In the wake of the devastating earthquake in Nepal, thousands have lost their lives and millions have been displaced from their homes. With the wreckage and widespread power outages, mobile phones have emerged as the most reliable form of communication and mobile reporting tools for frontline health workers (FHWs). In that context, Labrique et al. recently published a systematic review of the mobile health strategies for use by these first-line care providers.
The World Health Organization (WHO) predicts that there will be a worldwide shortage of healthcare workers that approaches 12.9 million by 2035. A shortage of this magnitude could have far-reaching effects on the health of billions across the world, not to mention in times of emergency. Mobile healthcare technologies driven by the widespread distribution of mobile phones have emerged as potential solutions to aid in this crisis.
The authors emphasize challenges faced by FHWs, including data collection, access to training and reference materials, communications, and scheduling. They found that multiple completed and ongoing studies investigated use in developing countries. The current systematic review screened 379 articles and finally reviewed 42 studies. The reviewed articles addressed the “feasibility of use of mobile phones”, “training of FHWs in the use of mobile phones for healthcare delivery,” “applications and effectiveness of the use of mobile tools – data collection and reporting, decision-support tools and training, emergency referrals, alerts and reminders, and supervision.”
The review showed that mHealth tools have the potential to address many of the hurdles faced by FHWs. However, upon review of the literature, little evidence is available on the effectiveness of mHealth solutions on quality and efficiency of health systems as well as clinical outcomes. The authors also note key challenges that may affect adoption and sustained use. These include cultural barriers, engagement of FHWs in the development and implementation of mHealth strategies, and optimal mHealth platform designs.
Labrique et al. identify a key issue underlying the digital and mobile health revolution: lack of high-level evidence showing that these technologies result in better quality and access, as well as improved outcomes. This article focuses on technologies for FHWs in the developing world, but we also face similar problems in modern healthcare systems. Digital health applications have flooded the market, many with unsubstantiated marketing claims. Although mobile and digital health technologies have potential to disrupt the healthcare system, we must effectively analyze which solutions improve quality and efficiency while also resulting in better patient outcomes.
The peer-reviewed literature has established that many mobile and digital health technologies are feasible and have the potential to affect outcomes. However, prior to widespread adoption (and the costs associated with that), these tools require clinical validation regarding the ability to improve quality and outcomes while reducing cost. Therefore, evidence-based medicine must be at the root of the current healthcare revolution if we want to see widespread adoption and sustained use.