Bronwyn Harris1, Motunrayo Ajisola2, Raisa Meher Alam3, Jocelyn Anstey Watkins4, Theodoros N Arvanitis5, Pauline Bakibinga6, Beatrice Chipwaza7, Nazratun Nayeem Choudhury3, Peter Kibe6, Olufunke Fayehun2, Akinyinka Omigbodun8, Eme Owoaje9, Senga Pemba7, Rachel Potter10, Narjis Rizvi11, Jackie Sturt12, Jonathan Cave13, Romaina Iqbal11, Caroline Kabaria6, Albino Kalolo7, Catherine Kyobutungi6, Richard J Lilford14, Titus Mashanya7, Sylvester Ndegese7, Omar Rahman15, Saleem Sayani16, Rita Yusuf3, Frances Griffiths4,17. 1. University of Warwick Warwick Medical School, UK. 2. Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria. 3. Centre for Health, Population and Development, Independent University Bangladesh, Bangladesh. 4. Warwick Medical School, University of Warwick, UK. 5. Institute of Digital Healthcare, WMG, University of Warwick, UK. 6. African Population and Health Research Center, Kenya. 7. St Francis University College of Health and Allied Sciences, Tanzania. 8. Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria. 9. Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. 10. Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK. 11. Community Health Sciences Department, Aga Khan University, Pakistan. 12. Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK. 13. Department of Economics, University of Warwick, UK. 14. Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK. 15. University of Liberal Arts Bangladesh, Bangladesh. 16. Aga Khan Development Network Digital Health Resource Centre (Asia and Africa), Aga Khan University, Pakistan. 17. Centre for Health Policy, University of the Witwatersrand, South Africa.
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.
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.
Keywords:
Digital health; health systems; healthcare services; low- and middle-income countries; mHealth; mixed methods; mobile consulting; mobile phone; remote rural areas; urban slums
Authors: Rubee Dev; Nancy F Woods; Jennifer A Unger; John Kinuthia; Daniel Matemo; Shiza Farid; Emily R Begnel; Pamela Kohler; Alison L Drake Journal: Reprod Health Date: 2019-07-08 Impact factor: 3.223