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Health Policy Plan. 2017 Feb;32(1):34-42. doi: 10.1093/heapol/czw095. Epub 2016 Jul 31.

Who bears the cost of 'informal mhealth'? Health-workers' mobile phone practices and associated political-moral economies of care in Ghana and Malawi.

Author information

1
Department of Anthropology, Durham University, Durham DH1 3LE, UK K.R.Hampshire@durham.ac.uk.
2
Department of Anthropology, Durham University, Durham DH1 3LE, UK.
3
Department of Geography and Regional Planning, University of Cape Coast, Ghana.
4
Centre for Social Research, University of Malawi.
5
Department of Geography, Environment and Earth Sciences, University of Hull, UK.
6
Department of Population and Health, University of Cape Coast, Ghana.
7
Deceased author.

Abstract

Africa's recent communications 'revolution' has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to 'care' even at substantial personal cost. Although there is significant potential for 'informal mhealth' to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.

KEYWORDS:

Care work; Sub-Saharan Africa; community health-workers; mobile phones; moral economy; political economy; task shifting

PMID:
27476501
PMCID:
PMC5886236
DOI:
10.1093/heapol/czw095
[Indexed for MEDLINE]
Free PMC Article

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