[Re: https://www.hifa.org/dgroups-rss/mhealth-innovate-50-introduction-brendo... ]
Thanks for highlighting some of the thinking from mHealth-Innovate. The initial definition appeals to me. I like the phrasing " ...using approaches that are initiated by the healthcare workers themselves and that are initially not standardized, regulated or endorsed ...".
My gut sense is that what matters more than precision is the framing as an emergent phenomenon. Something that no-one controls. As the Hampshire et al (2021) paper in World Development put it, an "emergent health system", in parallel with existing systems. Which is what makes it exciting to build on or build with. I'm not sure what the right vocabulary is to use.
I think the subsequent working definition you give is useful because it puts the focus on the health workers themselves, which is where practical interventions need to focus.
In response to your questions, but partly as a springboard for my own thinking:
1. Were "non-clinical volunteers using their own personal phones ... to register patients"? - It wasn't simply done by volunteers. Yes, whoever was responsible for registration (nurse, health promoter, formal Community Health Worker or volunteer) used their own personal phone.
2. What makes things complicated in practice in South Africa is that different kinds of staff in a clinic have different relationships to the formal health care system. And I think this applies in other countries too. Nurses have a formal training curriculum, possible post-qualification specialisations and national professional registration. With a defined career path in the formal health system. Health promoters and CWHs need to have a two-year certificate, and work on a salary. Volunteers usually have no formal training, may receive a small stipend and don't have a career path at all.
3. Why it was "decided to use people's mobile phones in this way": Since mobile phone ownership and use was widespread in South Africa at the project launch (2014), and the registration process was designed to be simple, staff using their personal devices was not seen as an issue. Registration only required the use of SMS.
4. Confidentiality and privacy issues: The mother's phone number and official ID or passport number gave the most problems. Phone number often changed because SIM cards were lost or the mother could get free credit if they changed to another service provider. The free credit really makes a difference when money is tight. ID or passport numbers gave problems when they were from foreign countries that the system did not recognise as valid. I was told that some mothers were illegal immigrants who would use papers belonging to someone else. Who obviously were concerned that their details might be accessed by the government and lead to deportation.
5. Endorsement from different levels: Use of personal phones in office hours and on clinic premises was the formally approved process. I wasn't aware of formal endorsement or pressure to work after hours or at home. But registration was sometimes done off premises and after hours. Volunteers were on a month-to-month contract, so in their case they did feel that it was in their own best interests to just get the job done.
For those who are interested, the MomConnect project is now ten years old and the South African Health Department describes it here:
https://www.health.gov.za/momconnect/
HIFA profile: Brendon Wolff-Piggott is a Research Associate at GIBS Business School, in South Africa. Professional interests: Telehealth; Digital Health; Artificial Intelligence; Primary Health Care; and Voluntary Labour. Email: wolffpiggottb AT gibs.co.za