.1.2. Education programmes
One of the reasons people do not seek proper health-
care is that they may not understand the severity of
their condition or the treatment options available to
them. Thirty-three of the mHealth projects educate
individuals on various aspects of healthcare benefits to
increase the appropriate utilisation of resources.
mHealth projects focussed on education are most
popular in Africa, followed by Asia. Communication
methods include SMS messages, smartphone apps,
website videos, Facebook pages, hotlines, online mes-
saging, and online learning modules. Services offered
include information on affordable drugs, childcare,
nutrition, diseases, sexual and reproductive health, and
referrals to local care centres. This broad scope of edu-
cation means audiences vary from healthcare workers,
to expectant and new mothers, to young adults who
want to know the truth about reproductive health, to
people with diseases including HIV/AIDS, hypertension
and diabetes.

Some projects reward customers with certifications
and other incentives such as small amounts of money
for good health behaviour. mPowering, which operates
in India, distributes smartphones loaded with mobile
apps that routinely ask how mothers and their babies
are feeling to monitor for post-partum depression and
award credits to mothers for answering. Participants
can cash in their earned credits for food, medicine or
books.[13] Overall, mHealth projects with this value
proposition enable, motivate and educate people on
adopting healthy practices.
4.1.3. Payment for medical care
Many of the barriers to accessing healthcare in the
developing world are ultimately a problem of finances.
Twenty-one of the mHealth projects reviewed are
designed to make healthcare easier to pay for or less
expensive. These projects are primarily found in Kenya,
where money transactions via cell phone are already
highly successful, with relatively few similar endeav-
ours in other African and Asian countries. mHealth
endeavours lower costs by: (1) providing discounts or
eVouchers for medical visits or drugs via text message,
(2) providing health insurance via a community-based
or biometric data collection, or (3) offering low-cost
medical services.
The Yarona Care Pay-As-You-Go Healthcare system
in South Africa uses eVouchers as an alternative
financing method for those who cannot afford trad-
itional healthcare insurance.[14] In India, the National
Health Insurance Program uses various information
and communication technologies including portable
biometric data collection methods to support a nation-
wide insurance programme.[15] All mHealth projects
in this category can lower financial barriers for people
who want to seek medical care.
4.1.4. Patient healthcare data collection and storage
(electronic medical records)
Thirty-five of the reviewed mHealth systems offer care-
providers a technological way to synthesise and store
medical records. Such innovations increase the utility
of patient health data and efficiency in navigating
through large health data sets. In addition, govern-
ments and NGOs can utilise such data to track national
health and development trends. mHealth projects
focussed on patient data collection use a variety of
methods for collection and transmission. SMS messag-
ing is the most common method, as even the most
basic cell phones have this capacity. However, charac-
ter limits on SMS messages restrict the information
that can be transmitted this way. Several other
JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 7
mHealth endeavours utilise applications on smart-
phones to allow more detailed information collection
as well as additional services such as location tracking,
mobile access to health information and networking
with other healthcare professionals. The remaining
projects use proprietary software or devices. For
example, the e-Analysis venture that operates in
Turkey uses a specialised monitoring device to collect
vital information including heart rate, blood pressure
and temperature from patients. The device interfaces
with a mobile phone to process and transmit the
information to a data centre.[16]
Due to the low cost of text messages, SMS-based
projects often include confirmation messages, health
education and drug adherence reminders as well as
data collection. For example, Cell-Preven, based in
Peru, uses basic phones to collect data on incidences
of sexually transmitted infections.[17] After data ana-
lysis, medical personnel receive real-time warnings of
outbreaks via text messages or email. Another pro-
gramme called MoTeCH in Ghana allows nurses to
record treatment information for women and new-
born patients.[18] The system then sends text notifica-
tions to both the nurses and patients regarding
upcoming treatment sessions. Smartphone apps can
provide these functions, though they are often less
accessible in developing countries.
Data collection devices created for the developing
world are generally designed to have a quick learning
curve to overcome barriers specific to the target
region such as language differences or infrequent
access to the internet. Jaroka Tele-Healthcare in
Pakistan has created an electronic medical records sys-
tem based on best practices that is simple to use even
in rural areas of the country, due to using Web, SMS
and data services to communicate between health
workers and medical specialists.[19] In addition, the
device accepts unique smart-cards to identify patients,
improving the accuracy of the data collected. Uniquely
identifying people is an enormous challenge in low-
resource settings but smart-cards can help, especially
