Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study

Abstract

Objective Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. Methods We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. Results We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms ( n = 5–17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported – for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. Conclusions There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.

Patient Readiness for Remote Healthcare Services in the Context of the COVID-19 Pandemic: Evidence From European Countries

“…A cross-sectional questionnaire-based household survey from Australia on the relationship between e-health access and respondents' characteristics shows that middle age, household size, broadband access and digital literacy increase the likelihood of access, while low educational levels, low socioeconomic status and remote locations negatively affect this access ( 20 ). A study on mobile consulting in healthcare in urban and rural settings (Pakistan, Tanzania, Kenya, Nigeria and Bangladesh) finds that the main challenges are in technology, infrastructure, data security, confidentiality, acceptability and health system integration ( 21 ). Another study on telehealth adoption in Indonesia shows that performance expectancy, effort expectancy, and facilitating conditions significantly affect behavioral intention to use telehealth, while social influence is not significantly associated with behavioral intention; performance expectancy is also significantly affected by doctor's opinions and effort expectancy is strongly influenced by computer anxiety ( 22 ).…”

Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review

“…A competent health workforce is a vital resource for health services delivery and health systems can only function with health workers; the improvement of the four capacities of health systems is therefore dependent on their availability, accessibility, acceptability, and quality. We found that most effective interventions were undertaken to increase health workers numbers, performance, knowledge, and skills in order to address to population needs and reduce disparities across urban and rural areas [40,50,63,67,81,89,90]. Community health workers may be faced with inadequate access to training and reference materials, poor-quality communication systems for feedback from experts or supervisors in the diagnosis and management of complex cases, and difficulty maintaining patients within the continuum of care through follow-up visits or referrals, thereby impacting the access to high-quality of essential services they can deliver.…”

“…Notably, we found that digital health has been leveraged to mitigate some of these challenges community health workers may face in low-and middle-income countries. An initiative of mobile consulting in Bangladesh, Kenya, Nigeria, Pakistan, and Tanzania, was explored to assess whether it is a viable option for communities with minimal resources, showing that there are indications of local readiness for mobile consulting in communities with minimal access to essential services, and that mobile consulting had the potential to strengthen health systems during and beyond the COVID-19 global pandemic [89]. The introduction of Millennium Villages Global Network (MVG-Net) in multiple African countries such as Ghana, Rwanda, Tanzania, and Uganda has facilitated point-of-care decision support through mobile phone systems based on a short message service [90].…”

Inclusive Digital Health

“…The co-editors of the Clinical Information Systems (CIS) section, Werner Hackl and Alexander Hörbst, did not identify any real novelties in the themes addressed in the 10 candidate articles selected this year compared to recent years [26]. The work by Harris et al, which is one of the two best papers selected in this section, conducted a large study in five different countries in diverse geographic locations to investigate the potential utility of mobile consultation for health care delivery [27]. The authors emphasized that low-and middle-income countries are motivated to embrace this digital shift, but that this requires addressing the inevitable technical and privacy issues and a robust health information system that is essential to ensure continuity of care.…”