Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study

Bronwyn Harris; Motunrayo Ajisola; Raisa Meher Alam; Jocelyn Anstey Watkins; Theodoros N Arvanitis; Pauline Bakibinga; Beatrice Chipwaza; Nazratun Nayeem Choudhury; Peter Kibe; Olufunke Fayehun; Akinyinka Omigbodun; Eme Owoaje; Senga Pemba; Rachel Potter; Narjis Rizvi; Jackie Sturt; Jonathan Cave; Romaina Iqbal; Caroline Kabaria; Albino Kalolo; Catherine Kyobutungi; Richard J Lilford; Titus Mashanya; Sylvester Ndegese; Omar Rahman; Saleem Sayani; Rita Yusuf; Frances Griffiths

doi:10.1177/20552076211033425

Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study

Digit Health. 2021 Aug 19:7:20552076211033425. doi: 10.1177/20552076211033425. eCollection 2021 Jan-Dec.

Authors

Bronwyn Harris¹, Motunrayo Ajisola², Raisa Meher Alam³, Jocelyn Anstey Watkins⁴, Theodoros N Arvanitis⁵, Pauline Bakibinga⁶, Beatrice Chipwaza⁷, Nazratun Nayeem Choudhury³, Peter Kibe⁶, Olufunke Fayehun², Akinyinka Omigbodun⁸, Eme Owoaje⁹, Senga Pemba⁷, Rachel Potter¹⁰, Narjis Rizvi¹¹, Jackie Sturt¹², Jonathan Cave¹³, Romaina Iqbal¹¹, Caroline Kabaria⁶, Albino Kalolo⁷, Catherine Kyobutungi⁶, Richard J Lilford¹⁴, Titus Mashanya⁷, Sylvester Ndegese⁷, Omar Rahman¹⁵, Saleem Sayani¹⁶, Rita Yusuf³, Frances Griffiths^{4

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Affiliations

¹ University of Warwick Warwick Medical School, UK.
² Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria.
³ Centre for Health, Population and Development, Independent University Bangladesh, Bangladesh.
⁴ Warwick Medical School, University of Warwick, UK.
⁵ Institute of Digital Healthcare, WMG, University of Warwick, UK.
⁶ African Population and Health Research Center, Kenya.
⁷ St Francis University College of Health and Allied Sciences, Tanzania.
⁸ Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria.
⁹ Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.
¹⁰ Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK.
¹¹ Community Health Sciences Department, Aga Khan University, Pakistan.
¹² Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK.
¹³ Department of Economics, University of Warwick, UK.
¹⁴ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK.
¹⁵ University of Liberal Arts Bangladesh, Bangladesh.
¹⁶ Aga Khan Development Network Digital Health Resource Centre (Asia and Africa), Aga Khan University, Pakistan.
¹⁷ Centre for Health Policy, University of the Witwatersrand, South Africa.

Abstract

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.

Keywords: Digital health; health systems; healthcare services; low- and middle-income countries; mHealth; mixed methods; mobile consulting; mobile phone; remote rural areas; urban slums.

Grants and funding

MR/S012729/1/MRC_/Medical Research Council/United Kingdom