Regulatory Sandboxes: A Cure for mHealth Pilotitis?

UNSTRUCTURED: mHealth interventions in the past decade have not scaled globally as earlier anticipated despite large investments by governments and philanthropic foundations. The implementation of digital health tools has suffered from two limitations: a) the interventions commonly ignore the "law of amplification" that states that technology is most likely to succeed when it seeks to augment, and not alter human behavior, and b) end-user needs and clinical gaps are often poorly understood while designing solutions, contributing to a substantial decrease in usage, referred to as the "law of attrition" in eHealth. The Covid-19 pandemic has addressed the first of the two problems -technology solutions, like telemedicine, that have been struggling to find traction are now closely aligned with health-seeking behavior. The second, that of poorly designed solutions, persists, as demonstrated by a plethora of poorly designed epidemic prediction tools and digital contact tracing apps, which were deployed at scale, around the world, with little validation. The pandemic has accelerated the Indian state's desire to build the nation's digital health ecosystem. We call for the inclusion of Regulatory Sandboxes, as successfully done in the fin-tech sector, to provide a real-world testing environment for mHealth solutions before deploying them at scale.