Community health workers in developing countries have mixed results in mHealth

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Opportunities exist for mHealth to play a critical role in low- and middle-income countries where community health workers deliver integrated community case management to children sick with malaria, pneumonia and diarrhea, according to a Journal of Medical Internet Research study.

Nevertheless, the review found very few formal outcome evaluations of mHealth in these countries and despite "vast documentation of project process evaluations," there were few studies demonstrating an impact on clinical outcomes.

Integrated community case management (ICCM) of malaria, pneumonia and diarrhea is currently being implemented at scale in several African countries, says the study. In the Healthy Child Uganda project, for instance, community health workers used mobile phones to send emergency alerts and requisition supplies to support ICCM activities. However, use of PDAs in a Rwandan ICCM program exacerbated, rather than lessened, volunteer workload in which mobile phone-assisted data collection became onerous and was felt to have distanced community health workers from the human side of their role, turning them into "data collection robots," the study states.

The most commonly documented use of mHealth cited in the study was one-way text message and phone reminders to encourage follow-up appointments, healthy behaviors and data gathering. Innovative mHealth applications for community health workers also cited in the study were the use of mobile phones as job aides, clinical decision support tools, and for data submission and instant feedback on performance.

"With partnerships forming between governments, technologists, non-governmental organizations, academia, and industry, there is great potential to improve health services delivery by using mHealth in low- and middle-income countries," concludes the study. "As with many other health improvement projects, a key challenge is moving mHealth approaches from pilot projects to national scalable programs while properly engaging health workers and communities in the process. By harnessing the increasing presence of mobile phones among diverse populations, there is promising evidence to suggest that mHealth can be used to deliver increased and enhanced health care services to individuals and communities, while helping to strengthen health systems."

Two recent studies published in PLoS Medicine similarly showed that while mHealth has tremendous potential, it has resulted in mixed effectiveness ad modest benefits. The problem is that nearly all trials demonstrating the success of mHealth have been conducted in developed countries and have been low quality, according to the studies.

To learn more:
- read the JMIR study

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