Dear HIFA colleagues,
Re: https://www.hifa.org/dgroups-rss/mhealth-innovate-15-why-are-health-work...
In our message 29 March, we asked:
"In your healthcare system, do you experience similar gaps to those described in Ghana, Uganda and elsewhere that might drive healthcare workers to use mobile phones informally?"
The example was given that “Even if the facility has a landline, these are limited in what they can do. They cannot take pictures for example..."
What other gaps are there? The informal research review says 'Healthcare workers worldwide explain that they use personal mobile phones because of gaps in the healthcare system, including formal communication systems and other infrastructure not being available or functional, or because personal phones have better functionality and are more user-friendly than the available formal communication systems'. The researchers express high confidence in this finding, which was found in the systematic review and both of the primary research studies in Uganda.
We have four examples from the systematic review:
1. "Some doctors want to see the patient’s heart rate and rhythm through the cardiac monitor. I am not able to do that with our unit phone because it is not a smartphone. It is only a feature phone. Using my own smartphone, I can do that by taking a picture of the cardiac monitor screen and sending the image [to the doctors] via Viber [a mobile instant messaging application] because that’s what doctors want" (Staff nurse, the Philippines) (Bautista 2016, in [1])
2. "So, if I need a doctor for anything, rather than having to go to a computer and log on to the paging system and send them a page, I will just send a text message or just call them directly and they will call me back. Usually, text message" (Hospital nurse, Australia) (Spink 2020, in [1]).
3. “One MO [medical officer] revealed that he persuades ASHAs and others in the PHC [public health center] to buy smartphones and install WhatsApp on the device as he felt that he could easily pass on work‐related instructions easily" ('ASHAs', India). (Venkataraghavan 2022, in [1])
4. "You cannot be in the system without saying that you don’t want to use your own credit to call somebody. It is part of our work … you know that you are there to save lives so whatever you will do to save lives, you don’t care about that (i. e. cost of airtime and data bundle)'" (Community Health Nurse, Ghana) (Abane 2021, in [1]).
With regard to #1, this raises the question of landline versus basic phone versus smart phone prevalence in health facilities. What is the setup in your setting? Does your unit have a landline? Who uses it and for what purposes? Do you carry your personal mobile phone with you? How do you use your phone for work purposes when working in the unit/ward/facility and when you are outside?
How many people now use smartphones as opposed to basic phones? Do we have any estimates for different countries and different settings?
We do not have any examples yet from the two primary research studies carried out last year in Uganda. How do health workers in Uganda plus gaps in the health system? How do they feel about it? Do they see it as something obvious that they would gladly do? Or do they feel pressured to use their own phone, to use their own airtime/costs, or even to buy a higher-spec phone to satisfy managers (as in #3)
If health workers do not have, say, a personal smartphone to use for work purposes, this could potentially limit their capacity and might even limit quality of care. If they have a smartphone and are happy to use it, then their use of this tool in itself may not be a problem (we shall talk later about potential breaches of patient privacy and confidentiality, which certainly could be a problem). If they are being expected to buy an expensive phone out of their own pocket, this would seem to be a problem. Is this a common issue? Also, if they are incurring significant personal costs as a result of using their own phone, this too is a problem. With regard to the latter two questions of cost, the solution should be straightforward?
Looking forward to your thoughts.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org