CycleTel in India: Using Pilot Results to Inform mHealth Business Planning

1. CycleTel™ in India: Using Pilot Results
to Inform mHealth Business Planning
INSTITUTE FOR REPRODUCTIVE
HEALTH, GEORGETOWN
UNIVERSITY
Victoria Jennings, Ph.D.
Priya Jha, MSW
Esha Kalra, MPH
Meredith Puleio, MBA
OCTOBER 30, 2012
American Public Health Association 140th
Annual Meeting & Expo
SESSION 4318.2
Innovations in International Health 2

2. Presenter Disclosures
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months: No relationship.

3. Agenda
1. Introduce Standard Days Method®
and CycleTel™
2. Explain research phases and results
3. Demonstrate how research results
inform business planning

4. Standard Days Method® (SDM)
 Modern fertility awareness-based
method of family planning
 Method characteristics:
 Appropriate for women with menstrual
cycles between 26 and 32 days long
 Identifies days 8-19 of menstrual cycle as
fertile
 Helps a couple avoid or plan pregnancy
 95% effective with correct use
 Typically used with CycleBeads® (at right)
to identify fertile days & communicate with
partner
 Available since 2002 in range of
programs, but has not realized full
potential

5. Expanding Access:
Direct to Consumer Approaches
SDM IS WELL-POSITIONED TO BE
OFFERED DIRECTLY TO CONSUMERS
 Knowledge based
 Does not require a visit to a provider (for
initiation or re-supply)
 Easy to teach & learn
VALUE PROPOSITION
 Effective, non-hormonal method of family
planning that has no health side effects
 Direct-to-consumer approaches expand
access to SDM thru avenues outside of
health services

6. SDM on the Mobile Phone
CycleTel™: SMS-based service

7. The Indian telecom market is immense.
 Over 900M subscribers
in India (1.2B
population).
 World's 2nd largest
telecom market, and
growing.
 Over 28% of women own
mobile phones
(compared to 40%
men), and another 20%
have access to mobiles
Source: Telecom Regulatory family of India, August
through Authority and
2012.
friends.

8. Model: Formative Research to Scale
Product
Launch
Partnership & Scale
Development up
Business
Planning Planned 2013
2012
Automated Jan-Feb ‗12
Testing
Proof-of-
Jul ‗11-Jan ‗12
Concept
Sep ‘09 – Jul ‗11

9. Proof-of-Concept: Structure & Findings
3 Phases Objectives
Focus Group  Understand phone use patterns
 Determine potential interest among target
Discussions audience
54 participants  Explore appropriate messaging and preferences
for the service
Cognitive Interviews  Verify comprehension of messages
18 participants  Adapt and finalize messages (in English &
Hinglish)
Manual Testing  Enroll women for 2 cycles to assess feasibility,
26 women in Lucknow satisfaction and correct method use
21-28 years old, housewives  Initially used a low-cost open source software to
manually send/receive messages (FrontlineSMS)
88 women in New Delhi  Troubleshoot problems and determine how to
24-33 years, working women improve service
 Determine target audience

10. Key Results—Manual Testing
Satisfaction & Helpline Male Willingness
Ease of Use Support Involvement to Pay
92% were very 37% of 76% said it was
83% of users they
satisfied with participants called easy to tell their
were willing to pay
CycleTel to prevent the helpline during husbands about
on average Rs. 33
pregnancy the 1st cycle of unsafe days
per month for the
use, 15% called
service (range
95% participants during the 2nd About 70% reported
from Rs. 15-400)
reported receiving cycle of use showing their
SMS at the husbands messages
appropriate times
23% wanted their
husbands to receive
unsafe day alerts
*Proof-of-concept results justified investment in technology development*

11. Technology Development
 Identified technology partner in
India—ThoughtWorks
 Participatory, iterative process
between IRH and a dedicated
project team of ThoughtWorks
developers
 Working prototype within 12 weeks
 Continued to build out and improve
features based on user feedback
 ThoughtWorks helped us navigate
the ecosystem to set up required
deployment partnerships

