The Mobile is Part of a Whole

A challenge with mHealth in developing countries is that implementations are frequently treated as standalone solutions. Implementations fail because they are not sufficiently aligned with existing health information infrastructures (II). An interesting tool for evaluating implementation efforts in the context of the overall health II strategy, and thus potentially useful for identifying and mitigating risks, is the Bootstrap strategy. Bootstrapping is concerned with addressing take-off challenges facing novel solution implementations through incremental progression, resource maximization, mutual learning, and complexity mitigation. Although the strategy has been previously employed in retrospect to explain how implementation take-off challenges can be alleviated, less is known about its effectiveness as a tool for real time implementation risk assessment. Drawing on an action research mHealth project in Malawi, the study confirms bootstrapping as an effective tool for risk assessment, although the case also reveals that it may not always be easy to mitigate risks identified.