TY - JOUR
T1 - Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries
T2 - A mixed-methods study
AU - Harris, Bronwyn
AU - Ajisola, Motunrayo
AU - Alam, Raisa Meher
AU - Watkins, Jocelyn Anstey
AU - Arvanitis, Theodoros N.
AU - Bakibinga, Pauline
AU - Chipwaza, Beatrice
AU - Choudhury, Nazratun Nayeem
AU - Kibe, Peter
AU - Fayehun, Olufunke
AU - Omigbodun, Akinyinka
AU - Owoaje, Eme
AU - Pemba, Senga
AU - Potter, Rachel
AU - Rizvi, Narjis
AU - Sturt, Jackie
AU - Cave, Jonathan
AU - Iqbal, Romaina
AU - Kabaria, Caroline
AU - Kalolo, Albino
AU - Kyobutungi, Catherine
AU - Lilford, Richard J.
AU - Mashanya, Titus
AU - Ndegese, Sylvester
AU - Rahman, Omar
AU - Sayani, Saleem
AU - Yusuf, Rita
AU - Griffiths, Frances
N1 - Funding Information:
We would like to thank all study participants for generously sharing their experiences and insights. We are grateful to the NIHR Global Health Research Unit on Improving Health in Slums for providing access to the data collected for the household and adult surveys and for providing contextual grounding for our work. Special thanks are extended to Samuel I Watson and Syed AK Shifat Ahmed for providing support with the secondary data analysis, and to Samantha Johnson for assisting with the search strategy used in our literature review. We are grateful to the anonymous reviewer and Kagiso Ndlovu for the thoughtful and constructive review. The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by a foundation grant from the Health Systems Research Initiative with funding from the UK Department for International Development, the UK Economic and Social Research Council, the UK Medical Research Council and Wellcome (grant no. MR/S012729/1). SP and MA (Global Challenges Research Fund Fellowship No. IAS/32013/19) gratefully acknowledge the support provided by the Warwick Institute of Advanced Study. FG receives funding as South Africa Research Chair in Health Policy and Systems from the National Research Foundation, South Africa. RJL is supported by the NIHR Applied Research Collaboration (ARC), West Midlands, UK.
Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by a foundation grant from the Health Systems Research Initiative with funding from the UK Department for International Development, the UK Economic and Social Research Council, the UK Medical Research Council and Wellcome (grant no. MR/S012729/1). SP and MA (Global Challenges Research Fund Fellowship No. IAS/32013/19) gratefully acknowledge the support provided by the Warwick Institute of Advanced Study. FG receives funding as South Africa Research Chair in Health Policy and Systems from the National Research Foundation, South Africa. RJL is supported by the NIHR Applied Research Collaboration (ARC), West Midlands, UK.
Publisher Copyright:
© The Author(s) 2021.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Digital health
KW - health systems
KW - healthcare services
KW - low- and middle-income countries
KW - mHealth
KW - mixed methods
KW - mobile consulting
KW - mobile phone
KW - remote rural areas
KW - urban slums
UR - http://www.scopus.com/inward/record.url?scp=85113180018&partnerID=8YFLogxK
U2 - 10.1177/20552076211033425
DO - 10.1177/20552076211033425
M3 - Article
AN - SCOPUS:85113180018
SN - 2055-2076
VL - 7
JO - Digital Health
JF - Digital Health
ER -
