Informal mhealth at scale in Africa: Opportunities and challenges

Abstract

Highlights Community health-workers across Africa use mobile phones ‘informally’ in their work. Informal mhealth is an emergent phenomenon, used to bridge gaps in formal provision. Informal mhealth is happening at scale, far outstripping its formal equivalent. Informal mhealth is inherently responsive to local needs and contingencies. But it carries hidden costs (financial and other) which are inequitably distributed.

Digital Health in East Africa: Innovation, Experimentation and the Market

“…But it is becoming increasingly apparent that digital technologies are offering more. A recent study in Africa has pointed to the variety of ways healthcare workers are using mobile phones, from googling symptoms to using the camera for medical procedures, suggesting that this informal digital health constitutes ‘a large‐scale emergent health system’ in itself (Hampshire et al., 2021, p. 21). The authors argue this is taking place independently of the formal digital health projects that have proliferated across Africa.…”

“…Integration may be more important than innovation, if digital health is to strengthen national healthcare systems and help achieve goals of health for all. Such integration would need to consider not only formal digital health projects, but also how, or even if, to include the proliferating informal uses of digital technologies in healthcare systems in Africa (Hampshire et al., 2021).…”

“…Digital health in East Africa is a dynamic and multifarious phenomenon. While it increasingly includes what might be called the informal uses of digital technologies around healthcare and healthy living, for instance, the use of a mobile phone by a patient or healthcare worker (Hampshire et al., 2021), it has more typically been understood as the formal, digital projects or systems in healthcare. A recent review in Kenya has pointed to the rising number of digital health projects since 2010 (Njoroge et al., 2017).…”

Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar

“…Similarly, differences exist in regard to mHealth. Developed countries predominantly use smartphones and have implemented formal mobile solutions, whereas in developing countries basic phones and feature phones still predominate and, given the lack of or limited regulations, mHealth is used more informally [ 11 ]. Thus, whilst sub-Saharan Africa (SSA) has been a focal point for many formal mHealth projects, informal use appears common [ 11 , 12 ].…”

“…Developed countries predominantly use smartphones and have implemented formal mobile solutions, whereas in developing countries basic phones and feature phones still predominate and, given the lack of or limited regulations, mHealth is used more informally [ 11 ]. Thus, whilst sub-Saharan Africa (SSA) has been a focal point for many formal mHealth projects, informal use appears common [ 11 , 12 ]. Such trends are likely to be spurred by recent global awareness and application of eHealth, including mHealth, due to the COVID-19 pandemic [ 13 ].…”