This study followed the successful implementation of a first-phase feasibility study, carried out in 2011. The interventions over the 12-month period were divided into two stages of six months each, and were separated into ‘wedges’ according to differential interventions. This step-wedge approach was chosen to create an ‘internal’ non-intervention group (Wedge 2) to compare interventions.
Stage 1 interventions (August 2012-January 2013) consisted of the establishment of a virtual private network (VPN) to improve health worker to health worker communication; this was implemented across both wedges, i.e. in all chiefdoms of Bombali district. All 98 peripheral health units (PHUs) also received a mobile phone and sim card that allowed health workers to call numbers in the closed user group network for free. Interventions regarding health worker to client communication and TBA involvement were also started in during this first stage but only in Wedge 1 facilities (Wedge 2 will implement this intervention only during Stage 2, Feb-July 2013) – this may have influenced how both wedges deal with the VPN intervention. In addition, all PHUs in the six chiefdoms included in Wedge 1 received a solar charger for the phone as well as phone credit to call clients, to remind them of appointments; Wedge 2 PHUs did not receive these during the first stage.
In one chiefdom in Wedge 1, selected TBAs were engaged and were provided with a mobile phone as part of the intervention, to improve health worker client communication. This will only be started in the one chiefdom selected from Wedge 2 at the second stage of interventions.
This report presents the results of the midline study that took place in January-February 2013 at the end of the first stage of interventions. Mixed methods were used for data collection. A quantitative method – consisting of a survey in all 13 chiefdoms – was used to collect background information on one part of the intervention (VPN) and one part of the outcomes (health worker job satisfaction). Qualitative methods were implemented in selected Wedge 1 chiefdoms, and consisted of semi-structured interviews with enrolled clients, TBAs, health workers and health managers, summary information from maternal death reports; and summary information from monthly PHU reports on mHealth enrolment and follow-up (Wedge 1 only).
The most important findings relate to facilitators and barriers for accessing phones, and what helped or hindered health worker to client communication and health worker to health worker communication. The findings from the midline analysis also present some tentative trends in outcomes.
Jalloh-Vos, H.; Herschderfer, K.; Jalloh, A.M.; Ormel, H.; de Koning, K.; Kamara, S.A.Y.; Wolmarans, L. Mobile health: Connecting managers, service providers and clients in Bombali district, Sierra Leone. Intervention study on mHealth for maternal and newborn health in resource-poor community and health system settings, Sierra Leone. Midline study report. Royal Tropical Institute (KIT), Amsterdam, Netherlands (2013) 108 pp.
Mobile health: Connecting managers, service providers and clients in Bombali district, Sierra Leone. Intervention study on mHealth for maternal and newborn health in resource-poor community and health system settings, Sierra Leone. Midline study report.