Assessing Scale-Up of mHealth Innovations Based on Intervention Complexity: Two Case Studies of Child Health Programs in Malawi and Zambia

Abstract

As interest in mHealth (including Short Message Services or SMS) increases, it is important to assess potential benefits and limitations of this technology in improving interventions in resource-poor settings. The authors analyzed two case studies (early infant diagnosis of HIV and nutrition surveillance) of three projects in Malawi and Zambia using a conceptual framework that assesses the technical complexity of the programs, with and without the use of SMS technology. The authors based their findings on literature and discussions with key informants involved in the programs. For both interventions, introducing SMS reduced barriers to effective and timely delivery of services by simplifying the tracking and analysis of data and improving communication between healthcare providers. However, the primary implementation challenges for both interventions were related to broader program delivery characteristics (e.g., human resource needs and transportation requirements) that are not easily addressed by the addition of SMS. The addition of SMS technology itself introduced new layers of complexity.

Acknowledgments

Many individuals reviewed drafts of this work and provided helpful feedback. We thank Christian Salazar, Mickey Chopra, Theresa Diaz, Khassoum Diallo, Kumanan Rasanathan, Ariel Higgins-Steele, and Ahmet Afsar. The manuscript was also reviewed by colleagues from the UNICEF office in Zambia; we thank Nilda Lambo and Lastone Chitembo. From the office in Malawi we thank Luula Mariano. For the inputs regarding the use of SMS technology for both projects, we thank Erica Kochi, Merrick Schaefer, and Kieran Sharpey-Schafer.