GSMA mHealth Country Feasibility Report Methodology Table of contents Methodology summary.......................................................1 Opportunity indicator metrics...........................................1 Output categories.......................................................2 Health burden.........................................................2 Reach and growth potential............................................3 Ability to pay........................................................3 Justification for use of selected indicators..............................3 Example of opportunity matrix indicator output............................5 Total addressable market forecast methodology………………………………………………………………………………..……..6 Methodology summary The intricacies of market evaluation are such that no single data source should be relied on in isolation. The most robust approach is to consider an amalgam of qualitative and quantitative inputs. For the GSMA mHealthCountry Feasibility Reports the primary qualitative inputs have come from the GSMA, in-country projects and initiatives and include multiple face-to-face interviews with all applicable mHealth value chain members. The GSMA has madediscoveries and investigated assertions in- country, in the process of forging relationships with mHealth stakeholders andbuilding scalable and sustainable business cases amongst public and private stakeholders. This data has been combined with the modelling of quantitative data inputs including socio-demographic indicators and expert 1
Table of contentsMethodology summary............................................................................................................................................................. 1
Health burden.................................................................................................................................................................. 2
Reach and growth potential............................................................................................................................................. 3
Ability to pay.................................................................................................................................................................... 3
Justification for use of selected indicators................................................................................................................................. 3
Example of opportunity matrix indicator output......................................................................................................................... 5
Total addressable market forecast methodology………………………………………………………………………………..……..6
Methodology summaryThe intricacies of market evaluation are such that no single data source should be relied on in isolation. The most robust approach is to consider an amalgam of qualitative and quantitative inputs.
For the GSMA mHealthCountry Feasibility Reports the primary qualitative inputs have come from the GSMA, in-country projects and initiatives and include multiple face-to-face interviews with all applicable mHealth value chain members. The GSMA has madediscoveries and investigated assertions in-country, in the process of forging relationships with mHealth stakeholders andbuilding scalable and sustainable business cases amongst public and private stakeholders. This data has been combined with the modelling of quantitative data inputs including socio-demographic indicators and expert opinion using Likert scaling and weighted decision matrices, considering the multiple criteria for success and bias of involved stakeholders. This weighted view allows each individual stakeholder and value chain player to independently gauge the viability of mHealth within the target country and thus reduces the potential for extrapolation of data bias. The overall aimof this approach was to take a balanced view leveraging analytical evaluationand striving for a methodological triangulation method.
The overall feasibility of mHealth is gauged using a combination of quantitative opportunityinputs based on a list of comparable data metrics across all of the 10 target countries combined with quantitative and qualitative metrics derived from in-country GSMA programmes, monitoring and evaluation and product and service development initiatives.
The mNutritioncountry feasibility reports concentrate on eight defined target countries. Including, Ghana, Nigeria, Malawi, Mozambique, Rwanda, Uganda, Mozambique and Zambia. The modelling considers 10 sub Saharan African in order to provide a statistically valid data-set that is broadly comparable across SSA.
For modelling purposes comparable data points where selected across the 10 indicator countries. In some instances this was not the most up-to-date information available.
1
Opportunity indicator metricsThe opportunity matrix indicator considers a number of data points categorised into specific indicators relating to core mHealth drivers.
Figure 1– Constituent data inputs and how they combine to define anmHealth driver
Source: GSMA M4D
The majority of data inputs considered are positive but there are a number of important indicators that are detrimental to market opportunitiese.g. a high Gini coefficient or high percentage of income held by the top 10% of any given population. The inclusion of both positive and negative indicators are important factors toward modelling actual, real-world scenarios incorporated into the analysis.
The overall output from this reduction model approach isa comparative index scoredabove or below the ideal market conditionsaveraged across the 10 Sub-Saharan African countries that the GSMA nutrition initiative considered.
Output categoriesAs markets evolve with time, indicator data points change, particularly as commercial propositions propagate. The metrics selected for the opportunity indicator matrix were chosen as the most revealing for showing the current status of mHealth in the countries we are considering. As such they should be seen as a snapshot of the market rather than a long-term forecast.
Health burdenMetrics considered for health burden where selected to give an indication of the potential addressable market defined against the parameters of improving nutrition for under-serviced markets and in particular for women and young children. Both addressable market and potential loss of economic units are considered as indicators of health burden.
