An overview of Kilkari – A maternal and child health service in India

, 6 December 2016

It’s been 12 months since we launched Kilkari, a mobile health education service designed to help new and expecting mothers make healthier choices and lead longer lives on a national platform for the Government of India.

During this time Kilkari has successfully reached two million subscribers and is now reaching 750,000 subscribers every week. Very few mHealth services in developing countries have managed to reach this scale.

Kilkari (a baby’s gurgle in Hindi) delivers free, time-appropriate audio messages about pregnancy, child birth and child care directly to families’ mobile phones via Interactive Voice Response (IVR).

Weekly, pre-recorded, outbound calls begin in the second trimester of pregnancy and continue until the child is one year old. Call costs are covered by the government.

In a case study published by the GSMA on 25 October 2016, BBC Media Action shares the lessons it’s learned from Kilkari’s three and a half year journey to scale. This runs from its inception in the state of Bihar as a cross operator short code subscription service, with a standard value added service (VAS) revenue share business model, to its current incarnation as a toll-free long code service, reaching families in six states.

These lessons include insights on mobile channels, business models, marketing strategy and technology deployments, which are relevant to other digital development verticals. The key learnings include:

What channels work?

  • Despite the excitement around increasing smart phone penetration in India, ownership among rural women is still less than 3 per cent.
  • Audio content is significantly more powerful than text content in Indian states where close to 50 per cent of women are illiterate.
  • As a result, ubiquitous Interactive Voice Response (IVR) technology remains the most effective channel for delivering Mobile for Development (M4D) VAS to the majority of women.
  • Standard VAS marketing channels, such as top up shop promotions, are not effective when promoting a mHealth service for rural women in India, because these points of retail are not conducive to conversations around maternal health, and the majority of rural women do not visit them.

Business models to ensure sustainability?

  • Standard VAS business models, based on revenue share, do not generate sufficient income to make preventative health education services sustainable for the base of the pyramid.
  • Subscription billing is logistically challenging in an environment where up to 50 per cent of the user-base has zero balance on their phone at any given time.
  • To reach rural women at the base of the pyramid with preventative maternal and child health education, services need to be free as cost is a significant barrier to take up.
  • A B2B enterprise agreement with a single mobile network operator (MNO), where call costs are covered by government, is more financially rewarding for a MNO than a VAS priced for the base of the pyramid.

What partnerships are needed for scale?

  • Partnerships with local and national governments can be powerfully leveraged to deliver immediate scale with very little investment in marketing by using data in government Health Management Information Systems.
  • Open source software can be challenging to develop and support at scale, but reduces the total cost of ownership and makes procurement less of a barrier to government adoption.
  • Mobile technology solution providers and/or aggregators that offer fully managed solutions as a core business proposition are better placed to support M4D services at scale than large multinational software and hardware vendors that make the majority of their revenue on license sales.