The MAPS Toolkit: An Assessment & Planning Tool for Scaling and Sustaining Mobile Health Interventions

By Nikhil D. Patil, Monitoring, Evaluation, & Research (MER) Department Manager at eHealth Africa

The Global mHealth Forum is a two-day event convening during the mHealth Summit, one of the biggest annual gatherings of mobile health professionals and entrepreneurs, globally. Presented in partnership with USAID and the mHealth Working Group, this year’s Global mHealth Forum took place in Washington, DC from November 9 - 11, 2015 and was attended by more than 4,000 delegates from around the world. The 2015 focus was on mobile and connected health in low and middle income countries.

One of the sessions that Taylor & I were most excited about was an interactive presentation on the newly released MAPS Toolkit: mHealth Assessment and Planning for Scale. The MAPS Toolkit was officially launched in September 2015, and the Global mHealth Forum was one of the first public meetings for stakeholders, partners, and beneficiaries to engage with the toolkit.

The MAPS Toolkit is a “comprehensive self-assessment and planning guide designed to improve the capacity of projects to pursue strategies that increase their potential for scaling-up and achieving long-term sustainability.” This tool is designed for use by project managers, specifically teams with an mHealth product that has already been deployed, and who are aiming to scale the product and increase impact. While global health experience formed the tool, its use can be expanded far beyond the health context and into related fields like economic equality and agricultural production. The toolkit was developed by a consortium of partners including the WHO Department of Reproductive Health and Research, the UN Foundation, and the Johns Hopkins University Global mHealth initiative.

Harnessing feedback from mHealth implementers and technical experts on their experiences with scaling mobile health interventions in the field, the MAPS Toolkit provides a framework for scale and sustainability using six major “axes”: groundwork, partnerships, financial health, technology & architecture, operations, and monitoring & evaluation. These six axes contain a set of structured questionnaires for both team members and teams as a whole with a resulting scorecard that will help projects gain a better understanding of where that project needs to go on its “journey” towards scale and sustainability. The toolkit also serves as a decision tool, helping implementers devise strategies to overcome barriers to scale. The activities contained within the toolkit are meant to be iterative and completed multiple times throughout the life-course of the project post-pilot.

According to the MAPS Toolkit, these are the six axes of scale, key determinants of successful scale-up and sustainability relevant to all mobile health projects:

1. Groundwork: The initial steps of specifying the key components of the project’s approach to scaling-up, assessing relevant contextual influences, and taking stock of the scientific basis for the product

2. Partnerships: Collaborations with external groups to support the process of scaling up, including strategies for identifying, developing and sustaining fruitful partnerships

3. Financial Health: The projection of scale-up costs, and the development of a financial plan for securing and managing funds over the long term

4. Technology & Architecture: Steps taken to optimize the mHealth product for scaling up based on its anticipated user base, purpose, integration with information systems and compatibility with other components of the information systems architecture

5. Operations: Organizational and programmatic measures for supporting the implementation, use and maintenance of the product throughout the scaling-up process

6. Monitoring & Evaluation: Decisions and activities that enable effective process monitoring and in-depth outcome evaluation, based on project and stakeholder needs

The presentation was extremely insightful for both Taylor & I, and the six interactive sessions following the introduction prompted us to discuss areas where we felt “weak” and “strong” with regards to projects within eHealth Africa’s product portfolio. Based on our experience with designing, implementing, and scaling mHealth products in low-resource settings, we felt the toolkit had a two main limitations.

First, the toolkit specifically states that it was designed for products that have already been deployed in the field, presumably an mHealth intervention that experienced proven “impact” in the pilot phase and is now looking to deliver value at scale. However, we feel that scale really should be considered prior to product development as there are key design factors related to the way that mHealth products are built that determine how and where the product can scale and be sustained. Building a product for 1,000 users is different from building a product for 10,000 users, which is different from building a product for 100,000 users. Invoking the recently developed Principles for Digital Development, a complementary tool that could be used prior to deployment would also be beneficial to mHealth organizations to ensure we’re ideating new products with scale in mind from inception. Fortunately, the toolkit’s axes are broad enough categories that they can provide a loose framework useful for program planners for this purpose. We were excited to chat with Dimagi at the mHealth Summit about their newly released Maturity Model which somewhat addresses this issue.

Second, assessment tools such as the MAPS Toolkit can require considerable resources and time on behalf of the implementing organization - including conducting the assessments and developing action plans to implement changes based on those results. In order to integrate the results of the MAPS Toolkit into scale and sustainability planning for mHealth products, donors and other stakeholders will need to see the value in such a tool and contribute funding for routine assessment & mid-course corrections throughout the journey to scale. Advocates for the toolkit should work with donors and encourage them to invest in the tool (financially) when working with implementers that are ready to scale their mHealth products.

Given the scope of the MAPS toolkit, there is definitely great potential to use it internally at eHA to better understand where our various mHealth products are and how we can help them scale across West Africa. We are excited to test out this tool and identify areas where eHA can improve our internal sustainability models to ensure impact at scale for our portfolio of mHealth products.

Nikhil D. Patil is the Monitoring, Evaluation, & Research (MER) Department Manager for eHealth Africa and is based in Kano, Nigeria. You can follow him on Twitter & Instagram (@npatil55). Taylor M. Snyder is a MER Consultant with eHA based in Salt Lake City, Utah. You can follow her on Twitter (@TaylorMarie_MPH).

