The use and impact of mHealth by community health workers in developing and least developed countries: a systematic review

Abreu, F. D. L.; Bissaco, Márcia Aparecida Silva; Silva, Alessandro Pereira da; Boschi, S. R. M. S.; Scardovelli, Terigi Augusto; Santos, M. F.; Rodrigues, Camila; Martini, Silvia Cristina

doi:10.1007/s42600-021-00154-3

Cited by 10 publications

(11 citation statements)

References 72 publications

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“…Similarly, recent reviews of mHealth and interventions among CHWs outline the effectiveness of training CHWs with mHealth. However, these studies note several challenges, such as lack of culturally relevant mHealth interventions, lack of consistent methodology to assess outcomes, and need for further studies evaluating effective training modalities [ 7 , 21 , 22 ]. This study addresses some of these concerns and highlights how a community-based training program can sustain effective health training in limited resource settings.…”

Section: Discussionmentioning

confidence: 99%

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda

Ebbs

Benson²,

Jasicki

et al. 2023

PLOS Glob Public Health

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Community Health Workers (CHWs) in low and middle income countries (LMICs) provide invaluable health resources to their community members. Best practices for developing and sustaining CHW training programs in LMICs have yet to be defined using rigorous standards and measures of effectiveness. With the expansion of digital health to LMICs, few studies have evaluated the role of participatory methodologies combined with the use of mobile health (mHealth) for CHW training program development. We completed a three-year prospective observational study aligned with the development of a community-based participatory CHW training program in Northern Uganda. Twenty-five CHWs were initially trained using a community participatory training methodology combined with mHealth and a train-the-trainer model. Medical skill competency exams were evaluated after the initial training and annually thereafter to assess retention with use of mHealth. After three years, CHWs who advanced to trainer status redeveloped all program materials using a mHealth application and trained a new cohort of 25 CHWs. Implementation of this methodology coupled with longitudinal mHealth training demonstrated an improvement in medical skills over three years among the original cohort of CHWs. Further, we found that the train-the-trainer model with mHealth was highly effective, as the new cohort of 25 CHWs trained by the original CHWs exhibited higher scores when tested on medical skill competencies. The combination of mHealth and participatory methodologies can facilitate the sustainability of CHW training programs in LMIC. Further investigations should focus on comparing specific mHealth modalities for training and clinical outcomes using similar combined methodologies.

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Section: Discussionmentioning

confidence: 99%

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda

Ebbs

Benson²,

Jasicki

et al. 2023

PLOS Glob Public Health

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“…In a 2015 review of 140 studies of CHW programs, only 49 had an M&E system in place [24]. In a 2021 systematic review of mobile technologies for CHWs, based on 63 studies between 2009-2019 in 23 countries, only 6% assessed CHWs' performance and adherence to clinical guidelines; 71% of studies utilized a health management information system/electronic medical record to standardize data entry and enable real time analysis of health problems within a community [42]. A 2019 scoping review of CHWs' use of mHealth tools across continents and populations in 64 studies noted the dearth of reviews on CHWs and mHealth as well as lack of evaluation, experimental, and longitudinal studies [43].…”

Section: Discussionmentioning

confidence: 99%

“…Several evaluations of CHW programs in South Africa have used mHealth strategies to assess CHWs' performance, although several reviews have not provided strong evidence to support their effectiveness [42,44]. An evaluation in one sub-district in South Africa's North West province compared the expediency, accuracy and supervisory proficiency of cell phonebased M&E to a paper-based M&E system and noted challenges with both [45].…”

