Institutionalizing a Community-level mHealth Initiative in Madagascar

In order to improve the quality of health services and health data at the community level in Madagascar, the USAID Mikolo Project worked with the Ministry of Public Health (MOPH), the private sector, other local and international implementing partners, and end users to develop a mobile health (mHealth) application. The CommCare platform used in this initiative became part of the national health reporting system at the community level. The team aimed to solve three primary challenges: limited tools and guidance about how to implement and scale an mHealth application in Madagascar; diverse and disparate mHealth applications in use throughout the country that were not necessarily harmonized; and a need for information on the feasibility, acceptability, sustainability, and potential impact of a community-level mHealth application in the Madagascar context.

The three primary components of the CLA approach were: 1) collaborating and coordinating with stakeholders and partners to streamline the country's mHealth systems, to design the technical application, and to generate local buy-in to ensure sustainability; 2) partnering with the private sector to leverage additional financial resources; and 3) conducting a pilot evaluation to learn about the program's successes and challenges to adapt and refine the application for scale-up. By promoting adaptive management and co-creating, testing, and learning, the initiative contributed to local ownership, which increases likelihood of long-term sustainability. Additionally, the partnership helped the MOPH develop its own mHealth taskforce and built the capacity of community health actors to problem solve with each other, without the assistance of trainers, engendering self-reliance.