Abstract
Background: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from facility staff to LHWs to follow up clients and LHW referrals of people who needed care at a facility. We implemented the system in two rural and semi-rural sub-districts in South Africa. Objective: To assess the feasibility of the mHealth system in improving continuity of care for clients in PHC in South Africa. Method: We implemented the intervention in 15 PHC facilities. The clerks issued recalls to LHWs using a tablet computer. LHWs used smartphones to receive these requests, communicate with clerks and refer people to a facility. We undertook a mixed-methods evaluation to assess the feasibility of the mHealth system. We analysed recall and referral data using descriptive statistics. We used thematic content analysis to analyse qualitative data from semi-structured interviews with facility staff and a researcher fieldwork journal. Results: Across the sub-districts, 2,204 clients were recalled and 628 (28%) of these recalls were successful. LHWs made 1,085 referrals of which 485 (45%) were successful. The main client group referred and recalled were children under 5 years. Qualitative data showed the impacts of facility conditions and interpersonal relationships on the mHealth system. Conclusion: Using mHealth for recalls and referrals is probably feasible and can improve communication between LHWs and facility staff. However, the low success rates highlight the need to assess facility capacity beforehand and to integrate mHealth with existing health information systems. mHealth may improve communication between LHWs and facility staff, but its success depends on the health system capacity to incorporate these interventions.
| Original language | English |
|---|---|
| Article number | 1717410 |
| Number of pages | 14 |
| Journal | Global Health Action |
| Volume | 13 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 10 Feb 2020 |
Bibliographical note
Funding Information:The Swedish Research Council funded the study. WO, SL, ES, and MM are supported by funding from the South African Medical Research Council; SA is supported by funding from Tampere University; Vetenskapsr?det [VR348-2013-6592]. We would like to thank the lay health workers, their supervisors, and NGO management, who made it an absolute pleasure to have them as study partners. We would also like to thank the clerks and facility managers, who always welcomed us amidst busy schedules, but more importantly, supported our study with such enthusiasm. We also wish to acknowledge the support we received from the health authorities at all levels, including the Provincial Head Office for Health, Eden district, and the sub-district managers with their community-based coordinators.
Publisher Copyright:
© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Keywords
- Client referral
- community-based services
- continuity of care
- healthcare facility
- lay health workers
- mobile health
- primary healthcare
- recall to care
ASJC Scopus subject areas
- Health Policy
- Public Health, Environmental and Occupational Health
Access to Document
- Using a mHealth system to recall and refer existing clients and refer community members with health concerns to primary healthcare facilities in South Africa: a feasibility study
© 2020 The Authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.