because they often target a specific population. The
Omomi project in Nigeria is geared towards child
health, and allows mothers and families to track vac-
cine schedules, monitor growth, and network with
other mothers in the region.[20]
4.1.5. Reduction or avoidance of stigma
The ease and privacy of providing counselling services
via internet or phone hotlines has led 18 mHealth sys-
tems in this study to leverage them in addressing stig-
matised health situations. Such services can be
8 I. GORSKI ET AL.
invaluable when dealing with sensitive diseases such
as HIV/AIDS and other STIs, where knowledge of a
patients status can influence their public perception,
acceptance and even employment. Almost all of the
projects of this type provide a confidential way for
individuals to receive information on sensitive topics,
with most focussing on HIV/AIDS. A large proportion
also educates users about contraception and family
planning. Each organisation employs counsellors or
healthcare professionals to staff confidential hotlines
or SMS messaging, most of which are toll free. Several
hotline services are catered towards specific popula-
tions. For example, Marie Stopes International created
a phone line targeted towards adolescents.[21] The
service My Question My Answer uses a Facebook page
in addition to text messaging and a phone line to fur-
ther target a younger population.
4.1.6. Empowering medical professionals and
governments
The review identified 33 mHealth solutions dealing
with empowering medical professionals with improved
access to information. Technologies available can
enable continued medical education for health profes-
sionals, better disease surveillance and immunisation
monitoring. These projects offer easy ways for health-
care professionals, including doctors and community
health workers, to stay up-to-date on the latest stand-
ards of care and other developments in the field. For
example, Mobiles for Quality Improvement sends par-
ticipating staff daily messages with information
designed to identify and fill relevant gaps in know-
ledge.[22] Most of these projects share data with med-
ical professionals via SMS messaging. For example,
Community Nurse On the Go provides a better way
for healthcare professionals to network with peers and
gain support outside of their areas of expertise.[23]
Twenty-two of these programmes focus on collect-
ing and using data on infectious diseases to help med-
ical professionals in making the most informed
decisions possible. For example, Reliefwatch (imple-
mented in several countries in Latin America) tracks
infectious diseases and medicine stocks to help care-
givers prevent outbreaks from becoming epidemics.
[24] Nineteen of these mHealth programmes are also
involved in data collection and storage. One such
example is CliniPAK, which both provides diagnosis
advice to community health workers and reports its
patient data to the Kenyan government. These pro-
grammes can have several methods of educating and
empowering professionals, including text messages,
emails and phone hotlines.[25]
4.1.7. Increasing institutional efficiency
Inefficiencies in healthcare systems of the developing
world are often caused by lack of qualified employees,
shortages of necessary medicines and equipment, and
poor resource management. The overall goal of proj-
ects with a value proposition of increasing institutional
efficiency is to maximise the effectiveness of the exist-
ing healthcare system without requiring additional
resources. The 11 mHealth projects with this value
proposition focus on the administrative aspects of
healthcare. Some, like GxAlert, bypass time-consuming
paper reports to reduce wait times for lab results.[26]
Others, like VillageReach in Mozambique, use propri-
etary software to optimise the logistical operations of
hospitals or clinics such as delivering supplies or
scheduling patients.[27] These types of projects tend
to be more technologically advanced and require
smartphones or computers.
One example of a programme that saves time for
hospitals and patients is Project Mwana in Malawi,
Zambia.[28] This initiative uses SMS messaging to rap-
idly transmit HIV test results for infants from the lab to
care facilities. Seven other projects improve the logis-
tical operations of healthcare institutions and related
infrastructure. Healthy Entrepreneurs, a venture operat-
ing in Burundi, Democratic Republic of the Congo,
Haiti and Rwanda, optimises the distribution of health
products and essential medicines.[29] This venture
improves the efficiency of the local pharmacies by uti-
lising a franchise model run by local entrepreneurs.
The entrepreneurs are provided with a tablet that
includes proprietary applications to monitor all busi-
ness operations, including stock replenishment, online
ordering and customer retention.
4.1.8. Quality control of care
Innovations in mHealth technologies can inform
patients of the healthcare options most accessible to
them. For instance, eight projects focus on authenti-
cating medication in locations where unreliable electri-
city can decrease shelf life (e.g. by offering information
on how to tell if a medication is still safe even if it has
not been refrigerated properly). mPedigree in Ghana
authenticates medicines by placing unique identifier
codes on medication bottles, which users can text to a
central number to confirm authenticity.[30] Such sys-
tems protect consumers while improving trust in the
healthcare system, such as by dissuading counter-
feiters. Other projects with this value proposition
improve quality and trust by facilitating feedback on
care providers. Swasthya Vaani in India is a radio

