Sustaining Mobile Health Applications in Africa

Nils van Osten is a recent master graduate who, as part of his studies, conducted research on the sustainability of Mobile Health (mHealth) in developing countries.

MHealth offers the opportunity for real-time communication and data transmission and thus shows promise to improve the education of users, empower them, and increase autonomy

van Osten defined mHealth in his research thesis as “healthcare interventions which are characterized by the usage of mobile devices to provide health information and services”. The research focuses on mHealth as part of healthcare delivery in Sub-Saharan Africa (SSA). In his work, van Osten finds that the potential of mHealth to facilitate healthcare in SSA is hindered by economic, political, technological, and social factors, e.g. “limited infrastructure, scarce resources, shortage of healthcare workers, and limited funding support”. This led to manifold failures of mHealth projects in the past, as for example in Uganda between 2008 and 2009 23 of 36 mHealth projects did not progress past the initial pilot phase.

Table 1. Existing barriers for the sustainability of mHealth projects in Sub-Saharan Africa

Economic Political Technological Social

-Funding issues

-Limited education 

-Missing cooperation

-Lack of regulation and support

-Missing evidence

-Scarce EHR

-Limited internet connectivity and electricity

-Absence of mobile devices and low usability

-Insufficient data collection

-High data costs

-Lack of education

-Technical knowledge

-Data privacy concerns


By interviewing mHealth experts of NPOs operating applications in SSA “regarding their experiences and actions to achieve sustainability as the long-term success of an application” van Osten identified the response strategies applied to overcome the aforementioned setbacks.

In his research van Osten interviewed one of our current project managers, Alyanne Boon, on the conditions to which Health[e]Foundation managed to continue the LUCY project in Ethiopia. LUCY used to be a voice and text service provider which, due to a few of the aforementioned barriers, was not able to continue. Nevertheless, this service was modified into an app to meet the challenges in Ethiopia, thus giving rise to a more cost-efficient and sustainable product, which is in use today.

As a result of the mHealth projects in question van Osten managed to develop a total of 23 fine-grained response strategies which are categorized into four types and visualized in the figure below.

Figure 1. Response strategies to overcome barriers of mHealth in SSA

The economic response strategies ensure financing and consideration of costs. For instance, it is necessary to generate evidence to underpin the investment case of the application and to ensure the provision of devices and charging options to the users.

Environmental strategies involve the government and the establishment of partnerships. It is vital to engage with the government to ensure the political support of the application while complying to the regulations and laws that are in place. Moreover, collaborating with other mHealth applications can help to provide a sophisticated application while offering multiple services in a single mHealth application.

Technological strategies ensure that the design of the application provides features like offline functionality (to deal with low connectivity) and that the generated data is used properly to improve the application as well as providing vital insights about the current healthcare situation to supervisors and stakeholders.

User-Acceptance strategies involve the user and embrace their feedback to ensure a direct value for the user through the mHealth application and provide continuous training on mobile device handling as well as the operation of the application and its upcoming features.

Read more on his work and research here.


Nils van Osten recently completed his master’s degree in management with a focus on digital transformation and information technologies. As part of his studies, he conducted research on the sustainability of Mobile Health in developing countries.

Throughout the program he assisted the Chair of Organization and Business Development in the areas of technology and research and gained additional work experience through an internal consulting internship.