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Unformatted text preview: Technology and Health Care 18 (2010) 137–144 137 DOI 10.3233/THC-2010-0576 IOS Press A text message-based intervention to bridge the healthcare communication gap in the rural developing world Nadim Mahmud a , b , ∗ , Joce Rodriguez b , c and Josh Nesbit b a Stanford University School of Medicine, Stanford, CA, USA b FrontlineSMS: Medic, Palo Alto, CA, USA c Stanford University School of Medicine Office of Global Health, Stanford, CA, USA Received in final form 4 February 2010 Abstract. Healthcare delivery in the rural developing world is limited by a severe shortage of health workers as well as profound communicative and geographic barriers. Understaffed hospitals are forced to provide care for patients that reside at a great distance from the institutions themselves, sometimes more than 100 miles away. Community health workers (CHWs), volunteers from local villages, have been integral in bridging this patient-physician gap, but still lose enormous of amounts of time in transit between hospital and village. We report the results of a retrospective mobile health (mHealth) pilot at St. Gabriel’s Hospital in Malawi designed to eliminate many of these trips in favor of communication via text messages. A group of 75 CHWs were supplied with cell phones and trained to utilize the network for a variety of usage cases, including patient adherence reporting, appointment reminders, and physician queries. At the end of the pilot, the hospital saved approximately 2,048 hours of worker time, $2,750 on net ($3,000 in fuel savings minus $250 in operational costs), and doubled the capacity of the tuberculosis treatment program (up to 200 patients). We conclude that mHealth interventions can provide cost-effective solutions to communication barriers in the setting of rural hospitals in the developing world. Keywords: Mobile health (mHealth), cell phones, text messaging, SMS, FrontlineSMS, Malawi, St. Gabriel’s, community health workers (CHWs), tuberculosis, HIV, patient adherence monitoring, communication barriers, hospital efficiency, brain drain 1. Introduction The World Health Organization (WHO) estimates a shortfall of 4.3 million health care workers in the developing world. This deficit is faced by 57 countries, 36 of which are in sub-Saharan Africa . Health care workers migrate and work in developed countries due to a lack of professional development and poor working conditions in their native countries. Given this trend, there has been a continuous effort to persuade health care workers from emigrating. According to health worker surveys in Cameroon, Ghana, South Africa, and Uganda, the route to success would involve improvements in working conditions and health care system management ....
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This note was uploaded on 01/21/2012 for the course HUMBIO 156 taught by Professor Katzenstein,d during the Fall '11 term at Stanford.
- Fall '11