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
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.