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- Convenors:
-
Kate Hampshire
(Durham University)
Simon Mariwah (University of Cape Coast)
Alister Munthali (University of Malawi)
Michele Castelli
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- Stream:
- Health
- Location:
- Gordon Aikman Lecture Theatre
- Sessions:
- Thursday 13 June, -
Time zone: Europe/London
Short Abstract:
Mobile/digital technologies can bridge healthcare gaps. In contrast to the top-down focus of most 'mhealth' initiatives, this panel explores the ways that people across Africa are using phones creatively and innovatively in the pursuit of health(care), and associated connections and disruptions.
Long Abstract:
Africa's much-heralded 'digital revolution' has generated optimism that mobile/digital technologies can bridge healthcare gaps, connecting geographically remote communities with services - an attractive prospect for international donors who have funded a raft of (often short-term) 'm-health' initiatives across the continent. However, much less visible, but at least as important, have been the myriad ways that people in Africa are already using mobile phones and digital technologies, creatively and innovatively, in the pursuit of health(care) for themselves and others. This panel explores the connections, disconnections and disruptions produced through this 'bottom-up' form of mhealth. Influenced by Hörst and Miller's (2006) concept of the 'society-technology dialectic', we are interested in the ways that 'informal' forms of mobile/digital health may generate new connections (within and beyond Africa), reinforce existing ones, and/or lead to rupture and disconnection. We seek contributions that explore improvisation, innovation and creativity in the use of digital technologies by patients, health-workers, carers, volunteers and others. We particularly welcome ethnographically-rich and theoretically-ambitious papers that challenge existing understandings of connection/disconnection in relation to digital technologies and health(care).
Accepted papers:
Session 1 Thursday 13 June, 2019, -Paper short abstract:
'Informal' mHealth - the self-directed use of personal mobile phones by health-workers - has become an integral part of healthcare delivery in many developing countries, albeit with some challenges. Our mixed-methods study of informal mhealth practices in Ghana can help inform policy and practice.
Paper long abstract:
Mobile health (mHealth) has been seen as a panacea for bridging healthcare gaps in resource-poor areas in many developing countries. While much research has focused on formal (top-down) mhealth initiatives, little is known about what community health nurses in Ghana are doing with their own mobile phones, and with what implications for healthcare. Using a mixed-method approach, we collected data from over 500 community health nurses from 15 districts in three regions, representing three ecological zones in Ghana. In addition, relevant national stakeholders were interviewed while nine FGDs were held across the three regions. We found that there is virtually no formal mHealth in the selected health facilities. However, Community Health Nurses (CHNs) across Ghana are using their own mobile phones and airtime to facilitate healthcare delivery, and saving lives in critical emergency situations. They use their phones to facilitate arrangements for ambulances, medicine supplies, and referral cases, as well as communication with colleagues, superiors, and patients (clients). However, most CHNs (especially those in rural areas) face several challenges in the use of their mobile phones for healthcare delivery, including poor network coverage, inadequate battery charging facilities, the expense of airtime, and unwanted calls at odd hours. In collaboration with the Ministry of Health and Ghana Health Service, we seek to use our evidence base to inform policy and practice on the use of personal mobile phones for healthcare delivery in Ghana.
Paper short abstract:
Most community health workers use personal mobile phones for work purposes. Our study shows that lack of airtime, lack of electricity to charge phones and poor networks limit use of mobile phones. Addressing these problems would significantly improve the use of mobile phones for work purposes.
Paper long abstract:
HSAs constitute the lowest cadre in Malawi's Ministry of Health, are based at community level and serve a population of 1,000 people. They are responsible for promotive and preventive health services. This paper explores the use of mobile phones among HSAs and how this impacts on their work. Eighteen FGDs were conducted with HSAs in Lilongwe, Mzimba and Zomba Districts: 57 FGD participants were males while 83 were females.
Most HSAs use their own mobile phones for (i) recording data at village clinics; (ii) communicating TB and HIV testing results to clients; (iii) following up clients who have defaulted ART and TB treatment; (iv) sending reminders to clients; (v) communicating among themselves; (vi) ordering medicines; and (vii) sending reports to their supervisors. HSAs appreciated the use of mobile phone technology as initially they walked long distances to reach clients and filled many forms including sending hard copies of reports to supervisors.
HSAs, however, cited challenges such as lack of airtime as in most cases it is not provided, the lack of electricity to charge phones especially for HSAs in rural areas and poor mobile phone networks. The charging of phones especially for HSAs in rural areas is expensive. These results demonstrate that the use of mobile phone technology by HSAs improves service delivery but there is a need to address the prevailing challenges.
Paper short abstract:
Short abstract Health Extension Workers (HEWs) in Ethiopia use their own mobile phones to bridge healthcare gaps. In contrast to the top-down focus of most 'mhealth' initiatives, we explore the benefits and drawbacks of this kind of 'informal mhealth' across two Regions of Ethiopia.
Paper long abstract:
Long abstract
Ethiopia's flagship Health Extension Worker (HEW) programme has been heralded as a model for other African countries with large rural populations to adopt in the pursuit of Universal Health Coverage. However, we know very little about the ways that HEWs in Ethiopia are using mobile phones to facilitate their work and with what consequences for patients and the wellbeing of health-workers. We report on a study conducted in two of Ethiopia's largest Regions, Amhara and Oromia, entailing a large survey and focus groups with HEWs and their patients. Overall, both health-workers and patients were enthusiastic about the benefits that mobile phone use can bring in healthcare. However, they also faced some challenges and the idea of being constantly 'in contact' placed extra responsibilities on HEWs. Given that large-scale roll-out of mhealth across Africa remains a distant dream, it is important to understand current digital practices and the connections and disruptions they might entail.