Dear HIFA colleagues,
I am completing a PhD at the University of Nigeria, Nsukka, on informal mobile-phone use among frontline health workers across five disease-control programmes (HIV, TB, malaria, diabetes, hypertension) in Enugu, Nigeria.
The study follows directly from HIFA's 2022 mHEALTH-INNOVATE discussion and the Glenton et al. (2024) Cochrane review, which called for more evidence on how these informal practices shape service delivery. [*see note below]
Using a mixed-methods design (128 health-worker surveys, 199 traced episodes of real phone-mediated decisions, 23 interviews, 13 focus groups), the study found personal phones doing much of the coordination work disease programmes assume happens through formal systems. Sixty percent of traced episodes clustered into five recurring mechanisms: defaulter recovery, clinical consultation, result-expediting, adherence support, and contact tracing. Workers fund this themselves, spending an estimated 3 to 12 percent of monthly income on airtime and data, with the heaviest burden falling on the lowest-paid cadres.
I would value the HIFA community's experience on two points. First, whether you have seen similar patterns in your own settings. Second, what policy options you would consider realistic for recognising and supporting this work, such as device or airtime allowances or secure-messaging alternatives, without adding further strain to stretched health systems.
Chikezie A Nwankwor. M.D; MSc; Cert (HRH); Cert (HPSR); Cert (HFP); FCIPM
Researcher & Lecturer, Department of Health Administration & Management
FHST, College of Medicine.
University of Nigeria, Enugu Campus
Enugu, Nigeria.
Tel: +234-703-242-2998
Email: chikezie.nwankwor@unn.edu.ng
Skype: live:chikezien
Orcid: https://orcid.org/0000-0002-4215-6383
The society that scorns excellence in plumbing as a humble activity and tolerates shoddiness in philosophy because it is an exalted activity will have neither good plumbing nor good philosophy: Neither its pipes nor its theories will hold water (John W Gardner)
[*Note from HIFA moderator (NPW):
https://www.hifa.org/projects/mhealth-innovate-what-can-we-learn-health-...
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015705.pub2/... ]