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      Scale Matters: A Cost-Outcome Analysis of an m-Health Intervention in Malawi

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          Abstract

          Background: The primary objectives of this study are to determine cost per user and cost per contact with users of a mobile health (m-health) intervention. The secondary objectives are to map costs to changes in maternal, newborn, and child health (MNCH) and to estimate costs of alternate implementation and usage scenarios. Materials and Methods: A base cost model, constructed from recurrent costs and selected capital costs, was used to estimate average cost per user and per contact of an m-health intervention. This model was mapped to statistically significant changes in MNCH intermediate outcomes to determine the cost of improvements in MNCH indicators. Sensitivity analyses were conducted to estimate costs in alternate scenarios. Results: The m-health intervention cost $29.33 per user and $4.33 per successful contact. The average cost for each user experiencing a change in an MNCH indicator ranged from $67 to $355. The sensitivity analyses showed that cost per user could be reduced by 48% if the service were to operate at full capacity. Conclusions: We believe that the intervention, operating at scale, has potential to be a cost-effective method for improving maternal and child health indicators.

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          Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world.

          Tigest Tamrat, Stan Kachnowski (2012)
          Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.
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            Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

            Natalie Leon, Helen Schneider, Emmanuelle Daviaud (2012)
            Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings.
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              Application of smart phone in "Better Border Healthcare Program": A module for mother and child care

              Jaranit Kaewkungwal, Pratap Singhasivanon, Amnat Khamsiriwatchara … (2010)
              Background To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area. Methods A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. Results The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. Conclusions The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Telemed J E Health
                Journal ID (iso-abbrev): Telemed J E Health
                Journal ID (publisher-id): tmj
                Title: Telemedicine Journal and e-Health
                Publisher: Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                ISSN (Print): 1530-5627
                ISSN (Electronic): 1556-3669
                Publication date (Print): 01 April 2016
                Publication date PMC-release: 01 April 2016
                Volume: 22
                Issue: 4
                Pages: 317-324
                Affiliations
                [ 1 ]Health Systems Group, VillageReach , Seattle, Washington.
                [ 2 ]Department of Health Services, University of Washington , Seattle, Washington.
                [ 3 ]Department of Epidemiology, University of Washington , Seattle, Washington.
                [ 4 ]Concern Worldwide Malawi Programme , Lilongwe, Malawi.
                [ 5 ]Independent Consultant , Bethesda, Maryland
                Author notes
                Address correspondence to: Erin Larsen-Cooper, MPH, MSW, VillageReach 2900 Eastlake Avenue E., Suite 230, Seattle, WA 98102, E-mail: erin.larsen-cooper@ 123456villagereach.org
                Article
                Publisher ID: 10.1089/tmj.2015.0060
                DOI: 10.1089/tmj.2015.0060
                PMC ID: 4817568
                PubMed ID: 26348994
                SO-VID: 534b3b47-a728-4b26-a749-4333e6f5d12a
                Copyright © © Erin Larsen-Cooper, et al., 2015; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Date received : 08 April 2015
                Date revision received : 28 July 2015
                Date accepted : 20 July 2015
                Page count
                Tables: 5, References: 16, Pages: 8
                Categories
                Subject: Original Research

                Keywords: mobile health,maternal health,child health,cost-outcome,information and communications technology,economic evaluation
                Data availability:
                Keywords: mobile health, maternal health, child health, cost-outcome, information and communications technology, economic evaluation

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