Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: a mixed-methods study

Bronwyn Harris, Motunrayo Ajisola, Raisa Meher Alam, Jocelyn Anstey Watkins, Theodoros N Arvanitis, Pauline Bakibinga, Beatrice Chipwaza, Nazratun Nayeem Choudhury, Peter Kibe, Olufunke Fayehun, Akinyinka Omigbodun, Eme Owoaje, Senga Pemba, Rachel Potter, Narjis Rizvi, Jackie Sturt, Jonathan Cave, Romaina Iqbal, Caroline Kabaria, Albino KaloloCatherine Kyobutungi, Richard J Lilford, Titus Mashanya, Sylvester Ndegese, Omar Rahman, Saleem Sayani, Rita Yusuf, Frances Griffiths

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Abstract

Objective
Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries.

Methods
We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country.

Results
We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5–17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported – for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices.

Conclusions
There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
Original languageEnglish
JournalDigital Health
Volume7
Early online date19 Aug 2021
DOIs
Publication statusE-pub ahead of print - 19 Aug 2021

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