Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania

BackgroundThere is increasing evidence that mobile phone health interventions (“mHealth”) can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania.MethodsWe delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume.ResultsIn three of four scenarios, costs exceeded revenue by $94,596,$34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54$203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a$5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs.ConclusionsThese results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program’s reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact

Promoting vasectomy services in Uganda

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Malawi

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in the Philippines

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Ethiopia

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Rwanda

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Kenya

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promouvoir les services de vasectomie au Burundi

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

How to create successful vasectomy programs

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Recent experiences and lessons learned in vasectomy programming in low-resource settings: A document review

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This report is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming