Feasibility Of Mobile Health For Treatment Coverage Reporting: Lymphatic Filariasis Control Programme In Ghana

ABSTRACT Background Health information plays a pivotal role in ensuring the success of health systems. It ensures the health system blocks receive the needed information for effective decision-making. Improving data reporting systems can, therefore, strengthen the delivery of health programmes and health systems. Information Communication Technology (ICT), particularly mobile phone applications (mHealth) have become pivotal in the delivery of quality health data. The Neglected Tropical Diseases (NTD) Control programme in Ghana engages community health volunteers (CHV) to conduct house-to-house mass drug administration (MDA) of albendazole and ivermectin for the treatment and management of lymphatic filariasis. Community health volunteers register community members during the MDA and collect information on dosage of drugs administered. They are expected to summarise the data collected in the registers and submit the reports to the sub-district supervisors and eventually to the NTD national office via regional supervisors. Unfortunately, this process delays and hampers mop-up drug distribution, reporting to donors and planning and decision making for the subsequent years’ MDA. The NTD programme intends to address reporting challenges using mHealth applications. However, little is known about the acceptability and feasibility of data reporting using mobile phones, particularly among community health volunteers (CHVs). This study assessed the feasibility of CHVs using mobile phones for reporting MDA data for the programme. In particular, the study assessed bottlenecks in data reporting for the MDA, CHVs mobile phone use, mHealth technology acceptance among the CHVs and the quality of data reported. Methods The study employed a mixed methods research design using multiple cross-sectional studies. This was an implementation research involving qualitative interviews, CHV training, mHealth v intervention, data collection and data quality assessment. The study was conducted in two episodes (T1 and T2) over a two year period in Ahanta West district and Nzema East Municipality, both in the Western Region of Ghana. Due to the small number of CHVs in the two study sites, all CHVs who consented to participate were enrolled without sampling. Supervisors at the sub-district, district, regional and national levels were interviewed to understand the context of programme implementation. Qualitative data were collected using in-depth interviews and focus group discussions. A structured questionnaire was administered to CHVs on mobile phone use patterns and challenges and to determine CHVs acceptance to use mobile phones to report MDA data. Quantitative data were analysed using Stata 13® (StataCorp LP) and MS Excel 2013®. Frequencies and proportions were used to describe the quantitative data. Generalised structural equation modelling was used to assess CHVs acceptance to use mobile phones for MDA reporting. Differences in proportions between programme data and data submitted by SMS and USSD were calculated to determine completeness and accuracy of MDA data reported. Qualitative data was translated, transcribed and coded. Data was uploaded into Nvivo® Pro by QSR International to store and organise the data. The data were analysed using thematic content analysis perspective. Results Mobile phone ownership and access were almost universal (99%) with voice calls being the most used function (73%) followed by text messages at 33%. Mobile phone use among CHVs was almost universal. Poor network connectivity and lack of electricity were significantly associated with challenges of using mobile phones. Behavioural intention was a strong determinant of actual use of the technology in T1 but was not significant in T2. The CHVs use of mobile phone technology for reporting MDA data was dependent on other factors such as volunteerism, incentives and submission to authority. Data completeness from both study sites vi in both episodes ranged from 0 – 100% with about half of messages received (n=56) reporting 100% of indicators expected. Data accuracy, on the other hand, was generally poor across study sites. Reasons for delays in reporting were attributed to poor numeracy skills among CHVs, difficult physical access to communities, high supervisor workload, poor adherence to reporting deadlines, difficulty in reaching communities within the allocated time and untimely release of programme funds. Poor accuracy of data was mainly attributed to the inadequate motivation for CHVs and difficulty in calculating summaries. Conclusions The results of this study have shown that the data reporting bottlenecks occur upstream (subdistrict and district levels). Community health volunteers are willing to accept mobile phones for reporting MDA data. However, health system and programmatic issues have an influence on their decisions to use mobile phones for reporting. Accuracy and completeness of MDA data were generally poor. Using mobile phones to report MDA data is feasible due to CHV high mobile phone use and CHV acceptance to use mobile phone for data reporting. Accuracy and completeness will have to be improved and network connectivity in various communities will also have to be improved. Choosing the right technology for data reporting can ensure data completeness. To improve data accuracy, measures will have to be applied to the current paperbased system to ensure it will be adequately translated in terms of technology. The immediate supervisors of CHVs; community health officers (CHOs) at the sub-district level, could be provided with the mobile technology tools to submit the summarised data from the sub-district level to ensure timely reporting