station that allows even illiterate patients to report
on the quality of care at health facilities via phone
calls.[31]
5. Economic sustainability analysis
All 234 mHealth projects reviewed in this study strive
to improve health outcomes for their patients. But
what makes a project successful in the long term? One
measure of success is a projects ability to sustain itself
without donations or government support. Forty-two
of the 234 mHealth projects are funded primarily by
their own revenue. This discussion takes a closer look
at these 42 projects and how they are able to achieve
economic sustainability.
5.1. Meta-analysis of mHealth projects funded
primarily by revenue
Ventures that improve quality control of care are
most likely to be funded by self-generated revenue
(Table 3), likely because they collect revenue from
institutions like hospitals, clinics, and ministries as
opposed to individual patients or doctors. Additionally,
with increasing regulation of healthcare institutions
and a lack of institutional capability to provide rigor-
ous quality control regimens, external agencies and
consultant groups have emerged to fill this need.
Since compliance with regulations is mandatory and
adhering to regulations can be a large strain for low-
resource institutions, services that ease that burden
have a high value, and healthcare facilities are likely to
pay for it. Instead of spinning out new patient-centred
systems, ventures that strengthen the extant system
are playing by strengths and are more likely to be
funded by self-generated revenue.
Education projects are the least likely to be funded
by revenue, which may be because the knowledge
they offer is not directly actionable or because organi-
sations operating them can rely on donors (26/32
Table 3. Percentage of mHealth projects funded primarily by
revenue within each value proposition.
Total number Percentage of
of mHealth projects that are
Value proposition projects (n) revenue-funded
Data collection/storage 35
Drug adherence 19
Easier access to healthcare 58
Education programmes 32
Empowering med professionals 33
Increased institutional efficiency 11
Payment for medical care 21
Quality control of care 7 43%
Stigma avoidance 18
All 234
JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 9
primarily funded by donors) so they are not driven to
derive revenue from their services. It may also be
attributed to the difficulty in communicating the value
of preventative healthcare. Additionally, it is common
for rural communities in developing countries to have
oral traditions where they tend to share knowledge
through stories. In such areas, there is a widely-held
conception that sharing knowledge should not have a
monetary component. The two educational mHealth
endeavours that are revenue-funded are SMS Info
Obat Murah and Nokia Ovi Life Tools. SMS Info Obat
Murah emerged to decrease the instance of fraud
within the pharmaceutical and insurance industries.
For five cents, customers can text the company to
receive reliable information on a range of pharmaceut-
ical products, allowing them to verify what type of
packaging the drug should have, how much it should
cost, and if there are cheaper, generic alternatives.
Nokia Ovi Life Tools aims to empower people living in
rural areas with valuable information and skills to help
improve their everyday lives. For a monthly subscrip-
tion fee, customers can receive daily text messages on
topics of interest, including childcare, fitness, diseases,
weather, agriculture, and sports. By offering this add-
itional useful information via SMS, farmers without
internet access can be more successful and people
interested in sports or in learning English can also find
value in the subscription. Both ventures have clear
value that people are willing to pay for avoiding
drug fraud and getting health, agricultural, and other
useful information daily without internet access. While
mHealth project leaders are looking at mHealth as an
entity in itself, this venture saw that customers also
valued sports and agricultural news and bundled these
projects together to gather revenue from customers.
mHealth teams can learn from their success that peo-
ple are willing to pay for products and services that
matter to them, and therefore, ventures need to align
with those products and services to accomplish health
outcomes. Unless people value a product or service,
they will not pay for it so framing messages positively
and providing actionable advice is more helpful to
venture success than using scare tactics or providing
matter-of-fact medical information. Revenue-funded
mHealth projects mirror the distribution of the 234
mHealth projects overall. Therefore, revenue-funded
14%
32% projects are just as likely to emerge anywhere and
24% there is not a strong correlation with geography.
6%
18% For-profit organisations operate the majority of the
9% mHealth projects that are primarily funded by revenue
29%
(n 34), with nonprofits (n 11) a distant second
11% (Table 4). For-profits prioritise economic returns so
18%
they are continually looking for reliable business
10 I. GORSKI ET AL.
Table 4. Operators of revenue-funded mHealth projects.
Type of organisation(s) operating project All
Academia 18
For-profit 107
Government 28
Multilateral 15
Non-profit 130
Partnerships between different types of organisations 53
Total 234
models to address a problem, create value and build a
sustainable organisation.
Academic and multilateral organisations do not
have this pressure for deriving revenue from their cus-
tomers because they are often funded by academic
grants or multilateral development funds. Neither aca-
demic nor multilateral organisations are involved in
any mHealth projects funded by revenue. Academic
institutions are driven to conduct research because
the grants they receive are often directed toward
advancing science. Building a venture around new
knowledge created is not expected, and is often dis-
couraged because taxpayer dollars are often funding
the research. Additionally, commercialising the results
of the research is often considered the job of the pri-
vate sector. However, it is difficult for new businesses
to commercialise the results of research due to the
phenomenon commonly referred to as the valley of
death, where it is difficult to cover the negative cash
flow in the early stages before their new product or
service can bring in revenue from real customers. This
leaves a gap where some new knowledge that is cre-
ated by the university is never developed further by
the private sector because it is unclear how to apply
or commercialise it. If academic institutions can
expand beyond traditional roles and demonstrate how
research findings can be applied and made economic-
ally viable, it becomes more palatable for the private
sector to take over. Multilateral organisations are
mostly focussed on policy work and directing resour-
ces than on developing and/or commercialising tech-
nologies and services. They fit the role of supporting
mHealth projects, but it is not their traditional role to
operate revenue-driven mHealth projects. Only four of
the revenue-funded projects are managed through a
partnership. While building partnerships implicates
coordination challenges, they arguably facilitate broad
innovation while sharing risk and revenue.[32]
5.2. Trends among revenue-funded mHealth
projects
Analysis of the revenue-funded mHealth projects
revealed several common approaches to maintaining
financial self-sustainability. These strategies include
Revenue collecting client payments over time (instead of all at
0 once), minimising overall costs, using context-driven
34
1 project design, keeping technologies simple, having a
0 broad customer base, employing expert staff, and scal-
11
4
ing up by strategically evaluating if they should
42 broaden facilities or services.
5.3. Collecting client payments over time or
minimising costs
Sudden illness or injury can result in overwhelming
medical expenses. While health insurance is common
in most of the world, many mHealth projects are the
first to offer it to people in developing countries.
Some health services, such as emergency surgery, bill
large amounts at one time. Most people in the devel-
oping world do not have the savings to cover these
costs, so some mHealth projects charge small mem-
bership or subscription fees that act as insurance so all
subscribers can collectively cover necessary expensive
health services over time. For example, subscribers to
AMCARE-Diabetes Management Bangladesh pay a
monthly fee starting from US $0.60 to AMCARE to get
help with at-home compliance with their diabetes care
protocol.[33] Other mHealth projects charge out-
of-pocket fees at the time of care, but they minimise
costs so that they are 1080% less than their closest
local competitors. This sometimes entails utilising slid-
ing scales so people pay what they can afford, includ-
ing offering free services to the poorest users. For
example, the price point of an average consultation,
diagnosis and treatment at Access Afya is around US
$4, about a fifth of the cost at the nearest private
clinic.[34] Their customers are Kenyans living in infor-
mal settlements and Access Afyas context-appropriate
price point is accomplished by building strategic part-
nerships with other community institutions.
5.4. Context-driven project design
Most revenue-funded projects partner with local, com-
munity-based organisations to better understand the
context and deliver more effective services. They rec-
ognise that they need a deep understanding of the
local context and sound validation of the value prop-
osition to derive revenue from their operations. In
studying the local context, they learn about local ways
of thinking and operating, local leaders and commu-
nity dynamics, and local challenges and strengths. An
example of a project grounding their value proposition
in the local context is DoctHERS-In-the-House, which
was created in light of local socio-cultural barriers for

