Who bears the cost of ‘informal mhealth’? Health-workers’ mobile phone practices and associated political-moral economies of care in Ghana and Malawi

Abstract

Africa’s recent communications ‘revolution’ has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to ‘care’ even at substantial personal cost. Although there is significant potential for ‘informal mhealth’ to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.

m-Health for Burn Injury Consultations in a Low-Resource Setting: An Acceptability Study Among Health Care Providers

“…A study from Malawi and Ghana raises the concern that the cost of ''informal m-health'' is mainly borne by the health workers themselves. 37 The implication of this is that different barriers to successful implementation have to be recognized at an early stage.…”

Nurses? use of smartphones for work purposes in the Philippines : predictors, outcomes, and issues

“…In the context of using health information technologies among Thai healthcare professionals, there was a positive association between intention and use (Kijsanayotin, Pannarunothai, & Speedie, 2009). Similarly, previous studies show that willingness among nurses (Chiang & Wang, 2016;Giles-Smith, Spencer, Shaw, Porter, & Lobchuk, 2017;Moore & Jayewardene, 2014;Stephens et al, 2017) and community healthcare workers (Hampshire et al, 2017) seem to influence the use of mobile phones for work purposes. Consistent with the theory and prior research, this study hypothesises that:…”

“…Although there are several mobile technologies associated with mHealth (e.g., wearables, mobile phones, personal digital assistants), the mobile phone has largest potential to influence healthcare as it is widely adopted by all segments of the population due to its increasing affordability, functionality, and portability (Hampshire et al, 2017;Patrick, Griswold, Raab, & Intille, 2008). Systematic reviews on the use of mobile phones for healthcare indicate that such technology could assist healthcare workers in community settings by facilitating immediate access to information, improved communication with patients and other healthcare workers, and enhanced data collection and reporting (Agarwal et al, 2015;Chib et al, 2015;Goel et al, 2013).…”

“…Aside from privacy and governance issues, there is the issue of cost from the perspective of employees. Recent studies show that healthcare workers are keen on using their own mobile phone to facilitate work in the hospital on the grounds that it might improve work productivity and the quality of care delivered to patients (Chiang & Wang, 2016;Hampshire et al, 2017;Stephens et al, 2017). However, they might be bearing the cost of its use unwillingly, which can lead to unintended financial constraints that employers may not realise (Chiang & Wang, 2016;Hampshire et al, 2017;Stephens et al, 2017).…”

“…Another point that needs to be considered based on the findings is that while nurses are using their smartphones for the benefit of their patients (by improving the quality by which healthcare services can be provided; Hampshire et al, 2017), it is also equally important that nurses should be mindful of preventing any harm resulting from the accidental transmission of patient information to people that are not part of the patient's healthcare team.…”