title: A mobile phone-based, community health worker program for referral, follow-up, and service outreach in rural Zambia: outcomes and overview.
abstract: BACKGROUND
  Mobile health (m-health) utilizes widespread access to mobile phone technologies to expand health services. Community health workers (CHWs) provide first-level contact with health facilities; combining CHW efforts with m-health may be an avenue for improving primary care services. As part of a primary care improvement project, a pilot CHW program was developed using a mobile phone-based application for outreach, referral, and follow-up between the clinic and community in rural Zambia.
  
  
  METHODS
  The program was implemented at six primary care sites. Computers were installed at clinics for data entry, and data were transmitted to central servers. In the field, using a mobile phone to send data and receive follow-up requests, CHWs conducted household health surveillance visits, referred individuals to clinic, and followed up clinic patients.
  
  
  RESULTS
  From January to April 2011, 24 CHWs surveyed 6,197 households with 33,304 inhabitants. Of 15,539 clinic visits, 1,173 (8%) had a follow-up visit indicated and transmitted via a mobile phone to designated CHWs. CHWs performed one or more follow-ups on 74% (n=871) of active requests and obtained outcomes on 63% (n=741). From all community visits combined, CHWs referred 840 individuals to a clinic.
  
  
  CONCLUSIONS
  CHWs completed all planned aspects of surveillance and outreach, demonstrating feasibility. Components of this pilot project may aid clinical care in rural settings and have potential for epidemiologic and health system applications. Thus, m-health has the potential to improve service outreach, guide activities, and facilitate data collection in Zambia.
authors.affiliation: 1 Centre for Infectious Disease Research in Zambia , Lusaka, Zambia .
authors.forename: Linnaea
authors.initials: L
authors.lastname: Schuttner
authors.forename: Ntazana
authors.initials: N
authors.lastname: Sindano
authors.forename: Mathew
authors.initials: M
authors.lastname: Theis
authors.forename: Cory
authors.initials: C
authors.lastname: Zue
authors.forename: Jessica
authors.initials: J
authors.lastname: Joseph
authors.forename: Roma
authors.initials: R
authors.lastname: Chilengi
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
authors.forename: Namwinga
authors.initials: N
authors.lastname: Chintu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040421:Cell Phone; D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers; D003266:Continuity of Patient Care; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012017:Referral and Consultation; D012424:Rural Population; D015024:Zambia
keywords: e-health; information management; technology; telehealth