females with medical training who are restricted to
their homes. Tele-healthlines allow these women to
care for patients via 24/7 hotlines.[35] Another
example is Smart Mobile, a venture which facilitates
timely and effective communication among public
health officials in response to infectious disease out-
breaks. Technologies are designed and built locally to
ensure the special needs of each region are accounted
for.[36] mHealth projects that intend to sustain them-
selves through self-generated revenue should ensure
they design their products and services with a deep
understanding of the context where they will be
operating.
5.5. Simple technologies
Revenue-funded mHealth projects tend to keep their
technologies simple: 29 of the 42 projects only used
phones and/or computers as their primary form of
technology, with the rest including other devices such
as PDA/tablet phones, unique IDs, and remote diag-
nostic tools. Amongst the revenue-funded mHealth
projects, the primary goal of the technologies is to
replace a traditional doctor visit by virtually connect-
ing doctors and patients. Secondarily, the technology
is used to improve data collection, organisation, or
analysis. Arogya Raksha Yojana Health Micro Insurance
enrols members by collecting their information via
mobile phone and sending it directly to the insurance
companys server.[37] Using mobile phones instead of
their former paper-based system has helped reduce
data entry errors, decreasing the time between enrol-
ment and delivery of insurance cards to customers.
LiveConsult relies only on computers and/or phones to
deliver its value of enabling clients to talk with a doc-
tor and receive health information and advice via
Internet chat software.[38] Instead of designing new
high-tech devices, mHealth projects can be successful
utilising existing widespread technology like cell
phones and/or computers.
5.6. Broad customer base
Revenue-funded projects seldom have a geographical
focusmost focus on urban, peri-urban and rural
areas. Most (29 of 42) of the revenue-funded projects
have a focus on primary care. This allows the projects
to work with a large range of ailments, rather than
focussing on a specific disease. Additionally, like a vast
majority of the projects overall, most (38 of 42) rev-
enue-funded projects work with the general popula-
tion. Focussing on a combination of urban and rural
areas, primary care, and the general population gives
JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 11
mHealth projects a broader customer base which
makes them more likely to derive adequate revenue
to become financially viable.
5.7. Expert staff and knowledge
Projects funded primarily by revenue tend not to cut
costs by cutting expertise. Thirty-four employ people
with medical training, using doctors or nurses that
work with them directly or remotely. These medical
professionals work for mHealth projects for extra
money alongside their formal job with a hospital, or
for a hospital in partnership with them. Projects that
only distribute general healthcare information also use
trustworthy sources, such as top tier universities and
research institutes. For example, Nokia Ovi Life Tools
uses information from the Gadja Mada University
Faculty of Medicine for its texts about pregnancy and
child care, health and fitness, and issues like respira-
tory problems and maintaining a healthy heart.[39]
Revenue-funded projects understand that for their
value proposition to be strong, they need to employ
people who are well-regarded and trusted in the com-
munities where they work. By spending money to hire
professionals, they are investing in expertise that will
drive people to pay for their services. Trust is incred-
ibly important for people to spend their hard-earned
money, so hiring the best professionals can pay off for
mHealth ventures.
5.8. Broadening facilities or services
Thirty-three of the projects only operate within one
country, with another eight operating in two or three
neighbouring countries, and just one operating glo-
bally. However, all revenue-funded projects have
growth aspirations, some in-country and others intelli-
gently translating their work to other countries. They
advertise strategies they will use to scale up their
operations to reach larger portions of the population.
Approaches include adding more facilities in the same
country (n 5), offering a wider range of products and
services (n 7), and replicating the project in nearby
countries (n 8). Increases in revenue are used to
expand the project to reach more patients. Revenue-
driven projects are always thinking how they can do
more in an economically sustainable way, leading to
economies of scale and economies of scope.
6. Conclusion
mHealth projects are tackling technological, social and
economic barriers to healthcare access in developing
12 I. GORSKI ET AL.
countries, and hold great promise due to the increas-
ing accessibility and affordability of mobile devices.
Each mHealth endeavour ought to provide a substan-
tive value proposition to its customer base, preferably
one that will generate self-sustaining revenue. The
nine value propositions delineated in this article are
by no means an exhaustive list, but can serve to help
governments, universities, NGOs, and other nonprofits
to design and sustain appropriate and effective
mHealth projects.
Among projects that sustain themselves primarily
from revenue, trends include dispersing costs of the
services offered over time; being responsive to the
local socioeconomic and cultural context; keeping the
technology and processes simple; appealing to a wide
segment of the population (primary care for multiple
demographics); offering expertise wherever possible;
and scaling up by strategically broadening facilities or
services. Each of these best practices can be adapted
by new mHealth projects as they aim for financial sus-
tainability. New mHealth endeavours may also want to
consider partnering with for-profits since they are the
most common type of organisation championing rev-
enue-funded mHealth projects and may have more
experience in figuring out how to generate revenue
with their operations.
Acknowledgements
The authors would like to thank BL, SR and PG for their feed-
back on this manuscript. Icons in Figures 1 and 3 made by
Freepik are from flaticon.com.
Disclosure statement
The authors report no conflicts of interest. The authors alone
are responsible for the content and writing of this article.
Funding
The authors would like to thank the Pennsylvania State
University's College of Engineering's Global Engineering
Leadership Programme (GELP) for providing seed funding to
conduct this study.
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[93] MedAfrica. About us [Internet]. Available from:
http://medafrica.org/.
[94] Center for Health Market Innovations. Patient
Satisfaction Survey Mobile Program-Uganda
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/patient-satisfaction-survey-
mobile-program-uganda.
[95] Center for Health Market Innovations. Salud a
su Alcance (Health within Your Reach) [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/salud-su-alcance-health-within-your-
reach.
[96] Center for Health Market Innovations. psVerify
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/psverify.
[97] My Question and My Answer Service. About us
[Internet]. Available from: http://www.myquestion.
org/about-us.
[98] Mobile for Development Impact. Young Africa Live
[Internet]. Available from: http://www.m4dimpact.
com/analysis/case-studies/young-africa-live.
[99] Learning About Living [Internet]. Learning about
Living.
[100] Center for Health Market Innovations. AIDS
Prevention and Control Project [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/aids-prevention-and-control-project-apac.

