Mobile Health Initiatives in Malawi: Understanding Impact, Funding Model and Challenges

Mobile Health Initiatives in Malawi: Understanding Impact, Funding Model and Challenges

Donald Flywell Malanga (University of Cape Town, Cape Town, South Africa) and Wallace Chigona (Department of Information Systems, University of Cape Town, Cape Town, South Africa)
DOI: 10.4018/IJPHIM.2018010104

Abstract

Mobile health (mHealth) has emerged as a tool to enhance efficiency of healthcare service delivery in developing countries especially in hard-to-reach areas. The purpose of this article was to review the mHealth initiatives implemented in Malawi as a developing country, since 2010-2017 and their impact on health outcomes. Data was gathered through published reports, peer-reviewed papers, grey-literature on electronic health (eHealth), telemedicine and mHealth. The findings reveal that although the majority of mHealth projects have registered positive impacts, implementation challenges still exist. The study also revealed that the majority of mHealth projects are driven and funded by Non-Governmental Organizations (NGO) and have not moved beyond pilot phase. There is also lack of funding model on part of the Malawi Government to scale-up the mHealth programmes. Based on the challenges, the article makes some recommendations.
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Introduction

Access to quality and affordable healthcare services continue to pose a big challenge to achieve Universal Health Coverage in developing countries (Trevor et al., 2012). This is manifested through poor health infrastructure, shortage of skilled health personnel, lack of adequate medical supplies, high burden of combating diseases, and limited budgets (United Nations Development Programme, 2017). About 60-75% of people living in rural areas are denied of critical healthcare access compared to those in urban areas (International Labour Organisation, 2015).

Mobile health (mHealth) interventions have emerged as cost-effective ways of addressing some of the health challenges, especially in hard-to-reach areas (Remaire, 2011). Studies show that the use of mHealth interventions has the potential to help overcome the traditional physical geographical barriers such as lack of physical access to a public health facility. They can also support the performance of healthcare personnel, to disseminate clinical updates, reminders, learning materials to patients or clients situated in remote communities (Kallander et al., 2013; Watkins, Robinson & Dalious, 2013). mHealth interventions are also useful for reducing delays in diagnosis treatment; disease outbreak monitoring and reporting.

While there is limited scientific evidence on the effectiveness of mHealth interventions, huge amount of investments in mHealth pilot projects have been reported in countries like Tanzania, South Africa, Kenya, Botswana, Nigeria, and others (Gursel, 2015; Mudenda & Chigona, 2013). The majority of these mHealth interventions are delivered in form of tip reminders and Short Text Messages (SMS) focusing on primary healthcare. Despite such investments, it is estimated that nearly 60-80% of mHealth projects fail to register success in Africa (Gursel, 2015; Cucciniello et. al., 2015). Some the factors that have been suggested include: inadequate personnel; lack of inadequate monitoring and evaluation; lack of incentives; low literacy levels; cultural barriers; and inadequate finances to scale up the projects (Nyemba-Mudenda &Chigona, 2013; Kaller, et. al., 2013).

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