Gillings School of Global Public Health (2018)

Note: This post is adapted from the paper of Hamshire et al. (2015) with some additional elements from Eze et al. (2016).

The World Bank (2014) mentioned that more Africans now have a mobile phone than have a toilet. Many factors are known to hinder health care delivery in developing countries, including infrastructural deficiencies (Xiao et al. 2013; Avgerou 2008) and limited access to medicare and healthcare workers (Scheffler et al. 2009). Mobile technologies have been touted as a ‘silver bullet’ to address these issues by improving the management of health services, supply chains, and communication (Kahn et al. 2010).  Strategies based around the use of such mobile technologies are collectively referred to as mobile health (mHealth) (Petrucka 2013; Kahn et al. 2010). Investments in mHealth are becoming popular (Bloomfield et al. 2014), however, the scope and coverage of the mHealth initiatives remain limited.

Hamshire et al. (2015) review the informal ways, as opposed to the formal mHealth programmes, in which youth (aged 8-25) in Ghana, Malawi, and South-Africa utilizes mobile phones to improve their healthcare. 84.4% of the 4246 young people surveyed reported that their household owned a mobile phone. Only 38.6% had a mobile phone themselves, however, 59.6% used a phone in the last seven days. Phones are shared and allow phone usage to outpass phone ownership significantly.

Hamshire et al. (2015) find four areas of young people’s health-related phone practice. First, mobile phones can enable communication with people who might be able to help in the event of sickness or other health crisis. Having access to the right contacts is crucial to receive the right help in case of emergencies.

‘Two months ago my grandfather collapsed at home. I took his phone quickly and phoned another old man who lives nearby to come and take him to the clinic. I have his phone number because he usually takes my grannies to collect their pension money. He did not take long to arrive at our house; he rushed grandfather to the nearby clinic.’ 

(South Africa, 11y girl)

Second, young people used mobile phones in the preceding 12 months to obtain health-related advice or information about specific symptoms, medicines, healers and on sexual/reproductive health. Some sought this information from personal contacts or health professionals, but many more used mobile phones to consult the Internet or other sources.

‘My son [5y] had a skin condition. I took him many times to the doctor but he couldn’t help. So I went to Google [on phone] and browsed. I found some information about allergic reaction, so then I went back to the doctor and showed him the website. He wrote something that I should go to the hospital.’

(South Africa, 23y woman)

Mobile phones allow youth to access the internet without a computer. However, the conflicting information found online and/or offline can result in confusion.

‘My doctor tells me this, Google tells me something else, so I feel confused and worried: will I die? Lately, they were putting [IV drip] in me at the hospital but I don’t always have money to go to hospital. So I go to Google to find if I can take some other medicines, like painkillers. Searching sometimes makes me worried because I get different information from the Internet and doctors, and I don’t know which one to trust.’ 

(South Africa, 18 y woman)

Being able to distinguish what sources are trustworthy and having trustworthy sources available is key for proper use of the internet to seek for advice. In all three countries, high-profile charismatic ‘pastors’, ‘prophets’ and other faith healers have a significant presence on the radio and internet, and claim to transmit healing power directly through these technologies.

Third, a few interviewees claimed not just to have received information, but to have been healed directly through the phone.

‘I got terribly sick, this year beginning and I made a call to a pastor who then promptly prayed for me and I got healed right there. So you see that a phone saved me.’

(Malawi, 23 y woman)

Fourth, mobile phones can facilitate healthcare indirectly, through enabling income generation. Only a few respondents had used earnings from phone-related business/work to meet health- care expenses (13 in Ghana, 8 in Malawi, and 11 in South Africa) but, for those few, this could provide an essential buffer in an emergency, as this young man’s account illustrates.

‘On average, I earn about GHc10 a day [about £2] selling Vodafone airtime, but on a bad day I earn nothing. I saved about GHc1000 from the business with the intention of using it to further my education. However, my mother fell sick about 4 months ago. I spent almost all the money on her medical expenses, about GHc 800. The rest was used to cater for my siblings’ needs since my mother was indisposed. Even though I could not go to school as planned, I am happy because my mother is alive and has begun to work again.’

(Ghana, 19y man)

Hamshire et al. (2015) conclude that a few requirements should be in place for a mobile phone to be used as an informal healthcare tool.

First, health-related phone use is, of course, predicated on having (access to) a mobile phone. As indicated above, phone ownership varies between and within countries, with those in rural Malawi and Ghana least likely to own a phone. However, ownership does not equate straightforwardly with access or use. Widespread phone sharing enables some non-owners to have access. On the other hand, to be usable, a phone needs to be in working order, with a charged battery, airtime (phone credit) and a network signal, none of which can be taken for granted.

Having the right people to contact is a crucial second requirement.While calling a close family member or neighbour can sometimes suffice, certain situations require mobilising contacts with better financial resources or a ‘gate-keeper’. Personal connections with a health professional e or even someone employed as a cleaner or security guard at a health facility e can be particularly useful when access through more formal channels is limited.

Finally, effective health-related phone use requires appropriate skills. Even just knowing how to manipulate a basic phone to make a call can prove crucial in an emergency. More sophisticated IT expertise is needed to navigate the complex and often opaque online world and assess the likely trustworthiness of information while using this information to engage in constructive dialogue with a health professional requires considerable self-confidence.

Both the digital and medical worlds are changing rapidly in ways that are hard to predict. It is crucially important to work in partnership with young people, who are often at the forefront of emerging practices and who know better than anyone else what these might mean for them.

References

Avgerou, C. (2008). Information systems in developing countries: a critical research review. Journal of information Technology, 23(3), 133-146.

Eze, E., Gleasure, R., & Heavin, C. (2016). Reviewing mHealth in developing countries: A stakeholder perspective.

Gillings School of Global Public Health (2018). Retrieved from https://sph.unc.edu/cphm/unc-gillings-is-leading-mhealth-innovation/mhealth/

Hampshire, K., Porter, G., Owusu, S. A., Mariwah, S., Abane, A., Robson, E., … & Milner, J. (2015). Informal m-health: How are young people using mobile phones to bridge healthcare gaps in Sub-Saharan Africa?. Social Science & Medicine, 142, 90-99.

Kahn, J. G., Yang, J. S., & Kahn, J. S. (2010). ‘Mobile’health needs and opportunities in developing countries. Health Affairs, 29(2), 252-258.

Petrucka, P., Bassendowski, S., Roberts, H., & James, T. (2013). mHealth: A vital link for ubiquitous health. Online Journal of Nursing Informatics (OJNI), 17(2), 2675-2681.

Scheffler, R. M., Mahoney, C. B., Fulton, B. D., Dal Poz, M. R., & Preker, A. S. (2009). Estimates of health care professional shortages in sub-Saharan Africa by 2015. Health affairs, 28(5), w849-w862.

World Bank, 2014. World Development Report, 2014. World Bank, Washington DC.

Retrieved 29/1/2015 at. http://siteresources.worldbank.org/EXTNWDR2013/ Resources/8258024-1352909193861/8936935-1356011448215/8986901- 1380046989056/WDR-2014_Complete_Report.pdf.

Xiao, X., Califf, C. B., Sarker, S., & Sarker, S. (2013). ICT innovation in emerging economies: a review of the existing literature and a framework for future research. Journal of Information Technology, 28(4), 264-278.