[101] Center for Health Market Innovations. ProFam
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/profam-benin.
[102] Center for Health Market Innovations. Saadhan
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/saadhan.
[103] Center for Health Market Innovations. DiMPA
Network [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/dimpa-
network.
[104] Center for Health Market Innovations. Text Me! Flash
Me! Helpline [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/text-me-flash-
me-helpline.
[105] Center for Health Market Innovations. The Cell-Life
Project [Internet]. 2016. Available from: http://health-
marketinnovations.org/program/cell-life-project.
[106] V. Rwanda Health Connection through a Hotline
Channel [Internet]. Available from: http://healthmar-
ketinnovations.org/program/rwanda-health-connec-
tion-through-hotline-channel.
[107] Freedom HIV/AIDS. About [Internet]. Available from:
http://www.freedomhivaids.in/.
[108] Center for Health Market Innovations. Plis Kontwol
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/plis-kontwol.
[109] The SHM Foundation. Project Zumbido [Internet].
Available from: http://shmfoundation.org/?page_id
323.
[110] Center for Health Market Innovations.
APPRENDE Bolivia [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
apprende-bolivia.
[111] Center for Health Market Innovations. E-counseling
PULIH [Internet]. 2016. Available from: http://health-
marketinnovations.org/program/e-counseling-pulih.
[112] Operation ASHA. About Us [Internet]. Available from:
http://www.opasha.org/about/.
[113] Center for Health Market Innovations. AMUA
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/amua.
[114] SANA: Open Source Telemedicine; 2016, January.
About Sana [Internet]. Available from: http://sana.
mit.edu/
[115] Center for Health Market Innovations. Uganda Health
Information Network [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/uganda-
health-information-network-uhin.
[116] Center for Health Market Innovations. RapidSMS
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/rapidsms-malawi.
[117] BRAC Manoshi; 2016, January. Who We Are
[Internet]. Available from: http://www.brac.net/our-
approach#.UFAXNq4myTM
[118] Center for Health Market Innovations. Nokia Data
Gathering [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/nokia-data-
gathering.
[119] Center for Health Market Innovations. GATHERdata
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/gatherdata.
JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 15
[120] Center for Health Market Innovations. Handhelds for
Health [Internet]. 2016. Available from: http://health-
marketinnovations.org/program/handhelds-health.
[121] Center for Health Market Innovations. Remote
Interaction, Consultation, and Epidemiology
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/remote-interaction-consult-
ation-and-epidemiology-rice.
[122] Center for Health Market Innovations. Global Polio
Eradication Initiative [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/global-
polio-eradication-initiative-gpei.
[123] Center for Health Market Innovations. Early Infant
Diagnosis Project [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/early-
infant-diagnosis-project-eid.
[124] Center for Health Market Innovations. Global
Authentification Network [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
global-authentification-network.
[125] Hope Foundation for Women & Children of
Bangladesh. About Us [Internet]. Available from:
http://www.hopeforbangladesh.org/about-us/.
[126] Center for Health Market Innovations. Jamii Smart
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/jamii-smart.
[127] Center for Health Market Innovations. ChildCount
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/childcount.
[128] Center for Health Market Innovations. Surveillance in
Post Extreme Emergencies and Disasters [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/surveillance-post-extreme-emergencies-
and-disasters-speed.
[129] Center for Health Market Innovations. Mobile Phones
for ttC/MNCH in Sierra Leone [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/mobile-phones-ttcmnch-sierra-leone.
[130] Center for Health Market Innovations. Aceh Besar
Midwives With Mobile Phones [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/aceh-besar-midwives-mobile-phones.
[131] Center for Health Market Innovations. All Purpose
Medical Information System [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/all-purpose-medical-information-system-
apmis.
[132] Center for Health Market Innovations. Health
Consortium Somalia [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/health-
consortium-somalia-hcs.
[133] Center for Health Market Innovations. BlueStar
Healthcare Network [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/blue-
star-health care-network-uganda.
[134] Center for Health Market Innovations. mHealth Sri
Lanka [Internet]. 2016. Available from: http://health-
marketinnovations.org/program/mhealth-sri-lanka.
[135] Center for Health Market Innovations. Arrow Web
Hospital [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/arrow-web-
hospital.
16 I. GORSKI ET AL.
[136] Center for Health Market Innovations. Kutana Cloud
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/kutana-cloud.
[137] Center for Health Market Innovations. Mobile Care
for Remote Diagnosis and Screening [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/mobile-care-moca-remote-diagnosis-and-
screening.
[138] Center for Health Market Innovations. Secured
Health Information Network and Exchange [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/secured-health-information-network-
and-exchange-shine.
[139] Lester Feder J. Cell-phone medicine brings care to
patients in developing nations. Health Aff
(Millwood). 2010;29:259263. Available from: http://
content.healthaffairs.org/content/29/2/259.full.
[140] Lester RT, Ritvo P, Mills EJ, et al. Effects of a
mobile phone short message service on antiretro-
viral treatment adherence in Kenya (WelTel
Kenya1): a randomised trial. Lancet. 2010;376:
18381845.
[141] Treatment Advice by Mobile Alerts. MOTECH Suite
[Internet]. Available from: http://www.motechsuite.
org/.
[142] Cell Life. About us [Internet]. Available from: http://
www.cell-life.org/about-us/.
[143] Donna B. Texting for change. Stanford Soc Innovat
Rev. [Internet]. 2013. Available from: http://ssir.org/
articles/entry/the_future_of_health_care_access.
[144] CDC Foundation. Mobile health: how phones are
reshaping healthcare in Africa [Internet]. Available
from: http://www.cdcfoundation.org/content/mobile-
health-how-phones-are-reshaping-healthcare-africa.
[145] Center for Health Market Innovations. uNotify system
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/unotify-system-technology-
provider.
[146] BroadReach Healthcare. About us [Internet].
Available from: http://www.broadreachhealthcare.
com/about-us/.
[147] Center for Health Market Innovations. Phoned pill
reminders for TB treatment [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
phoned-pill-reminders-tb-treatment.
[148] Center for Health Market Innovations. TRACnet
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/tracnet.
[149] Center for Health Market Innovations. Virtual Health
Pet [Internet]. 2016. Available from: http://healthmar-
ketinnovations.org/program/virtual-health-pet.
[150] Center for Health Market Innovations. Smartphone
Thyroid Disease Management [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/smartphone-thyroid-disease-management.
[151] GlicOnline. About us [Internet]. Available from:
http://gliconline.net/quem-somos/.
[152] Center for Health Market Innovations. Zindagi
Mehfooz Program [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/zindagi-
mehfooz-safe-life-program.
[153] Center for Health Market Innovations. TxtAlert
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/txtalert.
[154] Living Goods. Overview [Internet]. Available from:
https://livinggoods.org/what-we-do/overview/.
[155] Mobile Ultrasound Projects: Morocco. Our story
[Internet]. Available from: http://www.mobileultra-
soundprojects.org/about.php.
[156] Center for Health Market Innovations. Satellite
African e-HEalth vaLidation [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
sahel-satellite-african-e-health-validation.
[157] Center for Health Market Innovations. M-CHANJO
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/m-chanjo.
[158] Medicall Home [Internet]. Available from: https://
medicallhome.com/MedicallHomeWeb/index.php.
[159] MeraDoctor [Internet]. Available from: http://www.
meradoctor.com/.
[160] eSwasthya [Internet]. Available from: http://www.
eswasthya.in/.
[161] NayaJeevan. About us [Internet]. Available from:
http://www.njfk.org/about-us/.
[162] Center for Health Market Innovations. Tsilitwa
Telehealth Project [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/tsilitwa-
telehealth-project.
[163] Sehat First. Welcome [Internet]. Available from:
http://www.sehatfirst.com/.
[164] Center for Health Market Innovations. Integrated
Rural Healthcare Pilot [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
integrated-rural-healthcare-pilot.
[165] Apollo Telemedicine Networking Foundation. About
ATNF [Internet]. Available from: http://www.apollote-
lehealth.com:9013/ATNF/about.jsp.
[166] Center for Health Market Innovations. Viva Afya
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/viva-afya-formerly-carego-
livewell.
[167] Center for Health Market Innovations. Smiling Sun
Franchise Program [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/smiling-
sun-franchise-program-ssfp.
[168] Center for Health Market Innovations. Primary
Healthcare Nursing Promotion Program [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/primary-healthcare-nursing-promotion-
program.
[169] Center for Health Market Innovations. Daktari 1525
Program [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/daktari-1525-
program.
[170] Baby Monitor. How it works [Internet]. Available
from: http://www.babymonitor.co/#page-content.
[171] Airtel. Welcome to mediphone [Internet]. Available
from: http://www.airtel.in/medi-phone/about_medi-
phone.html.
[172] Center for Health Market Innovations. INPPARES
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/inppares.

