Best practices for Mhealth projects in Uganda: Lessons learned from Mobile money Banking
Uganda, officially the Republic of Uganda, is a landlocked country in East Africa bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of Congo and on the South by the Republic of Tanzania.[1] According to the Uganda Bureau of Statistics, The population of Uganda is projected to have increased to 32.9 million by mid 2011.[2]
In relation to use and access of mobile phone technology, It has been reported that Uganda has 16.45 million mobile phone subscribers [shared among the major five telecom operators including MTN, Airtel, UTL, Warid and Orange Uganda, according to Uganda Communications Commission (UCC) 52% of Ugandan households are reported to have access to a mobile phone, equal to the Sub-Saharan Africa average[3].
However the international consultancy firm PricewaterhouseCoopers (PWC) predicts that this number could rise to 25 million, 70% of Uganda’s population, by 2015. With penetration rates still below 40%, PWC argues that there is huge potential for growth.[4]
Uganda Communications Commission (UCC)’s Manager for Communications and Consumer Affairs Fred Otunnu, has on occasion been quoted by tabloids to say that may be an over-estimate, but not by much, “Maybe 20 million in three years,” Otunnu told The Independent on July 25 2012.[5] The World Bank reports that in 2001 per capita household consumption of Uganda (in constant 1995 US dollars) was $312[6]. Household consumption includes expenditures of individuals, households, and nongovernmental organizations on goods and services, excluding purchases of dwellings. The richest 10% of the population accounted for approximately 29.8% of household consumption and the poorest 10% approximately 3.0%. It was estimated that in 2001 about 35% of the population had incomes below the poverty line.[7]

In spite of the biting poverty levels in Uganda, with the innovation of cheap Chinese cellular mobile phones, Cell phones in Uganda can be accessed on the market for as little as $7 and found in every desolate corner of the countryside, where 85 percent of the country's residents live. With the dire need to be connected, people go to great lengths to use cell phones, charging them with car batteries or solar chargers.[8] It should also be noted that most cell phones in Uganda have only voice and SMS capabilities, this means a successful mhealth project targeting ordinary Ugandans should ideally ensure to make use of these as the available means of data collection or communication to the grassroots.

Statement of the ProblemIn a place where cell phones could outnumber light bulbs, several nonprofits have begun thinking that the best way to reach the country's poor and get them much needed information is through their phones[9]. What is shocking however is that despite the many mhealth projects and millions of dollars invested in these projects, none has registered as much progress as the mobile money banking project carried out by telecom giants in Uganda. What has made many of these projects fail to take off in many parts in Uganda is the problem I investigate through an analysis of what has made mobile money banking a success. The map below indicates the number of mheath initiatives so far implemented in Uganda.

Map of mHealth pilots in Uganda by Sean Blaschke (Unicef Uganda)[10]

Mobile Money banking in Uganda
Mobile Money banking is an electronic wallet service that enables you to send and receive money anywhere in Uganda using your phone[11]. This service provides a fast, secure, affordable and convenient way to send money to anyone on their mobile phone anywhere in Uganda no matter the network. It bridged the gap for many Ugandans who could not afford banking services to be able to store but also transfer money across the country without having to pay subscription fees, make lines etc.

This service is available to everyone with a mobile phone in Uganda and is offered by the 3 Mobile Net work Operators—MTN Uganda, Uganda Telecom, and Airtel Uganda.[12]The 3 mobile money offerings are largely similar, allowing registered users to load money into their accounts (cash-in), make transfers to other users (both registered or not), buy airtime top ups as well as withdraw money (cash-out). Each type of transaction attracts a predetermined charge, which varies across offerings[13]. This is all done using an SMS message. If one finds problems using the service, they can call a customer care advisor – these are available 24/7 and speak both English and all the common local dialects in Uganda. This means both literate and illiterate persons’ needs are met in terms of communication.

In their aggressive recruitment drives to win more subscribers – Mobile money agents troll streets for new customers[14]. They have ensured that Mobile Money outlets are everywhere in every village in Uganda however minor or remote[15]. This makes it easy for customers to easily access the service.
Lessons learned
1. Importance of identifying a problem and a viable solution that meets the need of the audience one is targeting.Mobile network operators in Uganda realized not so many Ugandans were using banking services due to the fact that these were only in urban centers that required one to move and queue in long lines yet transfer of money could be done alternatively over the phone using a simple sms application easily accessed even by illiterate poor people.
Project planners and non-profits planning mhealth projects in Uganda should consider using the available telecom applications accessible by their clientele to mitigate problems they have identified. If the audience only affords phones with voice and sms messaging service, then the project should be tailored to this.
2. Consider collaborating with colleagues doing similar projects in the countryMobile service operators collaborate to offer the service to Ugandans. If one operator has no service in a particular village in Uganda, customers can use the available network to send money. If you still think the best way to succeed is by handing out an iPad to every village health worker in the parish you're working in, great[16]. Just make sure first that no one else is handing out Androids there too[17]. And when your pilot crashes and burns because it can't scale country-wide, your data should at least be able to feed into a system that tracks the entire small-scale NGO graveyard of projects, because the sum total of the data actually is useful, even if the project itself ultimately wasn't[18]. If you're Big Aid, it means you're going to have to start re-thinking the budget of that $hundreds-of-thousands grant, because it probably shouldn't have your own branded software platform as a line item[19].
ConclusionDespite the increase of phones in Uganda, a digital divide still persists. It should be noted that information cannot be passed on unless the populace understands what is being implemented. Mobile companies have invested in door to door agents to not just solicit for customers but teach the people the simplest way of using their service. It is important that Non profits investing in mhealth work with the people they are seeking to help. They should understand that complex and detailed information cannot be managed by a Smartphone which is beyond the means of most Ugandans in terms of costs and maintenance.

[4] Ibid
[5] Supra note 3.
[13] ibid
[15] ibid
[17] ibid
[18] Note 16
[19] Supra note 17