Designing mHealth for maternity services in primary health facilities in a low-income setting – lessons from a partially successful implementation

Abstract

BackgroundIncreasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation.MethodsThe mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia.ResultsThe system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11% of the electronic forms were submitted on the day of the client visit, while an additional 17% of the forms were submitted within 10 days of clients’ visit. On average forms were submitted 39 days after the day of clients visit with a range of 0 to 150 days.ConclusionsIn conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.

Open Data Kit: Mobile Data Collection Framework For Developing Countries

“…-To propose new tools compatible with the ODK suite or with the ODK-X suite [20], [21], [22], [23], [24]; -To make improvements to a single component of the ODK suite or the ODK-X suite, without having to touch all the others [25], [26]; -To use one or some of the components of the ODK or ODK-X suite without having to use the whole suite. The tools of the two suites can even be used with other technologies that do not belong to ODK [31], [32], [34], [38], [40], [41]; -To extend a component of the ODK or ODK-X suite by adding new functionalities and then to use this extension with the other components of the suite [27], [28], [29].…”

“…3 [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [15], [40], [41], [42], [43] Use case of ODK. 15…”

Effectiveness of a mobile phone application to increase access to sexual and reproductive health information, goods, and services among university students in Uganda: A randomized controlled trial

“…MPAs are increasingly used in low-and middle-income countries for a wide range of applications, although applications in this setting are far exceeded by applications in high-income settings [12]. In sub-Saharan Africa and in the area of SRH, apps have been deployed to the public to support family planning [13] and to healthcare workers for improving provider quality of maternal and neonatal care [14][15][16][17][18][19][20]. To our knowledge, this is the rst report of an app deployed to members of the public to increase access to SRH information, goods, and services in the low-income setting.…”

Barriers to Sustainable Telemedicine Implementation in Ethiopia: A Systematic Review

“…According to this review, the most frequently reported barriers to the implementation of telemedicine services are cost 17,18,20,21,16,22,[23][24][25] and infrastructure. 13,17,18,21,22,24,26 The initial cost of establishing telemedicine services is very high, and to function telemedicine services in rural or remote areas for underserved communities needs telecommunication expenses, training (health personnel and 20 2013 Cross-sectional Cost, technical support, internet connection Mengesha et al 27 2013 Case study An internet connection and technical support system Abera et al 21 2014 Mixed method Cost, availability of technical support, Internet connection, ICT infrastructure, technological infrastructure, readiness, staff turnover Medhanyie et al 13 2015 Cross-sectional Health system, resistance to change, ICT infrastructure, awareness, language, poor application design, and technically challenged staff.…”

“…According to this review, the most frequently reported barriers to the implementation of telemedicine services are cost 17,18,20,21,16,22,[23][24][25] and infrastructure. 13,17,18,21,22,24,26 The initial cost of establishing telemedicine services is very high, and to function telemedicine services in rural or remote areas for underserved communities needs telecommunication expenses, training (health personnel and 20 2013 Cross-sectional Cost, technical support, internet connection Mengesha et al 27 2013 Case study An internet connection and technical support system Abera et al 21 2014 Mixed method Cost, availability of technical support, Internet connection, ICT infrastructure, technological infrastructure, readiness, staff turnover Medhanyie et al 13 2015 Cross-sectional Health system, resistance to change, ICT infrastructure, awareness, language, poor application design, and technically challenged staff. Xue et al 16 2015 Cross-sectional The technical support system, resistance to change, anxiety, costs Dusabe-Richards et al 19 2016 Mixed-method Network coverage, technical support system, language, phone (mobile), socioeconomic status Barkman and Weinehall 22 2017 Descriptive case report Reimbursement, infrastructures, cost Biruk and Abetu 32 2018 Cross-sectional awareness Steege et al 23 2018 Costs, level of education, culture, phone (mobile), awareness Shiferaw et al 24 2018 Cross-sectional Cost, health system, culture, staff turnover, ICT infrastructure, electricity, phone (mobile), service integration, internet, awareness Harding et al 25 2019 Descriptive case report Electricity, e-health literacy, health system, telecommunication service, cost, internet connection, phone (mobile), human resources Dessie Gashu et al 26 2020 RCT ICT infrastructure, e-health literacy, phone (smart mobile)…”