Integrating mHealth Applications: Motivation, Approach and Outcomes

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Abstract: mHealth has revolutionized the health care service delivery at all levels of
health care system in both developing and developed world. Both at patient level and
service provider level, mHealth has become very useful in areas of decision support,
data storage, data processing into useful information, information flow and
information use just to mention a few. For service providers with multiple service
deliveries, there is a challenge in managing well the various mHealth applications
across the various program deliveries. Standalone applications on different phones or
the same phone poses a number of challenges and complications in management and
use of these individual applications for patients across the health system. One
solution to such challenges is the use of integrated mHealth solutions. With mHealth
integrated application, we can address the challenge of health workers having
multiple phones and applications for use in various service deliveries which often
target the same audience. Integration also facilitates the continuity of care of patients
across different services usually provided by the same health service point.
Integration also ensures optimum use of resources thereby redirecting further
resources to other needed areas. For optimal results of integration process, it is
important to clearly define the problem, outline the intervention in line with the
entire health care system and provide for means to mitigate risks. As a rule of thumb,
intensive verification, validation and testing of the integrated application is crucial to
ensuring an acceptable solution that improves the health care of people.
Documenting the processes and learning from the them is important in improving the
next possible intervention. This paper discusses the motivation, approach and
outcomes of the integration process of mHealth applications.
Keywords: mHealth, integration, applications, solutions.

Introduction
Malawi, like many other developing countries faces an acute shortage of qualified medical
personnel. In 2014, the doctor to patient ratio stood at 1:50,000 while the nurse to patient
ratio was at 1:5000 [4]. To alleviate the situation, the government of Malawi adopted a
lower cadre of community health workers called Health Surveillance Assistants (HSAs).
The HSAs have an A level equivalent education level and undergo a ten week long training
in basic community health services and then detailed training in various specific health
services programs at varying time periods.
HSAs provide many health services in the communities and the health facilities
including: assessment and treatment of under five children in a program called Community
Case Management (CCM), assessment and counselling of Antenatal and Postnatal women
and neonates in Community Based Maternal and Neonatal Health (CBMNH), Under-five
outreach clinics and immunizations, Family planning, Nutrition, health education and sanitation, Integrated Disease Surveillance Response (IDSR) and many others [8]. Each of
these services has its own protocol to follow and a set of registers to use as well as reporting
formats and requirements. This entails a lot of varying decision and information demanding
services which often poses a challenge in both the decision making and information
management. The existence of the multiple independent registers is often attributed to the
complex nature of the health care system with each service delivery requiring specific and
unique pieces of information and decisions to be made [1]. Malawi health care system is no
exception to this phenomena.