[173] Center for Health Market Innovations. Micro Health
Franchise System [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/micro-
health-franchise-system-umeedsey.
[174] Center for Health Market Innovations. Mobile
Diagnostic Services [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/mobile-
diagnostic-services-modise.
[175] Center for Health Market Innovations. Sante Health
Platform [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/sante-health-
platform.
[176] Center for Health Market Innovations. Text Rx
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/text-rx.
[177] TMC Group. About us [Internet]. Available from:
http://tmcg.co.ug/?page_id 6.
[178] Center for Health Market Innovations. Safer deliveries
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/safer-deliveries.
[179] Center for Health Market Innovations. Telemed med-
ical services [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/telemed-med-
ical-services.
[180] Center for Health Market Innovations. AAD
Telemedicine Project [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/aad-
telemedicine-project.
[181] Center for Health Market Innovations. Africa
Teledermatology Project [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
africa-teledermatology-project.
[182] Healthspring. Who we are [Internet]. Available from:
https://healthspring.in/about/.
[183] Center for Health Market Innovations. Fistula Hotline
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/fistula-hotline.
[184] Totohealth. About us [Internet]. Available from:
http://www.totohealth.org/about.
[185] iKure. Mission [Internet]. Available from: http://www.
ikure.in/index.php/who-we-are/mission.html.
[186] Center for Health Market Innovations. Wayo-Nero
Strategy [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/wayo-nero-
strategy.
[187] Center for Health Market Innovations. You and Me
Sexual Reproductive Health Center [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/you-and-me-sexual-reproductive-health-
centers.
[188] Vishwas. Who we are [Internet]. Available from:
http://www.vishwas.org.in/who-we-are-2.
[189] Center for Health Market Innovations. Biocon
Foundation mobile early detection and prevention
of oral cancer [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/biocon-foun-
dation-mobile-early-detection-and-prevention-oral-
cancer-medpoc.
[190] Maombi Project. Our mission [Internet]. Available
from: http://maombiproject.org/our-mission/.
JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 17
[191] MIRA Channel. What is MIRA channel [Internet].
Available from: http://www.mirachannel.org/What_is_
MIRA_Channel.aspx.
[192] Center for Health Market Innovations. Hand to hand
renal care [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/hand-hand-
renal-care.
[193] Dimagi. About Dimagi [Internet]. Available from:
http://www.dimagi.com/about/.
[194] Vula Mobile. About us [Internet]. Available from:
http://www.vulamobile.com/#About-Us-Section.
[195] Center for Health Market Innovations. Integrated
eCCM [Internet]. 2016. Available from: http://health-
marketinnovations.org/program/integrated-eccm-
community-case-management.
[196] Hello Doctor [Internet]. Available from: http://www.
hellodoctor.co.za/.
[197] Center for Health Market Innovations. HOTLINE and
SMS counseling [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/hotline-
and-sms-counseling.
[198] Center for Health Market Innovations. Dial 1911:
Chikitsa Paramarsh Evam Rogi Shikayat Samadan
Seva [Internet]. 2016. Available from: http://health-
marketinnovations.org/program/dial-1911-chikitsa-
paramarsh-evam-rogi-shikayat-samadan-seva-health-
advice-and-complaints.
[199] Hello Doctor 24x7. How it works [Internet]. Available
from: https://www.hellodoctor24x7.com/index.
php#hiw.
[200] Center for Health Market Innovations. Mobile direct
observation treatment for TB patients [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/mobile-direct-observation-treatment-tb-
patients-mdots.
[201] Center for Health Market Innovations. Improving
health services in North Pakistan through eHealth
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/improving-health-services-
north-pakistan-through-ehealth.
[202] Center for Health Market Innovations. TeleDoctor
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/teledoctor.
[203] Center for Health Market Innovations. Amputee
screening via cellphone networking [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/amputee-screening-cellphone-networking-
ascent.
[204] National Telehealth Center. About [Internet].
Available from: https://telehealth.ph/about/.
[205] Center for Health Market Innovations. M-DOK:
Mobile Telehealth and Information Resource System
for Community Health Workers [Internet]. 2016.
Available from: http://healthmarketinnovations.org/
program/m-dok-mobile-telehealth-and-information-
resource-system-community-health-workers.
[206] Center for Health Market Innovations. Uliza clinicians'
HIV hotline [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/uliza-clini-
cians-hiv-hotline.
18 I. GORSKI ET AL.
[207] Center for Health Market Innovations. M-Kifafa
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/m-kifafa.
[208] Telenor Group. M4H [Internet]. Available from: http://
www.telenor.com/sustainability/initiatives-worldwide/
mhealth-partnership-supports-motherinfant-health/.
[209] Praekelt Foundation. Access for all [Internet].
Available from: http://www.praekeltfoundation.org/.
[210] Project Masiluleke. About [Internet]. Available from:
http://www.poptech.org/project_m.
[211] Center for Health Market Innovations. BlueStar
Vietnam [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/bluestar-
vietnam.
[212] Jacaranda Health. Jacaranda's Model [Internet].
Available from: http://jacarandahealth.org/our-
approach/jacarandas-model/.
[213] Center for Health Market Innovations. TTC: SMS to
improve HIV awareness [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
ttc-sms-improve-hiv-awareness.
[214] Center for Health Market Innovations. SMS bulktool
for HIV/AIDS education [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
sms-bulktool-hivaids-education.
[215] Center for Health Innovations. Health education
response [Internet]. 2016. Available from: http://
health marketinnovations.org/program/health-edu-
cation-response-her.
[216] Center for Health Market Innovations. HIV/AIDS
video distribution by mobile phone [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/hivaids-video-distribution-mobile-
phone.
[217] Center for Health Market Innovations. Chinese aged
diabetic assistant [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/chinese-
aged-diabetic-assistant-cada.
[218] Center for Health Market Innovations. Mobile phones
for health monitoring [Internet]. 2016. Available
from: http://healthmarketinnovations.org/program/
mobile-phones-health-monitoring.
[219] Center for Health Market Innovations. Enhancing
nurses access for care quality and knowledge
through technology [Internet]. 2016. Available from:
http://healthmarketinnovations.org/program/enhanc-
ing-nurses-access-care-quality-and-knowledge-
through-technology-enacqkt.
[220] Center for Health Market Innovations. HealthLine,
Pakistan [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/healthline-
pakistan.
[221] Center for Health Market Innovations. Community
Health Project [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/community-
health-project-chp.
[222] Center for Health Market Innovations. Health child
Uganda [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/health-child-
uganda.
[223] Center for Health Market Innovations. Kenya inte-
grated mobile MNCH information platform [Internet].
2016. Available from: http://healthmarketinnovations.
org/program/kenya-integrated-mobile-mnch-informa-
tion-platform-kimmnchip.
[224] Center for Health Market Innovations. Aponjon
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/aponjon.
[225] Gremeen Foundation. AppLab [Internet]. Available
from: http://www.grameenfoundation.org/where-we-
work/sub-saharan-africa/uganda.
[226] Our Family Clinic. About us [Internet]. Available
from: http://www.ourfamilyclinic.org/ABOUT_US.html.
[227] Center for Health Market Innovations. Wazazi
Nipendeni [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/wazazi-
nipendeni.
[228] Center for Health Market Innovations. Out of school
access to sexual health education and economic
strengthening [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/out-school-
access-sexual-health-education-and-economic-
strengthening-oases.
[229] SaferMom. About us [Internet]. Available from:
http://www.safermom.org/about_us.php.
[230] Mobile Alliance for Maternal Action. About Mama
[Internet]. Available from: http://www.mobilemamaal-
liance.org/who-we-are.
[231] Center for Health Market Innovations. SRHMatters
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/srhmatters.
[232] Center for Health Market Innovations. APROPO
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/apropo.
[233] Center for Health Market Innovations. COPPRENDE
[Internet]. 2016. Available from: http://healthmarke-
tinnovations.org/program/copprende.
[234] Center for Health Market Innovations. mHealth in
Vietnam [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/mhealth-viet-
nam.
[235] Center for Health Market Innovations. SMS Infor
Obat Murah [Internet]. 2016. Available from: http://
healthmarketinnovations.org/program/sms-info-obat-
murah.
 JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 19

