Effectiveness of Mobile Technology for Community Health Intervention on Performance of Frontline Health Workers in Five Motech Districts in Ghana

Abstract

Background: Deployment of Frontline health workers (FHWs) has been shown to be an effective and powerful intervention for improving community health in rural settings in Ghana. However, several challenges still persist in the performance of FHWs. Mobile health interventions such as the Mobile Technology for Community Health (MOTECH) project are implemented to enhance health worker performance and reduce maternal and child mortality in these rural areas. MOTECH delivers health messages to pregnant women and mothers of infants as well as sending defaulter alert SMS messages to frontline health workers. Though the health impact of the messages delivered to the clients has been evaluated, the effect of the defaulter SMS messages on performance of frontline health workers has not been assessed. Purpose: The purpose of this study was to assess the effectiveness of MOTECH on the performance of frontline health workers in five MOTECH Districts. Methods: A mixed methods study design was used. Both qualitative and quantitative data were collected, analyzed and related. Qualitative content analysis using Nvivo 10 Qualitative Software; bivariate analysis using chi square test, univariate logistic regression and multivariate logistic regression models using Software and Stata Statistical Software version 12 were used to determine associations at 5% level of significance. Findings: Community Health Nurses used the messages from the MOTECH system more than Community Health Officers, enrolled nurses and Health Extension Workers. Frontline health workers who felt the defaulter alert messages improved performance were more

likely to use the defaulter alert messages (AOR=1225.0, p = 0.001 95% confidence interval: 22.101 – 67896.160). Similarly, frontline health workers who felt the query messages improved performance were more likely to use the query messages to plan and conduct home visits (AOR=6.9, p = 0.001, 95% confidence interval: 2.194 – 21.984). Conclusion: Alert messages sent to health workers made their work easier, and motivated the tracing of clients who missed scheduled appointments. It also improved community outreach activities such as home visits. However, to attain the full effect of these interventions, supportive supervision and providing logistics and resources to strengthen health systems were critical.