Mobile phones to speed up healthcare delivery in EastAfrica

The report asserts that, “Community health workers offer a more realistic path to rapidly strengthening the healthcare workforces in low-income countries.”

Unfortunately, community health workers typically receive little training and have high staff turnover.

The mobile applications are thus mainly targeted at nurses and community health workers, whose effectiveness is often hampered by lack of comprehensive information on diseases and treatment procedures. The apps are not intended classroom-based training, but rather to supplement it with mobile refresher quizzes, quick access to reference materials, real-time feedback, and updates about new or improved treatment procedures.

Investing in community health workers has been shown to reap tangible and long-term rewards. Community health workers provide many of the same services that physicians and nurses perform at a lower cost. They also require less training than professional doctors: 2-3 years, compared with the 5-8 years that it takes for a doctor to be licensed and allowed to practice without supervision.

The report says, “Improved training and ongoing learning, especially of community health workers, mean better diagnosis, treatment and improved health outcomes.”
When healthcare workers are better trained, there are marked declines in maternal mortality, infant mortality, and the overall burden of widespread disease.

Training of midwives has been shown to reduce maternal deaths and infant mortality by significant margins. It is estimated that training and supporting midwives to provide a package of select neo-natal interventions could prevent 38 per cent of newborn deaths, or 1.3 million babies per year.

A recent WHO study found that training community health workers in Bangladesh reduced maternal mortality by two-thirds and still births by 40 per cent— results which, if applied globally, could save the lives of 120,000 mothers and 96,000 babies per year.

One mHealth Education pilot project has been undertaken in the Millennium Villages Projects, which includes the villages of Dertu in north eastern Kenya; Mbola in western Tanzania; and Ruhiira in south western Uganda. In these villages, community health workers are responsible for 100-200 households each, conducting home visits, routine and preventative check-ups. During evaluation, community health workers reported that having a mobile reference point eliminates the need to carry a heavy manual or constantly call a nurse for support.

The report highlights that a major problem is the small storage capacity of the phones, limiting the length and number of modules that can be stored, particularly for non-English versions. The fact that not all phones have the Java technology required to download the modules could also limit the project’s reach.

However, the technology is gaining ground. Anne Kamene, a former enrolled nurse at the Kangundo district hospital in Kenya said: “I [now] interact a lot with patients and give them more attention than before. Even the doctors respect us. Before, we were just there to follow instructions, but after seeing what we’re able to do, they listen to us and even consult us.”

The report is emphatic that the goals for mHealth Education must be ambitious, because the challenge is so great. It is estimated that in order to achieve the health-related Millennium Development Goals, the training of over 2.1 million current healthcare workers must be improved, and about 2.6 to 3.5 million new workers must be trained and deployed in developing countries.

Instead of developing several more pilot projects, the next step should be selecting a successful project and scaling it up to district or even national level.

Gustav Praekelt, whose foundation developed the Young Africa Live portal in South Africa, underscores the obligation to scale up: “Don’t do it unless you can reach at least one million people.”