What Are the Contextual Enablers and Impacts of Using Digital Technology to Extend Maternal and Child Health Services to Rural Areas? Findings of a Qualitative Study From Nigeria

Abstract

Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks.Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery.Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use.Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking.Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings.Trial Registration: ISRCTN32105372.

Sustainability of the Effects and Impacts of Using Digital Technology to Extend Maternal Health Services to Rural and Hard-to-Reach Populations: Experience From Southwest Nigeria

“…This underpins the importance of locally driven long-term investment for the survival of eHealth technologies in LMICs ( 16 ). While global funding of health-related problems is shrinking ( 37 ), there is a renewed interest in developing sustainable funding models that leverage better management skills and efficient deployment of human and material resources which is highlighted by our study from Nigeria ( 17 , 38 ). The lack of preparation of the government to assume financial responsibility for the eHealth project after donor funding elapsed in March 2019, demonstrates the centrality of embedding exit strategies into memoranda of understandings that specify project durations and who will be responsible for the project takeover after their completion.…”

“…However, in addition to classic TAM categories, the mTAM proposes that contextual factors within the setting that technology is implemented can influence people's perception of usefulness and adoption of technology (24). Findings of acceptance of VTR and data digitization interventions in Ondo state have been reported elsewhere as part of a broader project (17) and are therefore not repeated in this study.…”

“…This study was part of a broader project that involved introducing computer-tablet-based video training and data digitization applications to healthcare facilities across three Nigerian states: Kano and Ondo state and the Federal Capital Territory over 2-years (March 2017–2019). The study protocol ( 12 ) and overall findings from the broader project (contextual enablers and impacts of using digital technology to extend Mother and Child Health (MCH) services to rural areas of Nigeria) ( 17 ) have been reported elsewhere. This study, therefore, focuses on assessing the sustainability of the impacts of introducing digital health innovations in 62 intervention healthcare facilities located in three local government areas (LGAs) of Ondo state supported by satellite communication (SatComs) technology combined with the existing 3G mobile network.…”

Are prevention of mother-to-child HIV transmission service providers acquainted with national guideline recommendations? A cross-sectional study of primary health care centers in Lagos, Nigeria

“…This will provide health workers with a chance to review their answers to questions during the training. When maternal, newborn and child health (MCH) educational contents were delivered electronically using preloaded videos on tablets to frontline health workers in rural Nigeria, health workers knowledge improved, and they became motivated and confident to render health care services to their clients [ 38 ]. Hence, pre-loaded PMTCT-training contents on tablets as a learning model for ongoing PMTCT training of health workers should be considered.…”

“…Hence, pre-loaded PMTCT-training contents on tablets as a learning model for ongoing PMTCT training of health workers should be considered. This is because many health workers are familiar with smartphones and would find the training useful and acceptable [ 38 ].…”