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Management challenges in mHealth: failures of a mobile community health worker surveillance programme in rural Nepal
  1. David J Meyers1,
  2. Malina Filkins2,
  3. Alex Harsha Bangura3,
  4. Ranju Sharma4,
  5. Ashma Baruwal5,
  6. Sami Pande6,
  7. Scott Halliday5,7,
  8. Dan Schwarz5,8,9,
  9. Ryan K Schwarz5,8,10,11,
  10. Duncan S R Maru5,8,9,11
  1. 1Brown University School of Public Health, Department of Health Services, Practice, and Policy, Providence, RI, USA
  2. 2University of Massachusetts Medical School, Worchester, Massachusetts, USA
  3. 3Contra Costa Regional Medical Center, Contra Costa Family Medicine Residency, Martinez, CA, USA
  4. 4Medic Mobile, Kathmandu, Nepal
  5. 5Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
  6. 6United Nations Population Fund, Kathmandu, Nepal
  7. 7University of Washington, Henry M Jackson School of International Studies, Seattle, Washington, USA
  8. 8Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA
  9. 9Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, USA
  10. 10Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
  11. 11Harvard Medical School, Department of Medicine, Boston, MA, USA
  1. Correspondence to Dr Duncan S R Maru, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; duncan{at}possiblehealth.org

Abstract

Community health workers form the backbone of healthcare systems globally. The rapid expansion of mobile communications systems represents an opportunity to improve the productivity of community health workers in rural areas. Here, we describe a programme in rural Nepal that aimed to implement a mobile phone system for collecting health surveillance data, yet did not reach its fullest potential due to several programme management challenges during the implementation of the surveillance programme. Despite early successes with the mobile phone system itself, the programme ultimately failed due to leadership transitions, poor process design and a lack of consistent vision of how to operationalise the data. This field report provides important insights into the design, maintenance and pitfalls of similar community-based mobile health initiatives and technology innovation projects in general.

  • mHealth
  • Community Health Workers
  • Nepal
  • Process Design
  • Implementation Research

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Footnotes

  • Contributors DJM, AH, RS, AB, DS, RKS and DSRM conceived and designed the programme. DJM, AH and and RS oversaw the initial implementation of the programme and led the training. AB and SP managed the day-to-day operations of the programme. DJM and MF evaluated the programme. DJM, MF and SH drafted the manuscript. All the authors edited and revised the manuscript. All the authors approved the final draft and agree with the conclusions.

  • Funding This work was supported by a ‘Stars in Global Health’ grant from Grand Challenges Canada (0257-01). Grand Challenges Canada is funded by the Government of Canada and is dedicated to supporting Bold Ideas with Big Impact in global health. This work was also partially supported by a Thrasher Early Career Award provided by the Thrasher Research Fund.

  • Competing interests DJM is currently a doctoral student at a private university (Brown University School of Public Health). MF is a currently medical student at a public university (University of Massachusetts Medical School). AHB is a resident at a public hospital (Contra Costa Medical Center). SH is employed by and DS, RKS and DSRM work in partnership with a non-profit healthcare company (Possible) that delivers free healthcare in rural Nepal using funds from the Government of Nepal and other public, philanthropic and private foundation sources. At the time of programme implementation, RS, AB and SP were employed by Possible. RS is employed by a non-profit technology company (Medic Mobile) that receives philanthropic funding. SP is employed by a multilateral aid agency (United Nations Population Fund) that receives multilateral funding from numerous countries. SH is also employed part-time at a public university (University of Washington). DS, RKS and DSRM are employed at an academic medical centre (Brigham and Women's Hospital) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. DS and DSRM are also employed at a separate academic medical centre (Boston Children's Hospital) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. RKS is also employed at an academic medical center (Massachusetts General Hospital) that receives public sector research funding, as well as revenue through private sector fee-for-service medical transactions and private foundation grants. RKS and DSRM are also faculty members at a private university (Harvard Medical School). DSRM is a non-voting member on Possible's board of directors, but receives no compensation. All authors have read and understood BMJ Innovation's policy on declaration of interests, and declare that we have no competing financial interests. The authors do,however, believe strongly that healthcare is a public good, not a private commodity.

  • Ethics approval Nepal Health Research Council (number 79/2012) and the Brigham and Women's Hospital IRB (2013P000709).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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