The inSCALE study group from Malaria Consortium, University College London and the London School of Hygiene and Tropical Medicine have published a review paper on the approaches and lessons learned from the use of mobile health (mHealth) interventions in low and middle income countries to improve the performance and retention of community health workers (CHWs).
According to the World Health Organization (WHO), mHealth is defined as providing health services and information through the use of mobile technologies such as mobile phones. It can also play a part in supporting or improving the performance of health workers through the dissemination of clinical updates, learning materials and reminders. This is particularly true in rural areas of low and middle income countries such as the ones in which integrated community case management (ICCM) is delivered.
The inSCALE project is aiming to find feasible and acceptable solutions to some of the key areas affecting CHW motivation, retention and performance. Based on extensive research, it was decided that the use of mHealth could be one solution as it would allow for frequent performance based feedback, and increase the frequency of supportive supervision.
For this reason, a review was conducted to identify and learn from promising practices and experiences relating to the use of mobile phones in public health in low and middle income countries. Furthermore, the review intended to seek out innovative approaches to how mHealth can support CHWs.
The review focused on how common mHealth technologies are used for education and awareness, data access, supporting patient monitoring, clinical decision making, tracking of supplies and health information systems strengthening.
The research found that there are few formal outcome evaluations of mHealth interventions in low-income countries despite a large number of process evaluations. The review also highlights the key challenge faced by many mHealth approaches, namely, moving from pilot projects to national programmes fully engaging communities and health workers. The majority of mHealth projects were focused on one way text-messaging and phone reminder campaigns. Only a limited number of mHealth projects were found to specifically target CHWs; these use mobile phones as job aids, clinical decision support tools, data submission devices and for providing instant feedback on performance. None of the projects reviewed had evaluated the impact of mHealth tools on the quality of care provided by the CHWs.
The review concludes that, despite the lack of impact evaluation data, there is great potential to improve health service delivery through the use of mHealth; supporting the delivery of improved health care services and strengthening the health system.