The Covid-19 pandemic has led to significant global restrictions on mobility and reduced access to public services. For many people, technology – such as mobile phones – has played a vital role in supporting access to information that is essential for individuals’ health and livelihoods. However, these kind of restrictions are not a new challenge for many poor and marginalised communities in low-income countries, where timely access to agricultural and health extension services and support has been a persistent, major barrier to improving agricultural income, health and nutrition.
Over the past few decades many governments, mobile operators and development actors have invested in supporting and developing mobile-based services as a tool to channel information considered important for improving people’s health and livelihoods. Whether it be for rural farmers receiving weekly tailored information on crop prices and farming tips in areas where agricultural extension services are poor (as is the case with Vodafone Farmers’ Club service in Ghana), or new mothers receiving information about infant feeding practices when they can’t visit their local health centre (as is the case for the Wazazi Nipendeni programme in Tanzania). The objective of these services is often to fill a gap in people’s existing knowledge or compliment other sources of information to motivate individuals to change their existing practices and ultimately improve their lives.
But do we know if these sort of mobile advisory services actually help improve people’s knowledge and practices, as well as increasing mobile companies’ customer base? Alongside the rapid global spread of mobile phone use and ownership amongst low-income groups, evidence on the effectiveness of these services in changing behaviour has steadily increased and paints a largely positive picture. Having said that, this has mostly come from small pilot studies or research using limited/less robust methods making it hard to draw broader and concrete conclusions. The recently completed impact evaluation of the GSMA mNutrition initiative supported by the UK Foreign, Commonwealth & Development Office (FCDO), managed by Oxford Policy Management (OPM) and led by IDS together with the International Food Policy Research Institute (IFPRI) and Gamos, has in part addressed this gap. It has generated a wealth of evidence about the impact, cost effectiveness and commercial sustainability of these types of services in the low-income country context.
The mNutrition evaluation, which ran from 2016-2020, focused on two case studies in Ghana and Tanzania and revealed that whilst these types of mobile services have the potential to benefit poor and marginalised communities at scale, there are lots of lessons to be learned if their potential is to be fully realised.
Ensuring effective reach and uptake of service by target population
In both Ghana and Tanzania we found reach and uptake was lower than expected. Reasons include a lack of technological infrastructure (e.g. network coverage, electricity access), users’ capacity (e.g. high rates of illiteracy) and issues with service design (e.g. lack of human support) or implementation (e.g. services discontinued without warning or reason).
Changing people’s behaviours at scale
In Tanzania, we found some modest positive impacts of the service on improving women’s knowledge on infant and young child feeding and on women’s and children’s diets. In Ghana we did not see any impacts on diet, agricultural production, income, nutrition or farming knowledge. Findings point to the need for services to incorporate/strengthen interactive components and face-to-face contact, to combine with financial services or other types of programmes to boost incomes to act on advice and promote support from local services where these are available.
Advantages of mobile phones as delivery channel versus other approaches
Mobile phones were found to be well-suited to delivery of location and time-sensitive information such as weather forecasts, market prices and different stages of pregnancy, including in remote inaccessible settings – provided there is network coverage. Compared to other more traditional behaviour change interventions, mobile-phone based information can be delivered at scale at low cost, accessed when convenient for the user, in private, with the ability to reread, share and save information received. It also saves time and resources for individuals to seek information in other ways.
Dr Inka Barnett, lead Principal Investigator and qualitative lead researcher on the evaluation, outlines six factors that are important for mobile phone interventions that aim to change behaviour.
Business model development, partnerships, and political commitment
Mobile-phone based information services involve complicated partnerships between content and platform providers and the mobile operator. Their design and viability can depend heavily on the national political context. For Wazazi Nipendeni in Tanzania, there was substantial government support and donor investment which in turn affected their costing model and financial sustainability (the government prohibited users having to pay for the service, whereas for other services such as Vodafone Farmers’ Club in Ghana, a monthly subscription fee was introduced). Our findings suggest that partnership arrangements need to be based on solid relationships and designed to respond to changing technological and market environments to ensure proper future proofing.
Adapting to rapidly evolving technological environments
Telecoms markets are in the process of shifting from voice and SMS services (as per the Ghana and Tanzania mNutrition case studies we focused on) to data services, such as mobile money, social networks and entertainment services. Emerging digital information services are now starting to offer more comprehensive support packages, for example including credit, insurance and platforms for selling produce. However, these new types of services bring with them their own problems such as requiring higher digital literacy and the use of smartphones which risks widening the digital divide and leaving the poorest behind. Donor-led initiatives must be agile to fit with the rate of change in the telecoms industry and promote digital literacy.
Comparing business models
The evaluation’s findings suggest a service with a provider that markets the service themselves and is available across all networks may be more effective in changing behaviour than one which enters into partnership with a specific mobile operator and markets the service to all network subscribers. Achieving sufficient subscriber numbers is crucial, as is the opportunity to generate revenue through selling additional services.
Clearly mobile-phone based services have the potential to support improved nutrition and agriculture-related knowledge and behaviours, but only if measures are put in place to support, facilitate and sustain engagement with the service alongside other means of support. Given the additional challenges the Covid-19 pandemic has placed on communities accessing already poor or limited government services, there is an even greater gap in support that – if done in the right way – mobile-phone based services might be able to fill.