Abstract
BackgroundThe implementation of mobile health (mHealth) projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers. By contrast, the expectations of direct and indirect mHealth users are not often examined. In preparation for a proposed intervention in the Nouna Health District, in rural Burkina Faso, this study investigates the expected benefits, challenges and limitations associated with mHealth, approaching these expectations as a form of situated knowledge, inseparable from local conditions, practices and experiences.MethodsThe study was conducted within the Nouna Health District. We used a qualitative approach, and conducted individual semi-structured interviews and group interviews (n = 10). Participants included healthcare workers (n = 19), godmothers (n = 24), pregnant women (n = 19), women with children aged 12–24 months (n = 33), and women of childbearing age (n = 92). Thematic and content qualitative analyses were conducted.ResultsParticipants expect mHealth to help retrieve patients lost to follow-up, improve maternal care monitoring, and build stronger relationships between pregnant women and primary health centres. Expected benefits are not reducible to a technological realisation (sending messages), but rather point towards a wider network of support. mHealth implementation is expected to present considerable challenges, including technological barriers, organisational challenges, gender issues, confidentiality concerns and unplanned aftereffects. mHealth is also expected to come with intrinsic limitations, to be found as obstacles to maternal care access with which pregnant women are confronted and on which mHealth is not expected to have any significant impact.ConclusionsmHealth expectations appear as situated knowledges, inseparable from local health-related experiences, practices and constraints. This problematises universalistic approaches to mHealth knowledge, while nevertheless hinting at concrete, expected benefits. Findings from this study will help guide the design and implementation of mHealth initiatives, thus optimising their chances for success.
Highlights
The implementation of mobile health projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers
A priority area of mobile health (mHealth) interventions in sub-Saharan Africa and in low- and middle-income country (LMIC) in general has been maternal health [20]. mHealth projects have, for instance, been implemented to strengthen pregnancy [21] and postpartum monitoring [22], or to improve skilled attendance at delivery [23]. mHealth has been widely expected to contribute in achieving the targets of the Millennium Development Goals for child and maternal health [24,25,26]
The health infrastructure of the Nouna Health District (NHD) consists of one District Hospital (DH) in Nouna and 43 primary health centre (PHC), out of which 10 PHCs are included in MOS@N
Summary
The implementation of mobile health (mHealth) projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers. Duclos et al Health Research Policy and Systems 2017, 15(Suppl 1): to a mobile service [8] Under these circumstances, mHealth initiatives in sub-Saharan Africa have been taking many different forms [9]. MHealth interventions in sub-Saharan Africa, and in low- and middle-income countries (LMICs) in general, are raising high expectations among development agencies, policymakers and researchers [16,17,18]. Individual benefits often associated with mHealth include an increased access to healthcare and health information, increased cost-efficiency of service delivery, improved ability to diagnose, treat and track diseases, and timely public health information [19]. It has been suggested that mobile communication technologies hold the potential to reduce maternal health disparities related to cost, distance and inadequate health infrastructure [27]
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