The International Training of Trainers on Sweetpotato

Stephanie Okpere in Sweetpotato field during the ToT Training, ARMTI, Ilorin.

The International Training of Trainers (ToT) on "Everything You Ever Wanted to Know about Sweetpotato" was held in Ilorin, Kwara State, from October 5 -16. It was a 10-day intensive program, organized by the Agricultural and Rural Management Training Institute (ARMTI), the Federal Ministry of Agriculture and Rural Development, and the Government of Nigeria. eHealth Africa (eHA) was represented by Stephanie Okpere, Project Coordinator from the Nigeria office. Stephanie’s training was sponsored by the International Potato Center (CIP). 

ToT was organized as part of ARMTI's goal to train "extension personnel" on the latest developments in Sweetpotato production and utilization across Africa. ARMTI in the last three years has jointly organized this course with the CIP, and Helen Keller International’s and Reaching Agents of Change project. The ToT course aims at increasing investments in the Orange-Fleshed Sweetpotato (OFSP) to combat vitamin A deficiency among children and women of reproductive age.

"The Sweetpotato ToT Course was a great learning experience both in theory and practice. I did a presentation of the training to over 200 staff members of eHA, and also did a step down training on sweetpotato for 35 field personnel in Kano." Stephanie Okpere, Project Coordinator

Stephanie Okpere conducting step-down training in Kano.

ARMTI also seeks to build the capacity of public sector extension and NGO personnel to effectively implement initiatives aimed at promoting the dissemination and appropriate use of Vitamin A-rich OFSP in the value chain.

“The training on Sweetpotato to eHA staff was a great opportunity to build our programming capacity in OFSP-based Nutrition & Food Security interventions, and Agricultural Commodity Value Chain Drive in Kano and other States in Northern Nigeria.” - Dr. Sarma Mallubhotla, Program Manager, Health, Nutrition and Agriculture

Dr. Sarma Mallubhotla addressing the trainees in eHA.

Click here to read about the use of the Orange-Fleshed Sweetpotato to fight malnutrition in Africa.  

Information, Inspiration, & Equality: Reflections from the American Public Health Association 2015 Conference

by Nikhil D. Patil, MPH

In early November, I joined 12,000 of my fellow public health colleagues in Chicago, Illinois for the 2015 Annual Meeting of the American Public Health Association (APHA). APHA is a venue for public health professionals and leaders from around the world to discuss and share evidence and strategies for improving the health of populations, domestically and abroad. The theme for the 143rd meeting was “Health in all Policies,” highlighting the impact of where someone lives, works, learns, and plays on their ability to live a healthy life. The event focused on how we can create policies at community, state, and federal levels to ensure the scale and sustainability of public health interventions. 

Dr. Vivek Murthy, MD, MPA, the US Surgeon General reflected on this theme in his opening plenary saying “health has to be woven into every strand of public policy,” reminding all attendees that we must all step up and be the leaders that our world needs. He spoke of three elements at the heart of public health leadership: information, inspiration, and equality. First, public health needs to adapt to changing information platforms and identify the best avenues for communicating health messages. The information we communicate matters, but how we communicate that information is just as important and will require that public health modernizes its approach to reaching people through relevant channels. Second, information is not always sufficient to change behavior. Inspired messages through innovative platforms are necessary to increase people’s agency and empower them to live healthier lives. Finally, equity is central to public health practice and in order to remove inequality, every life has to been seen as valuable. 

He is hopeful about public health and the progress we’ve made in the field, saying “this is how we will change the world together: by modernizing how we share information; by finding ways to inspire and support people in their pursuit of health; and by ensuring we are creating a world that is grounded in equality, a world where opportunity is available to all.” I can’t think of a statement that is more reflective of the values eHealth Africa holds as an organization.

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Responding to this year’s theme, I was in attendance to present a poster on behalf of my Geographic Information Systems (GIS) and Monitoring, Evaluation, and Research (MER) colleagues. Titled “Mapping telecommunications coverage at public health facilities in Northern Nigeria,” the presentation focused on equitable mobile coverage being necessary to support mobile and electronic-health interventions, particularly in low-resource settings. The poster discussed a GIS-enabled methodology for modeling estimates of telecommunications coverage at public health facilities across Kano State, mapping two out of the four mobile network operators in Kano. The modeling methodology used a radio frequency approach and required location coordinates for cell towers and public health facilities; results estimated an overall low telecommunications coverage at health facilities across Kano. A methodology useful for program planners of mobile health programs, we advocated for the role that governments can play in developing policies to encourage improved mobile network infrastructure to support mHealth programs across the state, in partnership with the private sector telecommunications industry. 

eHA’s poster fit under APHA’s “Health Informatics & Information Technology” (HIIT) poster and presentation section. The accompanying poster presentation I gave was well-received. Several of the HIIT attendees requested additional information and connections with eHA and our services, which I look forward to following-up. Overall, the conference was well organized, although a bit hectic due to multiple, simultaneous meetings and presentations making it difficult to see and meet everyone. However, I left the conference excited about the advancements that my fellow public health colleagues were making to improve the health of populations around the world, and inspired to share some of what I learned with my colleagues back in Nigeria.

Nikhil D. Patil is the Monitoring, Evaluation, & Research Department Manager for eHealth Africa and is based in Kano, Nigeria. You can follow him on Twitter & Instagram (@npatil55).