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

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.

Citation

Hampshire, K., Porter, G., Mariwah, S., Munthali, A., Robson, E., Owusu, S. A., Abane, 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. https://doi.org/10.1093/heapol/czw095

• Journal Article Type: Review
• Acceptance Date: Jun 17, 2016
• Online Publication Date: Jul 31, 2016
• Publication Date: Jan 1, 2017
• Deposit Date: Jul 25, 2016
• Publicly Available Date: Jul 31, 2016
• Journal: Health policy and planning
• Print ISSN: 0268-1080
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 1
• Pages: 34-42
• 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
• Public URL: https://hull-repository.worktribe.com/output/441736
• Publisher URL: http://heapol.oxfordjournals.org/content/early/2016/07/25/heapol.czw095
• Related Public URLs: http://dro.dur.ac.uk/19113/
• Additional Information: Copy of article first published in: Health policy and planning, 2016, v.32, issue 1.
• Contract Date: Jul 25, 2016