Kate Otto

By Kate Otto. What do you think is the key to a great mHealth tool?  Is it efficiency?  Scalability?  Interoperability with similar systems?

I would argue none of the above.

I would say that the key to a great mHealth tool is a great health worker at the helm.

My name is Kate Otto and I work with the World Bank and other partners to develop and test the effectiveness of mHealth tools on health outcomes.  Based on two recent mHealth experiences – one with health extension workers (HEWs) in rural Ethiopia and another with midwives in urban Indonesia – I have noted a recurring lesson in this emerging field: that technology is not the solution itself but simply a means to arriving at a solution.  The people behind the tools are what make the difference between success and failure.

Too often, the sleek and impressive nature of new technologies makes the headlines: how they solve all the problems that human beings tend to mess up so sorely, how they avoid any mishaps in the first place with a fool-proof design.

Yet the truth is, the success of mHealth tools and applications are based largely on the intrinstic motivation of the end user – and how tools can be designed to leverage, not stamp out, that motivation.

Our product in Ethiopia allows HEWs to register expecting mothers and newborns so that they receive back appointment reminders, creating a patient schedule for the HEW and increasing the likelihood that she’ll deliver the proper care at the proper time, ideally decreasing maternal mortality, increasing vaccinations, and decreasing infant and child mortality.  But if a HEW does not deeply care about saving lives, if the tool does not work smoothly with her rugged lifestyle, if she cannot see the immediate benefit of using it over the status quo system, then will she take the effort to use it properly or consistently?

In Indonesia, it struck me that most midwives who helped developed the tool cared less about cutting data entry time from their day, and most about having quickly aggregated data fed back to them to compare across other neighborhoods: how did they compare and how could they improve performance?  I can’t say I had initially thought to design a feedback report into the system – but it quickly became part of the plan.

I would encourage investors in mHealth to think of the investment not as one in technology, but as one in human capital – if you’re doing it right.  This means spending extensive time iterating on design with end users, testing final models to ensure incentives are aligned across all partners, training providers and system administrators to work independently from a donor or innovator, and ensuring that the outcomes desired by the end users are being attained.

We must continue to invest in technology for health, but we must do so wisely: at the hand-holding the phone, and pay attention first to the people behind the tool.

Kate Otto works in the field of public health, experimenting at the intersection of new technologies and human behavior. She works with the World Bank in Ethiopia assessing the impacts of mobile phone tools on maternal health outcomes, and with Innovations for Poverty Action in Zambia, applying behavioral economics to find health systems solutions.  Kate has finished writing a book called Everyday Ambassador: Changing the World Starts with Changing Yourself.  More information is available through her website, TEDx talk, Facebook page, and on Twitter.

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