• No. pregnant mothers• No. mothers with children <5
• Unique mobile subscriber penetration• Mobile sub penetration 5-year growth rates• Mobile Geographical coverage
• Per capita income• Percentage above poverty line• Percentage of out-of-pocket spending health care• ARPU divided by per capita income (12mnth period)• GINI coefficient• Income held by top 10% of population
• Percentage of government health spending per capita• Percentage of health services funded by NGO
Maternal mortality
Child mortality
Incidence of stunting
Target audiences
Market growth indicators
Business to consumer potential
Business to business potential
Health burden
Available market
Market potential to pay
PROXY INDICATORS
Addressable market The overall addressable market for mHealth is considered within the parameters of maternal and under-five child health in combination with mortality and stunting indicators.
Mortality and stunting indicators The mortality rates of women at childbirth, infants and newborns are considered as indicators of health burden in particular as a grievous loss to society from a social and economicperspective. The logic of targeting these segments is clear and is based on their socio-economic potential and the impact for developing nations being effectively cut off before they reach optimal age to fulfil this potential. The impact of ongoing health burdenis also evaluated in terms of care requirements by considering stunting in children under-five (nutritional indicator).
Reach and growth potentialThe overall size of the target addressable markets was cross referenced with the potential growth of the primary delivery medium (mobile devices) to give an indication of the longer term viability of mHealth services.
Combining market potential indicators A market’s potential is defined by considering a combinationof factors incorporating features that are positive and negative to growth. As a consequence the market potential indicators for the comparative index were combined to better emulate this market feature. Penetration rate, unique subscriber penetration rate and subscription growth over a preceding five year period gave an indication of the market potential and impetus behind mobile growth. Geographic mobile coverage was also incorporated in this calculation, indicating the available audience’s ability to access mobile. Alow geographic coverage acts as a counterbalance to high penetration (population divided by number of active SIMs) and/or high growth, to give a truer indication of market potential and the addressed market. This is an important consideration with mHealth due to the lack of access to health services in rural and remote regions.
Ability to payThe ability to pay considers demand-side indicators including consumption patterns and available resources to purchase goods from a commercial B2C perspective and combines these with expenditure levels on comparable B2B indicators.
B2C category definition The commercial proposition for a given service is made up of a large number of factors that influence propensity and potential to spend. Some of these indicators are clear e.g. available dispensable income, but there are also less definable indicators such as propensity to spend or where wealth is situated within a society. As a result the number of data points considered in the B2C category are correspondingly large.
Consumption factors are considered through gross domestic product (GDP)per capitaand the number of available potential audiences, defined as those above the poverty line. Propensity to spend indicators include percentage of GDP spent on mobile combined with propensity to spend on health out of the consumer’s own pocket. Less definable factors, including the way money is distributed and allocatedare captured by considering Gini coefficient and percentage of wealth inequality (the degree of total wealth held by the top 10% of society). The higher the inequality the greater the obstacle to a volume-based market opportunity resulting from asmaller addressable consuming audience. The assumption made here isthat a volume-based business proposition is a better long-term opportunity. With these indicators ranking is reversed – the higher the figure/inequality the lower the score.
B2B category definition The data points considered to illustrate the opportunity for B2B mHealth are quite narrow. The metrics effectively identify mHealthas a subsidisation opportunity to be financed by either governments, NGOs or other funders. The revenue opportunity comes as part of a wholesale or B2B relation between the constituent providers (mobile operators, value added service (VAS) providers) and wholesale consumers (government, NGO and other provisioning agents).
These metrics are valid at this point based on the industry’s limited options for funding in developing Sub-Saharan African countries and the as yet unproven commercial proposition for mHealth in the region.
Justification for use of selected indicatorsIn order to make a valid estimation across the target countries comparable metrics were required. Within Sub-Saharan African data point methodological rigour, frequency of collection and replicability differ widely. The indicators chosen for the opportunity indicator metrics were selectedbased on their equivalence originating from single sources and time periods.
3
Figure 2- mHealth opportunity demonstrated by selected metrics
Source: GSMA M4D mHealth
Figures 1 and 2 provide the justifications from a mHealth service feasibility perspective for selection of the various indicator metrics.
4
Figure 3 - Data selection & justification
Source: GSMA M4D mHealth
Example of opportunity matrix indicator outputFigure 4 shows the type of indicator output from the opportunity matrix indicator. The target initiative countries are on the left, and in this instance show reach/addressable market. The 10 countries are ranked within this scale by providing an index score for each country, applicable to the particular driver in consideration. An index on or around 1 is desirable. An index higher or lower than one denotesan opportunity or absence respectively.
