Health Workers Perceptions on Use of Mobile Phones in Integrated Community Case Management in Nyaguda Sub-Location, Western Kenya

Abstract

Kenya is still lagging behind regional and global averages in child mortality rates despite the fact that substantial progress has been made in reducing child mortality since 1990. Furthermore, Kenya like other developing countries faces constraints in health system performance and access to services in hard-to-reach areas such as Nyaguda sub-location. Evidence shows that the integration of basic mobile phones in integrated Community Case Management (iCCM) could potentially address challenges of reducing under-five child morbidity and mortality due to common childhood illnesses. However, much evidence on mhealth is largely based on small-scale implementations which does not incorporate the experiences of stakeholders such as community health volunteers and others on the appropriateness of the mobile phones within different cultural settings. This study aims to assess the health workers’ perceptions and use of mobile phones in community case management of childhood illnesses in Nyaguda sub-location, Kenya. Specifically, the study investigated; the uses, examine the views of health workers and the challenges associated with the use of mobile phones among health workers and how they influence integrated community case management of childhood illnesses. The study was guided by the theory of cultural ecology by Julian Steward (1955), which proposes that culture is shaped by the physical and biological properties of the area in which it is developed. Due to its criticism of environmental determinism it will be complemented by the concept of spaces of care in global ehealth by Vincent Duclos (2015). The concept of spaces reveals how technology has linked bodies, knowledge and care practices in new spatial and temporal configurations. The study design is ethnographic. The study population consisted of 25 CHVs trained and supervised in iCCM and having access to mobile phones, 20 caregivers, 4 key informant interviews (KIIs) with Nyaguda dispensary in-charge, community health extension workers (CHEW) Nyaguda sub-location, a clinical officer and matron in-charge of maternal child health clinic (MCH) at Bondo sub-County hospital, 4 focus group discussions (FGDs) with the caregivers, CHVs, CHEWs within the intervention sites of iCCM and Bondo sub-county health management team. Data collection methods included; in-depth interviews, KIIs, FGDs, and direct observation. Data was analyzed through content analysis to examine the themes that emerge to explain specific objectives of the study. Ethical standards were followed by obtaining informed consent and respecting confidentiality. This study found out that the mobile phone is used within iCCM to further open up the existing and new spaces of care through improving the processes of child healthcare within the health system. The health workers viewed the mobile phone as an important tool that has helped to create new special and temporal configurations by breaking barriers in the overall stakeholder relations in healthcare. The informal integration process however, faced certain challenges which included physical challenges, integrity challenges such as lack of trust in the information given. Despite the few challenges, the integration of the mobile phone within iCCM will help to further strengthen the existing initiatives and practices in integrating mhealth in the Kenyan healthcare system and contribute to improving health policy.