Section: Discussionmentioning

confidence: 99%

"They are our eyes outside there in the community": Implementing enhanced training, management and monitoring of South Africa’s ward-based primary healthcare outreach teams

et al. 2022

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Introduction In 2018, South Africa’s National Department of Health provided additional resources for ward-based primary healthcare outreach teams (OT) with support from the U.S. President’s Emergency Plan for AIDS Relief. The intervention package included a new training curriculum, enhanced staffing, revised management and supervisory structures, and more intensive monitoring and evaluation (M&E). The goal was to strengthen OT and their impact on both primary healthcare and HIV-specific services. We conducted a process evaluation of this intervention package during its second year and examined implementation successes and challenges. Methods We conducted a mixed-methods evaluation at 20 purposively selected facilities in Bojanala and City of Tshwane districts, including surveys with 222 community health workers (CHWs) and outreach team leaders (OTLs); key informant interviews and online surveys with 28 policy and program stakeholders; 70 in-depth interviews with health facility staff; 20 focus group discussions with 194 CHWs; 20 structured health facility assessments; directly-observed time-motion studies; and review of program documents. Results Most participants highlighted the hiring and training of CHWs and OTLs as a key implementation success because this had partially alleviated staffing shortages and helped clarify CHWs’ and OTLs’ responsibilities and supervisory structures. The new monitoring tools were welcomed for their potential to improve data collection and program tracking. However, participants highlighted many program challenges: short-lived gains in CHWs’ knowledge and skills due to lack of ongoing training and mentoring; insufficient integration of OT into health facility management structures; persistent shortages of equipment, supplies, transportation, and workspace for CHWs; and insufficient remuneration for staff. Conclusion Strengthening and expanding CHW programs, such as OT, requires intensive support and continuous investments. To sustain improvements in training, supervision, and job satisfaction, CHWs must be equipped with needed resources, provided with ongoing supportive supervision, and strengthened by optimized program management, monitoring and processes.

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“…Further, mHealth has found a degree of acceptability among health workers who use them as well ( 3 ). Given the ever-increasing mobile phone usage in Low and Middle Income Countries (LMICs) ( 4 ), the use of mobile devices to deliver public health interventions is believed to be effective, particularly in low resource settings ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Methods and Lessons From Costing a Large mHealth Intervention at Scale in India

Shukla

Kapur²

2022

Front. Public Health

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The use of mobile devices to deliver public health interventions is rapidly increasing, particularly in low resource settings. Despite their proliferation, several mHealth interventions in developing countries fail to reach geographical scale, and long-term sustainability for most remains uncertain. There is a need to cost for such programs, to enable better planning and budgeting and tailor programs as required. Cost estimates can contribute to a more informed debate on resource allocation priorities and help make choices clearer for policymakers. This paper has two main objectives: (1) present a detailed protocol on determining the costs of a large national mHealth job aid and behavior change communication tool known as Integrated Child Development Services - Common Application Software (ICDS-CAS) in India, and (2) to present lessons for policymakers on how to ensure financial planning for scaling mHealth interventions. The study uses the Activity Based Costing—Ingredients (ABC-I) method. The major advantage of the ABC-I method is the clarity it brings to costs for each input and activity, across levels and geographies. It also accounts for indirect costs. There are five key lessons while costing for mHealth programs. First, that there are many activities and ingredients that must be budgeted for and discussed while planning and implementing mHealth programs. Second, the ABC-I method described in this paper provides great clarity on costs, yet its major limitation is the availability of data, which must be mitigated with the careful use of assumptions. Third, mHealth technology life cycles have financial implications which must be accounted for. Fourth, determining cost locations and all sources of funding including non-government sources is crucial. Fifth, since costing estimates are subject to a set of assumptions, a disaggregation of costs allows for scenario-building, which is useful while planning ahead and accounting for program changes. The evidence generated can be used for more informed debate on resource allocation priorities, given competing priorities in low- and middle-income countries.

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The use and impact of mHealth by community health workers in developing and least developed countries: a systematic review

Cited by 10 publications

References 72 publications

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda

"They are our eyes outside there in the community": Implementing enhanced training, management and monitoring of South Africa’s ward-based primary healthcare outreach teams

Methods and Lessons From Costing a Large mHealth Intervention at Scale in India

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