Figure 4 - Example output opportunity matrix indicator reach/addressable market
Example of combined opportunity matrix indicator outputThe opportunity matrix outputs are combined to produce an overall indicator for mobile health feasibility in each of the 10 mNutrition countries.
Figure 5 shows the combined outputs for health burden, reach and ability to pay. The combined score indicates the overall score of all indicators as a collective ranked scale.
Comparative size of market opportunityWhile the combined scale score output gives an idea of the overall feasibility of particular mobile health indicators it does not show the relative size of the market opportunity being based on a 10 point scale. For example a country ranked at 10 and a country ranked at a scale 9 are adjacent on the scale but the difference between these two points can be insignificant or considerable. The 10 point scale approach does not capture this nuance. Nigeria, for example, is ranked (scaled) highest across the evaluation indicators but also has a substantial market opportunity compared with ninth ranked Tanzania_ whereas Zambia and Cote D’Ivoire, which rank seventh and eighth respectively, are relatively similar in regard to the size of their market opportunity.
Figure 6 - Example output combined indicator rank and comparative size of marketopportunity
Indicates size of opportunity for combined health burden, reach & ability to pay
Zambia
Source: GSMA M4D mHealth
Figure 6 compare the particular ranking of the country and the size of that opportunity as a combined feature of all the indicator categories. The relative combined opportunity is an indication of the capacity of a country to be developed and provides additional detail for the country evaluation process. The respective countries position on the scale gives an additional indication of the ease with which mobile health services might be launched (degree of obstacle vs opportunity).
VAS and mHealth market evolution methodologyThe mobile value added service evolution indicator shows the specific point of vaue added service development and the comparative state of mHealth status development within the 10 GSMA mNutrition comparison countries.
Figure 7–Example GSMA total addressable market forecast methodology
7
Source: GSMA M4D mHealth
Each of the comparator countries have been mapped onto the total addressable market service evolution curve (Sigmoid Curve) with their respective positioning showing the status of VAS and mHealth service evolution (higher or lower on the curve).
A number of indicator metrics where considered to make a comparative assumption. These included:
ARPU and service data ARPUsplits (voice vs data) when available. Ratio of sophisticated versus simple mobile services Total number of mhealth services tracked by the GSMA, Number of persons using mhealth services, Analysis of smart phone VAS capable devices in-country compared against simple devices Number of mobile data users Penetration of data service use Qualitative insights from in-country interviews.
A large gap between the VAS data status point (red circle) and the mHealth status point(blue circle) indicates a gap in the market and a potential opportunity. The development of VAS services enablesand encouragesthe development of mHealth services. For example, commercial M2M needs to have developed to a certain point before advanced monitoring mHealth services are possible. If there is a large gap between VAS and mHealthservice pointsthere is the potential for a service provider to deliver the relativemHealth service and fill this gap.
Total addressable market forecast methodologyThe total addressable market for mHealthdefined in the GSMA Country Feasibility Reports was generated out of a larger mHealth addressable market. The particular sub-segments considered for evaluation were women with children under the age of five and pregnant women.These sub segments were further delineated into literate and illiterate mobile service users to gauge the addressable market for SMS and IVR mobile health services.
8
The issue of double counting, those within the target segment that are both pregnant AND have a child under the age of five,was tackled by removing a percentage of the addressable audience in each country considered to fall under this definition.
Figure 8 - GSMA total addressable market forecast methodology
Source: GSMA M4D mHealth
Service use was defined in terms of ownership and/or access to a mobile device.
Existing forecasts for literacy rates were taken from WorldBank data and proprietary GSMA Intelligence mobile access forecasts were used to generate forward looking indicators.
The total addressable market will be slightly higher than shown in the Country Feasibility Reports as some from the literate segment will use both SMSandIVRand these individuals have not been counted. The forecast considered individual use of either SMSorIVR.
In order to avoid research bias and exploit cumulative knowledge a conservative forecast was opted for. Only women who are pregnant or with a child under 5 are considered as addressable units. Moreover women who are pregnant and with a child are counted only once despite different services being offered (effectively two separate service streams). The addressable market is likely to be larger when women of a child bearing age and those who have a child and are pregnant are included in the calculation.
The conservative approach is designed to considerearly stage mHealth services that align with the generic GSMAmHealth service product; staged-based, aggregated MNCH messaging delivered over SMS and IVR.
The target segment of the GSMA nutrition initiative isitself part of a larger total addressable market for mHealth services.
