Beyond COVID-19: scaling up and sustaining mobile health in Africa – Authors' reply
Authors: N Hélène Sawadogo, Hamidou Sanou, Jeremy A Greene, Vincent Duclos
Journal: The Lancet (2021)

We thank Yap Boum for taking the time to respond to our Perspective.1Sawadogo NH Sanou H Greene JA Duclos V Promises and perils of mobile health in Burkina Faso.Lancet. 2021; 398: 738-739Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar Boum focuses on one particular dimension of our argument, namely that scaling up and securing long-term funding poses a considerable challenge for mobile health projects in Africa. It is indeed the case that the vast majority of mobile health interventions in sub-Saharan Africa are being designed as experimental, pilot infrastructure for care or surveillance. In response to this challenge, Boum calls for the creation of innovative financing mechanisms and strong political will. He appears particularly optimistic that more sustainable financing would lead to more viable mobile health infrastructure. In our own experience, however, long-term financing is only one among many conditions that need to be gathered for scaling up to be made possible. As we suggested in our Perspective,1Sawadogo NH Sanou H Greene JA Duclos V Promises and perils of mobile health in Burkina Faso.Lancet. 2021; 398: 738-739Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar a project such as MOS@N could not be durable without a series of improvisations in the face of challenges of all kinds—including crucial changes in the role of godmothers. The way that MOS@N has evolved over the course of 3 years was not anticipated. Although financing is certainly an important part of the story, MOS@N was held together by labour, commitments, and relations of care that do not easily translate into predictable features. In other words, while we agree with Boum that sustainable funding solutions are key to integrate mobile health into health-care infrastructure in sub-Saharan Africa, the work it takes to create scalability is messy and capricious. Funding is important but it is only one part of the story. Addressing the other parts entails rethinking our approach to mobile health projects altogether, perhaps insisting less on expectations of scalability and paying more attention to projects' capacity to transform and reinvent themselves as they expand. VD reports grants from a Steinberg Global Health Postdoctoral Fellowship at McGill University. HS reports grants from the International Development Research Center. All other authors declare no competing interests. Promises and perils of mobile health in Burkina FasoMobile health (mHealth) has attracted much attention in the global health community as a technological fix that can short-circuit inadequate health-system infrastructure and build access. But like many other technology-based approaches to remedy structural health inequities, mHealth interventions can be overhyped. We discusses here MOS@N, an mHealth network launched in 2013 by the Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso, with funding from the International Development Research Centre, Canada. Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in AfricaIn their Perspective,1 N Hélène Sawadogo and colleagues highlight the challenges of mobile health care in Africa with the MOS@N project, which provided medical support to pregnant women but ran out of funding 3 years into operation. Securing longer-term funding to sustain mobile health is a challenge in Africa.2 Social innovations such as BIMA (Ghana), AccesAfya (Kenya), Idocta (Cameroon), and Healthforce (South Africa) use telemedicine to improve access to quality health care but have not managed to scale up. Full-Text PDF