Abstract
The use of mobile phones is fast transforming the healthcare delivery landscape in Ghana. A substantial number of health facilities are now dependent on mobile phones to facilitate their work. Evidence of the use of mobile phones in Ghana’s healthcare is however limited. In order to contribute to the evidence of the value of using mobile phones to promote healthcare, we interrogated and highlighted unexpected costs imposed on community health nurses who use their personal mobile phones for healthcare delivery in the country. Data for the study were derived from 598 completed questionnaires and extracts from focus group discussions with community health nurses who were sampled from three regions across the three main ecological zones of Ghana. The results show that over 90% of nurses bear the cost of paying for airtime, bundles and chargers used for work-related activities, yet less than 10% of them receive direct compensation. This costly burden has the potential to demotivate the nurses and threaten the country’s progress towards the achievement of universal health coverage. More significantly, the data strongly suggest that physical distance, regional location and gender are the main factors triggering extra costs incurred by the nurses. We conclude that the use of personal mobile phones for healthcare delivery imposed huge financial burden on community health workers in Ghana. A suggested intervention to forestall negative consequences on performance is to offer incentive packages to nurses as a compensation for the financial and non-physical costs of using personal mobile phones for work-related activities.
Highlights
A healthcare delivery system that seeks to achieve universal coverage (Ghana Health Service, 2017) requires sufficient professional human capital (Abid et al, 2018; Mills et al, 2012; Opoku et al 2017)
The paper has demonstrated that Community Health Nurses (CHNs) in Ghana incur significant financial costs in using their personal mobile phones for work-related activities
We cannot forever rely on their good will and benevolence, because this may constitute cost shifting where health systems inadver tently exploit the moral imperative to care by lower-level health workers such as CHNs who are among the least paid (Hampshire et al, 2017)
Summary
A healthcare delivery system that seeks to achieve universal coverage (Ghana Health Service, 2017) requires sufficient professional human capital (Abid et al, 2018; Mills et al, 2012; Opoku et al 2017). According to the Ghana Health Service (2017), in 2016 there were 3365 doctors, 14,791 community health nurses, 7662 midwives, 619 pharmacists, and 13,231 registered general nurses, with a doctor-population ratio of 1:84813 Though this ratio falls far below the WHO recommended ratio of 1:10,000, Ghana’s ratio is one of the best in sub-Saharan Africa (WHO, 2019). The total general government expenditure on health (68.3%) is far higher than Africa’s average of 50.8% and the global average of 38.8% (World Health Organisation, 2015). In spite of these moderate strides, the country faces serious challenges when it comes to ensuring access to healthcare for all citi zens. There are issues of health-worker dissatisfaction with conditions of service and the tools to work with, occasionally resulting in strikes
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