Background: There is considerable optimism in the potential of mobile health (mHealth) to overcome health systems’ deficiencies to ensure access to safe, effective and affordable health services. WEEMA International, in partnership with D-tree International, developed a mobile-based decision support tool for health extension workers (HEWs). The tool incorporates the Ethiopian Integrated Community Case Management (iCCM) approach to child health through the application of checklists and decision information. The mobile iCCM tool is designed to improve adherence to recommended steps in the assessment, diagnosis, and treatment of children presenting with symptoms commonly linked to childhood morbidity and mortality.

Methods: We conducted a qualitative study to explore the perceptions and experience of the mHealth pilot intervention among the HEWs and caregivers of children under-five in Tembaro woreda. In-depth interviews were held with 12 HEWs who have been using the iCCM mobile tool for over 1 year, as well as four caregivers who caregivers whose under-five children have been assessed using the iCCM mobile tool. Two FGDs were conducted with caregivers whose under-five child have been assessed and treated using the iCCM mobile tool/application or know someone close whose child has been treated using the mobile tool/application. Data were analyzed using the content analysis approach

Results: The finding of this study suggests acceptability of the iCCM mobile tool among the HEWs and caregivers. HEWs reported the tool to be easy to use, important and has the potential to improve the quality of assessment and treatment of children under-five for the iCCM illnesses. The mobile tool ensures assessment of children under-five for all the signs and symptoms of the iCCM illnesses and recommends treatment appropriate for the age, weight, and illness of the child. Reduced unnecessary referrals and improved caregivers’ treatment-seeking behaviour for sick under-five children were among the reported benefits of the iCCM mobile tool. The caregivers perceive that the iCCM mobile tool helps their child recover fast from their illnesses. The HEWs believe that the tool builds their confidence in treating under-five children as they perceive that they are getting new knowledge and skills. However, contextual factors including internet accessibility and availability of consistent power source for charging of the phones are expected to influence the use of mHealth tools. Moreover, some HEWs reports the need for ongoing technical and supervisory support.

Conclusions: The mobile-based iCCM tool is acceptable and has the potential to improve the quality of assessment and treatment of children under-five. Ongoing training and tailored technical support are important to strengthen the positive effects of the mobile tool. The use of the tool is highly influenced by the contextual factors. Findings from this study may help guide future design and implementation of mHealth interventions in Ethiopia and optimizing their chances for success.