Project Overview - REIMAGINE

PROJECT BACKGROUND

The overall goal of the REIMAGINE project is to co-develop, deploy, and evaluate an intervention that will recognise and support Community Health Workers’ ‘informal’ use of personal mobile devices in Ghana, Malawi, and Ethiopia.

This project is borne out of previous work, including our own, which showed that over 97% of CHWs in these three countries use their personal mobile devices to support their work everyday or most days for a variety of reasons, including to call/message patients, calculate medicine dosages, and even to use the torch function in the absence of electricity to deliver babies. Although the use of personal mobiles have benefits, they also bring new costs and challenges, borne disproportionally by those based in remote areas. These include practical difficulties, such as difficulty keeping phones charged without reliable sources of electricity; financial hardships in meeting phone costs out of personal salaries; threats to personal wellbeing and risks of burnout from 24/7 availability; risks to patient confidentiality from using shared/unsecured phones; and lack of digital skills to confidently assess the reliability of online information.

We shared these findings with CHWs in all three countries, who identified three effective and low-cost interventions they believed could make a big difference: 1) Provision of basic training on digital literacy and online safety, 2) Developing and implementing locally-relevant guidelines on appropriate/effective use of mobile phones in community healthcare, and 3) Paying CHWs a small monthly contribution towards work-related phone costs to offset the financial hardship.

The aim of the REIMAGINE project is to take the next steps through a 30-month project that will:

(a) Develop and trial a participatory intervention to support CHWs’ informal mhealth use, through training, guidelines and financial compensation across six ‘hard to reach’ sites in Ghana, Ethiopia and Malawi

(b) Evaluate the feasibility, acceptability, and cost implications of the intervention

(d) Work with Ministries of Health and other stakeholders towards national-level scale-up, as appropriate

PROJECT APPROACH

This study uses a mixed-methods, pre-post design, which we considered more cost-effective and better-suited to a community based participatory intervention than a randomised trial. Quantitative data will be collected from CHWs (n=212 per country) pre- and post-intervention to measure changes in informal mhealth practices and work-related wellbeing to assess acceptability, feasibility, and cost implications of the interventions. This will be complemented with qualitative data, collected through focus group discussions with CHWs, service users and local supervisors and managers, to understand the experiences of these groups in greater depth, and to help elucidate potential causal pathways and mechanisms for any changes observed.

HOW WILL THE PROJECT RESULTS BE USED?

The findings from this study will:

(a) Indicate the feasibility, acceptability and cost implications of implementing a participatory intervention to support CHWs’ use of personal mobile devices in remote rural sites in Ethiopia, Ghana and Malawi.

(b) Provide quantitative and qualitative data on changes in CHWs’ working practices, CHW work-related wellbeing and retention, and CHWs’, service users, and local managers’ experiences.

(c) Form the basis of policy to scale up measures supporting CHWs’ appropriate informal mhealth usage in the three countries, and provide generalisable guidelines for implementation in other LMIC contexts.