GLOBVAC-Global helse- og vaksin.forskn

Background and Project aim: Digital technologies are seen as an important mechanism for enhancing workforce performance, supporting implementation, advancing universal health coverage and achieving other SDG3 targets. But while much research has focused on ‘top-down’ digital strategies initiated by researchers, governments and NGOs, far less research has explored healthcare workers’ own solutions. Healthcare workers in low and lower middle-income countries (LLMICs) increasingly use mobile phones to overcome clinical and health systems challenges and deliver the services expected of them. The aim of this project is to explore how informal uses of mobile phones by healthcare workers can be used to strengthen health systems and inform digital health interventions in low and lower middle-income countries. Results: We conducted a systematic review to explore the perceptions and experiences of health workers and their managers regarding informal, innovative use of mobile devices to support their work (Workpackage 1). We searched four databases and screened approximately 13000 references. Thirty studies were included in this review. Preliminary findings indicate that health workers informally use their personal mobile phones to communicate within and outside their networks including for seeking advice for patient management, for emotional support and to manage staff members’ work; and also use their personal phones to seek online information and store patient information. Health workers are using informal systems because they provide better functionality or are more user-friendly than formal communication systems, because the use of personal phones has been normalized in the workplace, and because of feelings of obligation towards their patients and colleagues. Although health workers reported improved efficiency and quality of care for patients, they also reported negative impacts such as breeches to privacy and confidentiality of patient information, cost implications, concerns about the legal implications of offering advice through informal channels, and loss of data from the formal health information system. A draft report has been developed and has been submitted to the Cochrane editorial process. The included studies in the systematic review will be used to build a repository. The preliminary findings are being used to inform an analysis of Ugandan policies relevant to informal mobile phone use (Workpackage 3). We have searched for and are currently analyzing Uganda policy documents to explore how current policies and regulations on ICT and digital health in Uganda address or fail to address informal mobile phone use among health workers. In addition, we plan to interview national level stakeholder to explore their perceptions on the benefits, challenges and suggested way forward for the informal use of mobile phones. The preliminary findings from the systematic review are also being used to inform the data that will be collected in Uganda (Workpackage 2). Ethics clearance for this work has been obtained from the Makerere University School of Social Sciences Research and Ethics Committee, and administrative clearance has been obtained from the Uganda National Council of Science and Technology and Ministry of Health. The Phd Candidate based in Uganda, has held discussions with the health facility managers, and started to observe how health workers use their phones including as part of online groups. Expected outcomes: This project will generate new evidence about how healthcare workers use mobile devices to create informal solutions to everyday challenges at work. We will examine the strengths and weaknesses of these solutions and their implications for policy and governance. Finally, we will explore how innovative solutions can be formally integrated within health systems to enhance service delivery and ultimately reduce disease burden and promote equity.

The aim of this project is to explore how innovative informal uses of mobile phone messaging apps by healthcare workers can be used to strengthen health systems and inform digital health interventions in low and lower middle-income countries (LLMICs). Digital technologies are seen as an important mechanism for enhancing workforce performance, supporting implementation, advancing universal health coverage and achieving other SDG3 targets. But while much research has focused on ‘top-down’ digital strategies initiated by researchers, governments and NGOs, far less research has explored healthcare workers’ own solutions. Healthcare workers in LLMICs increasingly use free and accessible mobile phone messaging applications (‘apps’) to overcome clinical and health systems challenges and deliver the services expected of them. We will generate new evidence about how healthcare workers use these technologies to create innovative solutions. Further, we will explore how these innovations can be formally integrated within health systems to enhance service delivery and ultimately reduce disease burden and promote equity. We will also examine the implications of these innovations for policy and governance. We will investigate these themes in Uganda—a low-income country where the Ministry of Health has a strategic plan for using ICT to transform health service delivery, and where there is widespread informal use of messaging apps to address health challenges. To secure user involvement when evaluating the transferability of evidence to other settings and the acceptability and feasibility of new solutions, we will convene deliberative dialogues built on the principles of co-design and co-production. Overall, we will promote an interdisciplinary implementation research agenda that cut across policy studies, health services research, medical anthropology and information and communications technology; and identify lessons for future development of digital interventions.