Abstract
BackgroundMobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems.MethodsA qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa.ResultsFour key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings.ConclusionAgainst a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings.
Highlights
Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems
Developing a health systems framework for decisionmaking about mHealth for community-based health services (CBS) Against the background of multiple systems challenges identified in the literature, we identified the need for a framework with a more explicit focus on the health system dimensions of implementing mHealth
We developed a health systems framework to guide our reflection on the potential challenges of scaling up mHealth for the monitoring and evaluation of CBS in the South African setting
Summary
Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. There is widespread enthusiasm for the use of mobile phone technology to improve health services (or mHealth), but evidence is limited on how to implement mHealth effectively at scale in health systems. In a parallel initiative the South African primary health care system (PHC) is undergoing a process of revitalization in which the currently fragmented community-based ‘outreach’ functions are being prioritised for greater development, through integration with and management by the health department [10]. This formalisation of CBS is expected to bring greater standardisation of M&E and supervision systems for community health workers (CHWs).
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