Tiwonge Davis Manda

Implementing Mobile Phone Solutions for Health in Resource Constrained Areas: Understanding the Opportunities and Challenges

This paper presents results from a study on mobile phone use to connect two rural hospitals in Malawi with community health workers (CHWs), the hospitals work with. Mobile phone use at the hospitals has helped reduce the need for face-to-face communication to permit patient information exchange, meetings and appointments scheduling, as well as work coordination. On the other hand mobile phone use has proved paradoxical as it has introduced users to challenges, like recharging of phone batteries, they did not anticipate. The paper highlights use context-centric and solution based opportunities and challenges associated with mobile phone use in rural settings.

Socio-technical Arrangements for mHealth: Extending the Mobile Device Use and Adoption Framework

This paper extends the mobile device adoption model by Sarker & Wells [1]. We extend this model from being focused on individuals, to discuss intra and extra organisational socio-technical arrangements that interplay with mHealth solution implementation and adoption, in low resource contexts. Among others, highlighted factors include user characteristics, influence of supported work, modality of user mobility, technological characteristics, change management, and other contextual factors such as economic, social, and political factors. This is done by reviewing an mHealth initiative from Malawi and related mHealth literature. We argue that the above mentioned factors form the installed base on which solutions are built, and continuously interplay with the use of mHealth solutions, thereby influencing adoption outcomes.

Enacting technology: Accounting for the interplay between mHealth solutions and existing paper-based data reporting practices

Purpose – The purpose of this paper is to discuss implications of human-technology interaction in organizational change, especially where mobile phones are introduced to replace paper-based reporting. Design/methodology/approach – The paper employs a case study approach, focusing on implementation of mobile technology for health (mHealth) solutions to support remote data communication, between health facilities and a district health office (DHO), in Malawi. Findings – The findings suggest that mobile phones are relevant to parts of multi-stage tasks such as data reporting, which comprise compilation, transportation, and digitization of data, and delivery of feedback. Consequently, innovation due to the introduction of mobile phones, is found in their interaction with other artefacts (paper, desktop computers, etc.), and existing paper-centric and emerging work practices. Research limitations/implications – Although lessons from this study could be transported across contexts, practitioners, and researchers should pay particular attention to contextual differences. Practical implications – In accounting for the mutual shaping between technology and context/work practices the paper demonstrates that mHealth innovation demands significant practical work. Originality/value – mHealth research is often preoccupied with capabilities of mobile devices. First, the authors account for interaction between artefacts, existing, and emerging use contexts, and the use process, at multiple levels of organization. Through this, the authors argue for a need to seriously consider idiosyncrasies of artefacts and tasks at hand, as well as distributed affordances across artefacts, in mHealth implementations. Second, the authors argue that contrary to the general focus on mobile phones as tools for supporting people on the move, their relevance might actually be found in reducing people’s mobility.

A Post-development Perspective on mHealth -- An Implementation Initiative in Malawi

While the sheer number of mHealth implementations around the world have been increasing dramatically, authoritative voices on global health have tried to put the focus on quantifiable evaluations and comparisons of these projects (e.g. health outcomes, cost savings, efficiency) in order to channel donor funds and investments into proven and scalable solutions. Drawing on empirical data from an mHealth implementation in Malawi we argue that quantitative evaluation of health interventions often assumes a top-down and limited view on the developmental impact of mHealth. Through our action-research involvement with facility-based reporting of routine health data through mobile phones, we conclude that developmental impacts of mHealth are local and each locale experience a different developmental impact depending on the context of use and available resources. The paper contrasts global concerns for quantifiable development with local priorities with respect to mHealth projects and information system (IS) interventions in health more broadly.

Intervention Breakdowns as Occasions for Articulating Mobile Health Information Infrastructures

This study investigates a mobile health project launched in Malawi and considers its sustainability in light of activities that occur in the pilot stage. It has been said that most projects of this nature fail during piloting hence it is pertinent to review the activities in this early stage. The study follows a grounded theory inspired research approach and is focused on the day to day breakdowns that occur in the pilot, what they reveal, and how the resolutions relate to the projects goals. It is found that when breakdowns occur, an articulation process to sustain the intervention becomes visible. Breakdowns can reveal tensions in the technical design and organisational context thereby offering opportunities for action in order that an intervention is sustained. The ensuing activity, for analytical purposes, is termed articulation work, and its variety and limitations are explained. In this study we discover two categories of articulation work, technological and human. Further to this, we argue that these two categories of articulation work can be further analysed into different dimensions, based on the levels of organizational involvement required to resolve them: (i) localised; (ii) multiple levels within a single organization; (iii) and multiple levels inter‐organizational.

ICT solutions for financial inclusion: Reaching out to the unbanked in low resource settings

Most of the population in developing countries remains unbanked and financially excluded. On the other hand, mobile phones have proved to have the potential for mobile payments in developing countries. Mobile payment is financially inclusive, offering great potential for financial integration. Africa, by and large, is considered to be having a higher percentage of the unbanked. This paper concerns how the mobile payment potential can be leveraged in the context where most of the population is financially excluded. The paper reflects results of a study carried out in Malawi focusing on provision of ICT-based financial solutions to the unbanked in developing countries, particularly in the low resource settings of Africa using a technology called e-ticketing system. Mobile payments encompass a range of different payment types, some of which may not appeal in some contexts. In this study USSD communication mode was adopted, choice of which depended on its affordability, ease of use and responsiveness.

Branchless banking in rural Malawi: Potential customers' perspective on bank-led mobile banking

Branchless banking is a distribution channel used for delivering financial services without necessarily relying on constructing bank branches. This offers customers the ability to conduct banking transactions at a whole range of retail agents instead of accessing banking services at bank branches. The study attempted to answer the question on whether Branchless banking can be used to reach the unbanked and underbanked rural areas in Malawi. Data were collected through a self-administered questionnaire that was developed based on the three main dimensions of the Technology Acceptance model, Perceived Usefulness, Perceived Ease of Use and Attitude towards use, and the two main requirements in branchless banking; Availability of Telecommunication Infrastructure and retail agents. The sample was drawn from a population in unbanked rural areas. The results shows that Branchless banking is feasible in the unbanked rural areas in Malawi.

Developing capacity for maintenance of HIS in the context of loosely coordinated project support arrangements

Over the paper decade the health sector has witnessed significant investments towards development of digital health information systems (HIS) infrastructure. Despite the promise and enthusiasm surrounding such efforts, challenges remain regarding how to enhance prospects for long-term maintenance. Observed challenges arise from lack of technical, financial, and human resources. Due to the inadequacy of aforementioned resources, most resource-constrained countries are overly reliant on loosely coordinated and discretely arranged short-term project-based support arrangements. Project-based interventions largely ignore long-term change processes and development of local capacity for implementation and maintenance of digital health infrastructure. This paper discusses possible strategies on how to enhance organizational implementation and maintenance capacity, in the context of changing project support arrangements.