Defining a staged-based process for economic and financial evaluations of mHealth programs

Mobile and wireless technology for health (mHealth) has the potential to improve health outcomes by addressing criticalhealthsystems constraints that impede coverage, utilization, and effectivenessof health services. To date, few mHealth programs have beenimplemented at scaleand there remains a paucity of evidence on their effectiveness and value formoney. This paper aims toimproveunderstanding among mHealth program managers and key stakeholders of how to select methods for economicevaluation (comparativeanalysis for determining value for money) and financial evaluation (determination of the cost ofimplementing anintervention, estimation of costs for sustaining or expanding anintervention, and assessment of its affordability). We outline a 6 stage-basedprocess for selecting and integrating economic and financial evaluation methods into the monitoringand evaluation of mHealth solutions including (1)defining the program strategy and linkages with key outcomes, (2) assessmentof effectiveness, (3) full economic evaluation or partial evaluation, (4)sub-group analyses, (5) estimatingresource requirements for expansion, (6)affordability assessment and identification of models for financialsustainability. Whileapplication of these stages optimally occurs linearly,finite resources, limited technical expertise, and the timing of evaluationinitiationmay impede this. We recommend that analysts prioritize economic andfinancial evaluation methods based on programmatic linkageswith healthoutcomes; alignment with an mHealth solution's broader stage of maturity andstage of evaluation; overarching monitoringand evaluation activities;stakeholder evidence needs; time point of initiation; and available resourcesfor evaluations.