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Who bears the cost of ‘informal mhealth’? Health-workers’ mobile phone practices and associated political-moral economies of care in Ghana and Malawi

Hampshire, Kate; Porter, Gina; Mariwah, Simon; Munthali, Alister; Robson, Elsbeth; Owusu, Samuel Asiedu; Abane, Albert; Milner, James

Authors

Kate Hampshire

Gina Porter

Simon Mariwah

Alister Munthali

Samuel Asiedu Owusu

Albert Abane

James Milner

Abstract

Africa’s recent communications ‘revolution’ has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to ‘care’ even at substantial personal cost. Although there is significant potential for ‘informal mhealth’ to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.

Journal Article Type Review
Publication Date Jan 1, 2017
Journal Health policy and planning
Print ISSN 0268-1080
Electronic ISSN 1460-2237
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 32
Issue 1
Pages 34-42
Institution Citation Hampshire, K., Porter, G., Mariwah, S., Munthali, A., Robson, E., Owusu, S. A., …Milner, J. (2017). Who bears the cost of ‘informal mhealth’? Health-workers’ mobile phone practices and associated political-moral economies of care in Ghana and Malawi. Health Policy and Planning, 32(1), 34-42. doi:10.1093/heapol/czw095
DOI https://doi.org/10.1093/heapol/czw095
Keywords Care work, Community health-workers, Mobile phones, Moral economy, Political economy, Sub-Saharan Africa, Task shifting
Publisher URL http://heapol.oxfordjournals.org/content/early/2016/07/25/heapol.czw095
Related Public URLs http://dro.dur.ac.uk/19113/
Copyright Statement The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Additional Information Copy of article first published in: Health policy and planning, 2016, v.32, issue 1.

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Copyright Statement
The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.



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