Mobile Phones and Expanding Human Capabilities in Plural Health Systems

Introduction

This chapter discusses how the integration of mobile phones into a wider communicative ecology of rural and urban settings expands the capabilities of marginalised publics to negotiate healthcare services in Sierra Leone’s plural healthcare system. It discusses the extent to which these processes do or do not facilitate the access to timely and affordable healthcare services. Similar to other countries in sub-Saharan Africa, Sierra Leone’s public health system is plagued with several challenges—ranging from outdated policies, poor medical equipment, limited and ill-equipped medical personnel, to poor drug management and information delivery mechanisms (GoSL, 2009b). As part of continuing efforts to reverse the deplorable public health system, the government of Sierra Leone developed an ambitious five-year (2010-2015) national health sector strategic plan in 2009. Some of the key priorities of this plan included the accessibility to medicines and health technologies to the public and the standardisation of health information flow among the government’s funded Peripheral Health Units (PHUs) and public hospitals across the country (GoSL, 2009b, p. 33).

Until recently, the effect of the Sierra Leone government’s healthcare strategy is less evident in the planning and delivery of public healthcare services to citizens. Many public hospitals and community healthcare centres still work under considerably difficult conditions to attend to patients, make appointments and coordinate other health related activities. More importantly, a good number of ordinary Sierra Leoneans are still unable to access quality, affordable and well organised public healthcare services. Consequently, this limitation forced many vulnerable and marginalised publics to explore alternative means for healthcare services. These alternative means are facilitated by a plural healthcare system, which involves a wide array of state and non-state health providers that people navigate between to seek health care (Scott et al., 2014). The system offers sick patients the options to negotiate health care from multiple sources such as home treatments, herbalists, religious healers, drug peddlers and facility-based providers (Scott et al., 2014, p. 293). Given the diversity of healthcare providers in the plural healthcare system, it is likely for patients or caregivers to search, negotiate, coordinate and make decision about where and how to seek healthcare services. In this chapter, the author discusses the place of mobile phones as communication devices to facilitate these processes by the marginalised—that is, people who are socio-economically disadvantaged and have limited access to healthcare information and services in Sierra Leone.