title: A text message-based intervention to bridge the healthcare communication gap in the rural developing world.
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.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. nmahmud@stanford.edu
authors.forename: Nadim
authors.initials: N
authors.lastname: Mahmud
authors.forename: Joce
authors.initials: J
authors.lastname: Rodriguez
authors.forename: Josh
authors.initials: J
authors.lastname: Nesbit
mesh_terms: D001071:Appointments and Schedules; D040421:Cell Phone; D003150:Community Health Workers / Q000191:economics / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D003906:Developing Countries; D006801:Humans; D008295:Malawi; D010349:Patient Compliance; D012189:Retrospective Studies; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000628:therapy