Appendix A
234 mHealth projects reviewed

Project/organisation Country/region Source

Empowering medical professionals
VillageReach Africa [27]
Project Mwana Malawi, Zambia [28]
GxAlert Botswana, India, Kenya, Mozambique, Myanmar, Nigeria [26]
1075 IDSP Call Center India [40]
The Chipatala Cha Pa Foni (CCPF) Program Malawi [41]
TIBU Kenya [42]
Energize the Chain (EtC) Africa [43]
Reliefwatch Honduras, Mozambique, Nicaragua, Panama [24]
Medic Mobile Malawi [44]
MEEDS Botswana, Tanzania [45]
CliniPAK Kenya, Nigeria [25]
Narayana Hrudayalaya Africa, India [46]
Magpi Global [47]
Voxiva Global [48]
SEWA Rural India [49]
RapidSMS Global [50]
Mobile Care, Support and Treatment Manager (MCST) India [51]
MediNet Healthcare Management System Trinidad and Tobago [52]
Alerta DISAMAR Peru [53]
Cell Phone Application Suite Mozambique [54]
Health eVillages Haiti, Sudan, Kenya, Uganda [55]
D-Tree International Pakistan, Malawi, Tanzania, Sri Lanka, Benin, India [56]
Trilogy Emergency Relief Application Haiti [57]
FrontlineSMS Africa [58]
Community Health Nurse on the Go Ghana [23]
Mobiles for Quality Improvement Uganda [22]
Ad-din Ambulances Bangladesh [59]
Bettercare South Africa [60]
PACE MD Mexico, Panama [61]
Mobile Doctor Network Ghana [62]
Community Health Workers PhoneReporting Uganda [63]
Increased institutional efficiency
International Planned Parenthood Federation Global [64]
SMS for Life Africa [65]
Community Health Information Tracking System Philippines [66]
TexTB Philippines [67]
MediAngels Global [68]
Wireless Health Incident Monitoring System India [69]
Capacity Kenya Kenya [70]
CommTrack Ghana, Malawi, Tanzania, Uganda [71]
Healthy Entrepreneurs Burundi, DRC, Haiti, Rwanda [29]
Danish Refugee Council mHealth Project Somalia [72]
Blood 24/7 India [73]
Payment
MobiSure Kenya [74]
Changamka MicroHealth Kenya [75]
BayadLoad Philippines [76]
Dengue Fever Insurance Indonesia [77]
CIC M-BIMA Kenya [78]
PhilHealth Remittance By-Air Philippines [79]
m-Money for Women with Fistula Kenya [80]
National Hospital Insurance Fund Kenya [81]
Movercado Mozambique [82]
Afya Milele Kenya [83]
The SureHealth Plan Nigeria [84]
InstAid Kenya [85]
Penda Health Kenya [86]
Linda Jamii Kenya [87]
LUnion Technique de la Mutualite Malienne Mali [88]
BlueStar Pilipinas Philippines [89]
Yarona Care Pay-As-You-Go Healthcare South Africa [14]
Mamakiba Kenya [90]
Sajida Foundation Health Program Bangladesh [91]
Quality control of care
mPedigree Ghana [30]
(continued)
20 I. GORSKI ET AL.

Project/organisation Country/region Source

Sproxil India [92]
MedAfrica Africa [93]
Patient Satisfaction Survey Mobile Program Uganda [94]
Swasthya Vaani India [31]
Salud a su Alcance Guatemala [95]
psVerify India [96]
Stigma avoidance
Marie Stopes International Global [21]
My Question My Answer Nigeria [97]
Young Africa Live South Africa, Kenya, Tanzania [98]
Learning About Living Nigeria [99]
AIDS Prevention and Control Project India [100]
ProFam Benin [101]
Saadhan India [102]
DiMPA Network India [103]
Text Me! Flash Me! Helpline Ghana [104]
The Cell-Life Project South Africa [105]
Rwanda Health Connection through a Hotline Channel Rwanda [106]
Freedom HIV/AIDS India [107]
Plis Kontwol Haiti [108]
Project Zumbido Mexico [109]
APPRENDE Bolivia [110]
DoctHERS-In-the-House Global [35]
E-counseling PULIH Indonesia [111]
Data collection/storage
Cell-PREVEN Peru [17]
MoTeCH Ghana [18]
Operation ASHA India, Cambodia [112]
National Health Insurance Program India [15]
Arogya Raksha Yojana Health Micro Insurance India [37]
AMUA Kenya [113]
SANA: Open Source Telemedicine Brazil, Greece, Haiti, India, Kenya, Philippines [114]
Uganda Health Information Network Uganda [115]
RapidSMS Malawi [116]
BRAC Manoshi Bangladesh [117]
Nokia Data Gathering Brazil [118]
GATHERdata Mozambique, Uganda [119]
Handhelds for Health India [120]
Remote Interaction, Consultation, and Epidemiology (RICE) Vietnam [121]
Global Polio Eradication Initiative (GPEI) Global [122]
Early Infant Diagnosis (EID) Project Kenya, Uganda [123]
Global Authentification Network Ghana, Nigeria [124]
Hope Foundation for Women and Children of Bangladesh Inc. Bangladesh [125]
Jamii Smart Kenya [126]
ChildCount Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Tanzania, [127]
Uganda
Surveillance in Post Extreme Emergencies and Disasters (SPEED) Philippines [128]
Mobile Phones for ttC/MNCH in Sierra Leone Sierra Leone [129]
Aceh Besar Midwives with Mobile Phones Indonesia [130]
All Purpose Medical Information System (APMIS) Nigeria [131]
Health Consortium Somalia Somalia [132]
Access Afya Kenya [34]
BlueStar Healthcare Network Uganda [133]
Jaroka Tele-Healthcare Pakistan [19]
mHealth Sri Lanka Sri Lanka [134]
Arrow Web Hospital Kenya [135]
e-Analysis Turkey []
Kutana Cloud Kenya [136]
Mobile Care (MoCa) for Remote Diagnosis and Screening Indonesia, Laos, Malaysia, Philippines, Vietnam [137]
Text4Baby USA [11]
Secured Health Information Network and Exchange (SHINE) Philippines [138]
Omomi Nigeria [20]
Drug adherence
SIMPill South Africa [10]
Vitality GlowCap USA [11]
VidaNet Mexico [139]
WelTel Kenya [140]
Treatment Advice by Mobile Alerts India [141]
Cell Life South Africa [142]
Vumi South Africa [143]
mPEP Kenya [144]
(continued)
 JOURNAL OF MEDICAL ENGINEERING & TECHNOLOGY 21

