Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda

ABSTRACT

This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.

Cet article examine des résultats de terrain qui mettent en évidence le potentiel pour les technologies de santé mobile (m-santé) au moment d'aider les agents sanitaires communautaires (ASC) à fournir des services de base marternels et néonataux au Rwanda. L'adéquation de RapidSMS, une technologie de m-santé de l'UNICEF/du ministère de la Santé, est examinée par l'intermédiaire de groupes de réflexion avec des ASC. Les résultats mettent en relief la nécessité d'une formation supplémentaire en utilisation de RapidSMS, de la continuation de la mise à niveau des téléphones portables, de la conception de manières innovantes de charger les téléphones portables et de la garantie de la disponibilité d'ambulances. Nous suggérons que la supervision des ASC soit un processus bilatéral intégré dans RapidSMS qui utilise la communication en temps réel pour améliorer l'efficacité.

El presente artículo examina los resultados de estudios de campo que dan cuenta del potencial que conlleva el uso de tecnologías de salud móviles (mHealth en inglés) para apoyar a las trabajadoras de salud comunitarias (tsc) que brindan servicios básicos a madres y a neonatos de Ruanda. A partir de la realización de grupos de enfoque con las tsc se valoró lo adecuado que resulta el uso de Rapidsms, una tecnología mHealth impulsada por Unicef y el Ministerio de Salud. Los resultados arrojados por este ejercicio subrayan la necesidad de brindar más capacitación en el uso de Rapidsms, de actualizar continuamente los teléfonos celulares, de diseñar maneras innovadoras para recargarlos y de garantizar la disponibilidad de ambulancias. La autora sugiere que la supervisión de las tsc se lleve a cabo como un proceso bidireccional incorporado al uso de Rapidsms, utilizando la comunicación en tiempo real para mejorar su eficacia.

KEYWORDS:

• Technology
• Social sector – Health
• Sub-Saharan Africa

Acknowledgements

The author would like to acknowledge Dr Samuel Brazys, a Lecturer of International Relations and Geary Institute Fellow at University College Dublin, whose guidance and advice made possible and greatly enhanced this research project. I am thankful to Dr Herman Musahara and Birasa Nyamulinda (University of Rwanda) who provided support and guidance in accessing field research locations. I am greatly indebted to the community health workers who participated in this study as well as supervisors and the entire health centre staff in research locations who gave their time and experience to offer insights on this study.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Purity Mwendwa is a Ph.D. candidate in the Global Human Development Initiative, University College Dublin, Ireland. Her main area of research interests embody the concept of primary health care, that of bringing services closer to the people through community participation. In particular, Purity is driven by her passion to support initiatives that seek to reduce maternal and new-born mortality in low-resource settings.

Notes

1 Open-ended questions were used to probe CHWs regarding their experience with RapidSMS and how it impacted their work. The focus groups were conducted by a moderator who spoke fluent Kinyarwanda and English. At the start of every focus group the purpose and procedure were described and the participants were informed that participation was voluntary. Once written consent was obtained from participants, the focus group began by following the guide presented in Table 1. The first focus group was conducted with CHW leaders followed by 14 focus groups with CHWs for maternal and new-born health. This approach was chosen as it was believed that CHW leaders would be well positioned to offer a greater insight at the start of the study. Most focus groups took place either at health centres or administrative offices which were deemed convenient for the participants. The focus groups lasted between 45- 60 minutes. Participants’ statements were audio recorded and transcribed verbatim. Written data were encrypted and stored in a safe location only accessible to the researcher and research assistant to maintain participants’ anonymity. All participants were offered refreshments during the interview sessions. Prior to the study, ethical approval was granted by the Human Research Ethics Committee, Humanities, of the researcher's university.