Lessons from Failed mHealth Pilots in Sub‑Saharan Africa

Abstract

Although mHealth holds tremendous promise to improve healthcare delivery in Sub‑Saharan Africa, many pilot projects fail to scale or sustain long-term impact. Drawing on systematic reviews and case studies, this paper explores the common barriers—including fragmented pilotitis, weak infrastructure, regulatory gaps, funding dependency, and limited user engagement—and offers strategic guidance to inform future digital health initiatives across Africa and beyond.

Introduction

Mobile health (mHealth) is widely promoted as a scalable solution to healthcare access challenges in Sub‑Saharan Africa. Yet despite rapid mobile-phone adoption, many pilot projects fail to mature into sustainable, integrated systems (Betjeman et al., 2013; Aranda‑Jan et al., 2014). This white paper analyzes key reasons behind these failures and extracts usable lessons.

1. The “Pilotitis” Phenomenon

Pilots—often funded by international organizations—typically run in isolation with little thought for scale-up. A 2013 World Bank study noted nearly 500 disparate global mHealth pilots, particularly in Sub‑Saharan Africa, that failed to integrate into health systems (Digital Impact Alliance, 2014). Without plans for continuity, they ended shortly after pilot completion.

2. Infrastructure Limitations

Major infrastructure hurdles—poor network coverage, electricity unreliability, and lack of digital literacy—frequently force pilots to close (Betjeman et al., 2013; Aranda‑Jan et al., 2014). Inconsistent connectivity disrupted SMS-based programs, while low-tech fluency inhibited usability.

3. Funding Dependence & Cost-Effectiveness

Pilots often rely on short-term grants without solid business models. Aranda‑Jan et al. (2014) found that many projects collapsed when initial funding ended, with insufficient evidence of cost-effectiveness to attract further investment.

4. Lack of Policy Alignment

Uncoordinated regulatory environments and absent national digital health strategies created misalignment with government systems (Betjeman et al., 2013; Krah & de Kruijf, 2018). This weakened opportunities for adoption and scale.

5. Complexity & Context Ignorance

Overly ambitious features without contextual appropriateness often backfire. Krah and de Kruijf (2018) stress that simplicity guided successful projects, while complex interventions unsupported by user needs and infrastructure fail.

6. Weak Stakeholder Engagement

Many pilots maintained a techno-centric design that overlooked socio‑technical integration and user involvement. Ikwunne et al. (2021) observed that poor user engagement led to low uptake and eventual abandonment.

7. Evaluation Gaps

Limited or insufficient evaluation frameworks impede evidence generation. Most pilots lacked standardized metrics or randomized designs, undermining their ability to demonstrate impact and justify scale (Aranda‑Jan et al., 2014).

Recommendations for Sustainable Design

1. Embed Scalability from Inception

Design pilots with scale-up in mind: align with health ministry frameworks, pursue interoperability, and create sustainability plans.

2. Simplify for Local Context

Choose modest, well-defined objectives; prioritize core functionality over feature-rich systems (Krah & de Kruijf, 2018).

3. Invest in Infrastructure & Literacy

Ensure reliable networks, power, and training in digital skills before deployment (Aranda‑Jan et al., 2014).

4. Engage Stakeholders

Include end-users and executives in co-design; apply socio-technical approaches to ensure relevance and buy-in (Ikwunne et al., 2021).

5. Build Viable Business Models

Combine public funding, private partnerships, and user fees to support long-term operations.

6. Standardize Evaluation

Adopt frameworks like ICAMO or include cost-effectiveness, user satisfaction, and clinical outcomes in assessment (Gilano et al., 2024; Aranda‑Jan et al., 2014).

7. Strengthen Policy & Governance

Advocate for national digital health policies, regulatory sandboxes, and interoperability standards to foster integration.

Discussion & Implications

Addressing pilotitis requires systemic change—from funders, policymakers, and implementers. Africa's mobile infrastructure and ecosystem are ripe for transformative digital health, but only if new projects apply lessons from past failures. For global actors, African context-specific insights offer valuable guidance.

Conclusion

Failures of past mHealth pilots in Sub‑Saharan Africa stem from common themes: fragmentation, overspecification, lack of evaluation, poor context fit, and weak stakeholder engagement. Future initiatives must be designed with simplicity, sustainability, rigorous evaluation, and integration with health systems.

References

Aranda‑Jan, C. B., Mohutsiwa‑Dibe, N., & Loukanova, S. (2014). Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health, 14(1), 188. https://doi.org/10.1186/1471-2458-14-188

Betjeman, T. J., Soghoian, S. E., & Foran, M. P. (2013). mHealth in Sub‑Saharan Africa. International Journal of Telemedicine and Applications, 2013, 482324. https://doi.org/10.1155/2013/482324

Digital Impact Alliance. (2014). Fending off “pilotitis” in global tech. Retrieved from https://dial.global/fending-off-pilotitis-in-global-tech/

Gilano, G., Zeleke, E. A., & Dekker, A. (2024). Contextual success and pitfalls of mHealth service for maternal and child health in Africa: A ... qualitative evidence. BMC Pregnancy and Childbirth, 24, 690. https://doi.org/10.1186/s12884-024-06885-2

Ikwunne, T., Hederman, L., & Wall, P. J. (2021). Designing mobile health for user engagement: The importance of socio‑technical approach. arXiv. https://arxiv.org/abs/2108.09786

Krah, E. F. M., & de Kruijf, J. G. (2018). Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa. Global Health Action, 11(1), 1433236. https://doi.org/10.1080/16549716.2018.1433236