12. Automated Testing—
Methodology
715 female participants recruited to sign up
and use CycleTel for 2 cycles
 197 follow up interviews after 1 cycle of use
 653 exit interviews with female participants
 131 male exit interviews conducted
PROFILE
 Age 19-36 (average 30)
 Education level: ―higher secondary‖ or
above
 Need for family planning
 28% were employed

13. Key Results—Automated Testing
(Pilot)
What did users like most about CycleTel (n=653)?
As a family planning method… As a mobile health service…
% %
It is low-cost/free 53.9 Easy to use 78.7
Doesn't affect health 80.1
It maintains my privacy 79.5
No side effects 88.4
Timely reminder 87.4
My husband opposes using another 17.2
method Messages come when expected 66.6
Religious/moral reasons 9.0 Right amount of messages 65.5
It is easy to use 72.9 Accessible helpline 27.6
It is effective 56.5
Frequency features 9.2
It is convenient 49.2
Other 36.6
Other 6.3

14. Key Results—Automated Testing
(Pilot)
96%
reported receiving SMS at the
appropriate times
97%
indicated receiving the right
amount of messages

15. Key Results—Automated Testing
(Pilot)
While women would recommend the service to
friends, there was less interest to continue use of
the service.
WOULD RECOMMEND TO INTERESTED IN
FRIEND/FAMILY MEMBER CONTINUING USE
Yes 10.4 Yes
No No
47.3
52.7
89.6

16. Business Analysis
 Business planning was critical to understand the inputs
(target market size, go-to-market strategies, prospective
partners, financing, etc.) needed for CycleTel to be a
sustainable venture in India at scale by 2017.
 The analysis was based on:
1) Proof of concept and pilot results
2) Interviews with industry experts
3) Secondary data sources
4) Rigorous financial analysis

17. Business Analysis: Steps and Key
Steps
Questions
Key Questions (Examples)
Identify target  How many women of reproductive age in India (1) have an
segments and size the unmet need for birth spacing, (2) own a mobile phone and (3)
market use SMS?
 What age group would be most attracted to CycleTel and
why?
Industry analysis to  How many users does the service need to attract corporate
develop core donors?
business  What % of mobile phone owners use and pay for mHealth
assumptions services?
 Would telcos be interested in launching CycleTel? Why?
 What is the role of the aggregators and other stakeholders?
Develop a Go-to-  Prospective partners—who will work with us to
Market strategy acquire/sustain users?
 Prospective donors—who will be willing to provide seed
capital?
 How do we market the service?
 Operating model—how will the venture operate?
Identify possible  Define a high achievement and modest achievement case. In
business scenarios each case, what level of resources is needed to reach target #
based on of consumers within a specified period of time?
assumptions/risks

18. Business Analysis: Key Findings
1. CycleTel should target ~16 million young Indian
women (20-34 years old) with high birth spacing needs,
and independent access to mobile phones in 2 phases.
 Different target markets for 2 phases, technology will be adapted
2. Sustainability is possible within a 5-year period, but it
will take significant investment from donors to reach
break even
3. Success would require broad based promotion via
mix of channels—high engagement approaches (face
to face) early on are key to attract customers

19. Q:How did proof of concept
and pilot results inform business
analysis?

20. A: In the following ways…
Data point Business implication
WILLINGNESS TO PAY Subscription-based service
PROFILE OF PARTICIPANTS Sizing the target market, focus on
younger tier initially
LIKES/DISLIKES Value proposition—easy to use, no side
about the service and the family effects, reliable
planning method
CONTINUATION interest Need for high engagement model with end
(lower in pilot only) users for acquisition and motivation over
Varying levels of CORRECT USE time
MANAGEMENT of fertile days Packaging/advertisement with condoms
would be effective
RECOMMEND to a friend Referral service could support client
acquisition

21. Key Learnings
Formative research and pilot research results can in fact inform
1. planning for sustainability—if sustainability is a goal, ensure key
questions (as demonstrated on previous slide) are included in
interviews.
2. Ensure that theoftechnology canmarkets—this model can
suit the needs distinct target
be adapted over time to
drive sustainability. Testing the service with different
demographics will inform the business case.
Business planning serves as a reality check for
3. what level of investment is actually needed to take
an mHealth innovation to sustainable scale.

22. Thank you.
Email: irhinfo@georgetown.edu
Website: www.irh.org