CHWs + mHealth. An assessment of mHealth interventions utilized by community health workers in low and middle-income countries

The growth of mobile networks and access to mobile phones has led to the design of health interventions reliant on the utilization of existing infrastructure. The use of mobile phones to improve health outcomes is known as mobile health (mHealth). One health domain within which mHealth technology is currently used is in assisting community health workers in delivering maternal health care in low and middle-income countries (LMICs). Community health workers (CHWs) are members of their community, although not qualified health professionals, chosen to receive varying amounts of training and consequently provide a range of health services to their communities, including maternal health information and advice. CHWs are often volunteers and are essential in rural areas of LMICs with nation-wide shortages of human resources for health. However, it is important to note that CHWs cannot replace professional health workers. Human resources for health are important for overall health outcomes including maternal health. Research has shown that the countries with the worst maternal health indicators are also some of those that have the least amount of health workers. In these countries, women of low socioeconomic status in rural areas are the most affected. The presence of CHWs has helped improve the overall outcomes for women in rural communities; however, these health workers often have limited education and training and insufficient supervision, which leads to difficulties in conducting their tasks. The use of mHealth technologies can serve as a bridge between these gaps in education, training, supervision and communication (between CHWs and the communities and CHWs and other health workers). This thesis aims to contribute to the evidence-base to develop solutions for solving maternal health problems related to maternal knowledge and health-seeking behaviors in rural settings in LMICs. Based on the overall research objective, four research questions were formulated: 1. What is the effect of mHealth interventions utilized by CHWs on maternal health? 2. How does mHealth program implementation influence the performance of health workers, including community health workers? 3. What contextual factors influence the effectiveness of a mHealth intervention utilized by CHWs on maternal knowledge and healthseeking behaviors? 4. How do program-targeting strategies influence observed outcomes of maternal mHealth interventions?