Project/organisation Country/region Source

uNotify System India [145]
BroadReach Healthcare Down Referral Model South Africa [146]
Phoned Pill Reminders for TB Treatment Thailand [147]
TRACnet Rwanda [148]
Virtual Health Pet Brazil [149]
Smartphone Thyroid Disease Management Mexico, Uganda, USA [150]
GlicOnline Brazil [151]
Zindagi Mehfooz (Safe Life) Program Pakistan [152]
TxtAlert South Africa [153]
X Out TB Nicaragua, Pakistan [12]
AMCARE Bangladesh [33]
Living Goods Uganda, Kenya [154]
Easier access to healthcare
Mobile Ultrasound Patrol Program Morocco [155]
SAHEL Kenya, Senegal [156]
M-CHANJO Kenya [157]
World Health Partners India [8]
Medicall Home Mexico [158]
MeraDoctor India [159]
E-swasthya India [160]
Text for Life Kenya [144]
Naya Jeevan Pakistan [161]
Tsilitwa Telehealth Project South Africa [162]
Sehat First Pakistan [163]
Integrated Rural Healthcare Pilot India [164]
Apollo Telemedicine Networking Foundation Bangladesh, India, Kazakhstan, Maldives, Nigeria, Oman, Pakistan, [165]
Sri Lanka, Sudan, Yemen
Viva Afya Kenya [166]
Smiling Sun Franchise Program Bangladesh [167]
Primary Healthcare Nursing Promotion Program Guatemala [168]
Daktari 1525 Program Kenya [169]
Baby Monitor Kenya [170]
Mediphone India [171]
INPPARES Peru [172]
Micro Health Franchise System (UmeedSey) Pakistan [173]
Mobile Diagnostic Services (MODISE) Kenya, Tanzania [174]
Sante Health Platform South Africa [175]
Text Rx India [176]
The Medical Concierge Call Center and Service Uganda [177]
Safer Deliveries Tanzania [178]
Djantoli Mali [9]
Telemed Medical Services Ethiopia [179]
AAD Telemedicine Project Botswana, Egypt, Ghana, Kenya [180]
Africa Teledermatology Project Botswana, Burkina Faso, Lesotho, Malawi, Swaziland, Uganda [181]
NationWide Primary Healthcare Services India [7]
Healthspring India [182]
Fistula Hotline Sierra Leone [183]
Totohealth Kenya [184]
iKure India [185]
Wayo-Nero Strategy Uganda [186]
You and Me Health Center China [187]
Vishwas India [188]
Mobile Early Detection and Prevention of Oral Cancer (mEDPOC) India [189]
The Dr. Maombi Project Tanzania [190]
MIRA Channel (Women Mobile Lifeline Channel) India [191]
Hand to Hand Renal Care Kenya [192]
Dimagi Afghanistan, African continent, Guatemala, India, Myanmar, Nepal, [193]
Pakistan, Thailand, United States
Vula Eye Health App South Africa [194]
Integrated eCCM (Community Case Management) Malawi [195]
Hello Doctor South Africa [196]
HOTLINE and SMS Counselling Indonesia [197]
Smart Mobile Cambodia [36]
Dial 1911: Chikitsa Paramarsh Evam Rogi Sikayat Samadan Seva India [198]
(Health Advice and Complaints Cell for Health Services)
Hello Doctor 24/7 India [199]
Mobile Direct Observation Treatment for TB Patients (MDOTS) Kenya [200]
Improving Health Services in North Pakistan through eHealth Pakistan [201]
LiveConsult Indonesia [38]
TeleDoctor Pakistan [202]
Amputee Screening via Cellphone Networking (ASCENT) Philippines [203]
(continued)
 22 I. GORSKI ET AL.

Project/organisation Country/region Source

National Telehealth Center Philippines [204]
M-DOK: Mobile Telehealth and Information Resource System for Philippines [205]
Community Health Workers
Uliza Clinicians' HIV Hotline Kenya [206]

Education programmes
M-Kifafa Kenya [207]
Mobiles for Health (M4H) Bangladesh [208]
Praekelt Foundation South Africa [209]
mPowering India [13]
Project Masiluleke South Africa [210]
BlueStar Vietnam Vietnam [211]
Jacaranda Health Kenya [212]
TTC Uganda [213]
SMS Bulktool Kenya [214]
Health Education Response (HER) Namibia [215]
HIV/AIDS Video Distribution by Mobile Phone Georgia [216]
Chinese Aged Diabetic Assistant (CADA) China [217]
Mobile Phones for Health Monitoring India, UK [218]
Enhancing Nurses Access for Care Quality and Knowledge through Antigua and Barbuda, Dominica, Dominican Republic, Saint Kitts & Nevis, [219]
Technology (ENACQKT) Saint Lucia
HealthLine Pakistan Pakistan [220]
Community Health Project (CHP) Tanzania [221]
Health Child Uganda Uganda [222]
Kenya Integrated Mobile MNCH Information Program Kenya [223]
(KimMNCHip)
Aponjon India [224]
AppLab Ghana, Indonesia, Uganda [225]
Our Family Clinic India [226]
Wazazi Nipendeni Tanzania [227]
Out of School Access to Sexual Health Education and Economic Nigeria [228]
Strengthening (OASES)
SaferMom Nigeria [229]
MAMA SA South Africa [230]
SRHMatters Pakistan [231]
APROPO Peru [232]
COPPRENDE Ecuador [233]
mHealth in Vietnam Vietnam [234]
Nokia Ovi Life Tools China, India, Indonesia, Nigeria [39]
SMS Info Obat Murah Indonesia [235]

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