‘The phone is my boss and my helper’ – A gender analysis of an mHealth intervention with Health Extension Workers in Southern Ethiopia

Abstract

BackgroundThere is considerable optimism in mHealth’s potential to overcome health system deficiencies, yet gender inequalities can weaken attempts to scale-up mHealth initiatives. We report on the gendered experiences of an mHealth intervention, in Southern Ethiopia, realised by the all-female cadre of Health Extension Workers (HEWs).MethodologyFollowing the introduction of the mHealth intervention, in-depth interviews (n = 19) and focus group discussions (n = 8) with HEWs, supervisors and community leaders were undertaken to understand whether technology acted as an empowering tool for HEWs. Data was analysed iteratively using thematic analysis informed by a socio-ecological model, then assessed against the World Health Organisation’s gender responsive assessment scale.ResultsHEWs reported experiencing: improved status after the intervention; respect from community members and were smartphone gatekeepers in their households. HEWs working alone at health posts felt smartphones provided additional support. Conversely, smartphones introduced new power dynamics between HEWs, impacting the distribution of labour. There were also negative cost implications for the HEWs, which warrant further exploration.ConclusionMHealth has the potential to improve community health service delivery and the experiences of HEWs who deliver it. The introduction of this technology requires exploration to ensure that new gender and power relations transform, rather than disadvantage, women.Keywordscommunities, e-health, gender

A Review on Barriers to Sustainable Telemedicine Implementation in Ethiopia

“…Six studies identified inadequate ICT infrastructure, including poor internet connection, e-health equipment and insufficient access of electric power for proper implementation of telemedicine and telehealth services, which were considered as the most common organizational barriers [2], [10], [14], [17]- [19]. unawareness of the existence of telehealth products and services [2], [9], [12], [14], [16], [17]. The educational level of the consumer has a high impact on the acceptance of telemedicine services as well as the socioeconomic status influences the access to a cell phone in Ethiopia.…”

“…The educational level of the consumer has a high impact on the acceptance of telemedicine services as well as the socioeconomic status influences the access to a cell phone in Ethiopia. Two studies reported that culture affecting the adoption of telehealth services [14], [16], because still there is a challenge in rural communities related to women's healthcare decision, they don't decide alone about their healthcare and to use e-Health services even to participate in awareness programs including meeting and discussion without permission. This is true for married women.…”

“…According to this review, the most frequently reported barriers to the implementation of telemedicine services are cost and infrastructure [2], [9], [10], [13], [14], [16]- [20]. The initial cost of establishing telemedicine service is very high and to function telemedicine services in rural or remote area for underserved communities needs telecommunication expenses, training (health personnel and patients), needs for new advanced technologies and electric power supplies.…”

“…On the other hand, culture [14], [16], [18] and staff resistance to change [2], [9], [20] are the critical factor affecting telemedicine implementation in developing multicultural countries like Ethiopia. The language is also another barrier [9], [14] because users with no technical supporter, the limited language knowledge is one of the factors to use-friendly the system.…”

How should community health workers in fragile contexts be supported: Qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

“…CHWs should not be required to spend their own money becoming impoverished through undertaking this role. Out of pocket payments by CHWs, linked to moral economies of care, adds increased financial pressure to those least able to afford it and are not unique to these contexts [41][42][43][44]. Clear communication of the incentive package, as well as any delays is needed, not just with the CHWs but with other health workers and communities, so that they understand the constraints under which CHWs may be working.…”