title: Who bears the cost of 'informal mhealth'? Health-workers' mobile phone practices and associated political-moral economies of care in Ghana and Malawi.
abstract: Africa's recent communications 'revolution' has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to 'care' even at substantial personal cost. Although there is significant potential for 'informal mhealth' to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.
authors.affiliation: Department of Anthropology, Durham University, Durham DH1 3LE, UK K.R.Hampshire@durham.ac.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Hampshire
authors.affiliation: Department of Anthropology, Durham University, Durham DH1 3LE, UK.
authors.forename: Gina
authors.initials: G
authors.lastname: Porter
authors.affiliation: Department of Geography and Regional Planning, University of Cape Coast, Ghana.
authors.forename: Simon
authors.initials: S
authors.lastname: Mariwah
authors.affiliation: Centre for Social Research, University of Malawi.
authors.forename: Alister
authors.initials: A
authors.lastname: Munthali
authors.affiliation: Department of Geography, Environment and Earth Sciences, University of Hull, UK.
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Robson
authors.affiliation: Department of Population and Health, University of Cape Coast, Ghana.
authors.forename: Samuel Asiedu
authors.initials: SA
authors.lastname: Owusu
authors.affiliation: Department of Geography and Regional Planning, University of Cape Coast, Ghana.
authors.forename: Albert
authors.initials: A
authors.lastname: Abane
authors.affiliation: Centre for Social Research, University of Malawi.|Deceased author.
authors.forename: James
authors.initials: J
authors.lastname: Milner
mesh_terms: D040421:Cell Phone / Q000191:economics* / Q000706:statistics & numerical data; D003150:Community Health Workers / Q000191:economics* / Q000706:statistics & numerical data; D003361:Cost Allocation / Q000706:statistics & numerical data; D005869:Ghana; D006801:Humans; D008295:Malawi; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data; D017216:Telemedicine / Q000191:economics* / Q000706:statistics & numerical data
keywords: Care work; Sub-Saharan Africa; community health-workers; mobile phones; moral economy; political economy; task shifting