Dear Brendon,
Many thanks for your very interesting message to HIFA https://www.hifa.org/dgroups-rss/mhealth-innovate-46-introduction-brendo...
You referred to your paper (2020) and I would like to share the citation and abstract:
CITATION: The Challenge of “Informal mHealth” and Community Health Worker Practices
October 2020
DOI: 10.1145/3406324.3424595
https://dl.acm.org/doi/10.1145/3406324.3424595
ABSTRACT
The technology of mHealth is often presented as a solution to improve health care for underserved populations, through empowering and improving the efficiency of work flows for health care staff, particularly in developing countries. mHealth has frequently been implemented as part of small-scale projects, so increasing the coverage of mHealth through scaling up has been posed as a logical way to improve the situation. The phenomenon of “informal mHealth” challenges this paradigm: recent research has identified that community health care workers are helping patients using their own mobile phones in the absence of any formal mHealth initiatives, drawing on their own airtime (credit) and time to do so. A close reading of prior empirical research reveals that similar behavior of going “above and beyond” the formal requirements of an mHealth project is not unusual, even though it has received little direct attention. This research draws on a rereading of the mHealth literature to inform reflection on field work in a successful, large-scale mHealth project to argue that “formal” and “informal” mHealth are not easily separated out. This raises important challenges for understanding and practice; notably that some core concepts in the field such as “adoption” and “resistance” need to be reconsidered in order to design effectively and with due regard for the lived experiences and practices of community health workers.
You make the point that “formal” and “informal” mHealth are not easily separated out. This distinction has not been easy in the current mHealth-Innovate research project either. We agreed a definition: 'Healthcare workers’ use of mobile phones to support their work, using approaches that are initiated by the healthcare workers themselves and that are initially not standardized, regulated or endorsed by the health system or organization to which they belong’, but words like 'initiated', 'standardized', 'regulated' and 'endorsed' are open to different interpretations.
For clarity, one option is to sidestep the 'informal/formal' spectrum and focus on 'health workers' use of personal mobile phones for work purposes'. I think there is agreement that this is our main area of interest (although there are examples of other use such as 'informal use of work phones' and 'bring your own device schemes').
In your original message I was also very interested to read: 'This registration took place on personal mobile devices at no cost to themselves (a government sponsored number), which is not informal mHealth in itself.'
When I think of 'use of personal mobile phones for work purposes', I think especially of frontline health workers using their phones to support frontline care. The description you give suggests that personal mobile phones may be used for administrative purposes within facilities, to register patients, often with several non-clinical volunteers using their own personal phones for this purpose. Please can you say a bit more about this and why it was decided to use people's mobile phones in this way?
Did you get a sense of the patient confidentiality and privacy issues? Coming back to the informal-formal issue, this seems a case where it is not easy to categorise. For example, were the actions 'formally' endorsed by supervisors (and how do we define 'formally endorsed?). If endorsed by the supervisors, was this activity in turn formally endorsed by the facility or by the MoH? If not, then such activity might be considered 'formally endorsed' by individual workers/volunteers (because they are instructed by their supervisors), while at the same time being 'informal' (with respect to supervisors endorsing activity that is not formally endorsed by facility or national guidance.
With thanks, Neil
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