Abstract

Background: Ethiopia has committed to achieving universal health coverage through major investments in health extension programmes. Health extension workers (HEWs) are using their own mobile phones on their own initiatives for many work related purposes (informal mhealth), and this represents vast unexploited potential that could have positive public health implications. However, HEWs are struggling with the financial burden of meeting their phone costs, particularly where call charges are high and without stipends time/emotional costs could be significant.

Objective: The aim of this study was to estimate and explore the perceived challenges and perspectives of current informal mhealth uses for HEWs in Ethiopia.

Methods: A mixed method of quantitative and qualitative cross-sectional study design was employed in Oromia and Amhara National Regional States. In the quantitative component two stage stratified and cluster sampling techniques were employed to select the study HEWs. Zones, districts and health centres in each regions were stratified and randomly selected. All health posts with a total of 1,019 HEWs were included in the study. A face-to-face interview using structured and pretested questionnaires was used. In the qualitative component focus group discussions, key informant interviews, and in-depth interviews were carried out with health extension workers, women and coordinators. Descriptive analyses were performed to describe challenges and prospects of HEWs in using informal mhealth.

Results: In this study revealed that the cost of airtime, problems with battery charging, network coverage, costs of data bundles, and accessing internet services were the commonest major challenges faced by HEWs. The most popular solutions proposed by HEWs were provision of free calls and SMS, monthly airtime allowances, a mobile phone for work use, a good-quality solar phone charger, and training on using phones for work.

Conclusion: Though health extension workers use their own mobile phones in the absence of large-scale mhealth programmes to improve health care in their communities, however, benefits are limited by high cost of airtime, network and battery charging problems in seeking to meet Ethiopia’s efforts for wards universal healthcare coverage. Hence, priority should be given to developing free calls and SMS packages, provision of monthly airtime stipends, good-quality solar phone chargers and training for HEWs on how to use their mobile phones effectively for health care.

Keywords: Ethiopia, health extension workers, informal, mobile phones, healthcare