Duality of m-Heath: Enabler or Inhibiter of Community Health Workers Empowerment for Maternal and Child Health (Case Study of RapidSMS in Rwanda) Work in Progress Said Rutabayiro Ngoga 7th East African Health & Scientific Conference Dar es Salaam - Tanzania 27th – 29th March 2019

Background Poor maternal and child health outcomes remain a major for low and middle-income countries due to severe shortage of health workers and limited infrastructure (World Health Organization, 2015). In Rwanda, community Health Worker (CHWs) have shown to improve considerably maternal and child health outcomes (Musabyimana 2018) Despite these improvements, mortality and high rates of health service utilization, maternal and new- born mortality remain high, however most of the remaining deaths are preventable.

Background Cnt’d The use of mobile devices in medical and public health practice is known as mHealth (WHO Global Observatory for eHealth 2011). Rwanda is an early of mHealth adopter and has deployed an innovative tool, RapidSMS, to track pregnant mothers and their infacts. (Ngabo et al., 2012). The RapidSMS platform was implemented to facilitate communication between CHWs and the broader health system, including the ambulance system, health facilities, and Ministry officials.

Motivation CHWs serve as the interface between the communities and the health system, hence using mHealth tools may help them overcome many of the barriers they face in the day-to-day activities These barriers includes as lacking appropriate tools to provide services and collect data, and limited access to training and supervision (Braun et al. 2013) However, empirical studies has shown that mHealth tools can either promote or hinder health workers’ efforts (Arvey et al. 2012) This calls for a need to understand in what circumstances the mobility mediated by IT empowers CHWs to provide(Baumgart, 2005).

Objectives To provide insights into how IT is appropriated in and affords mHeath enabled services, particularly in settings where prompt responsiveness of CHWs and timely supervision and follow-up can be difficult to monitor and implements. To develop an architecture model to support understanding of CHWs practices and guide action afforded by IT

Contributions The article makes a contribution to the literature about front-line health workers by focusing on mHealth dual affordances conferred to them as a response to their needs in their words. This article seeks to provide clarity and bringing out CHWs voices from the field And also to understand how CHWs use this technology the delivery of their tasks; and the challenges and opportunities attributed to technology for CHWs in the role of producer and consumer of information services at the same time

Case Study

Research Design Our theorizing is grounded in a qualitative field study on the RadipSMS services, by using a socio-material viewpoint emphasizing how configurations of people and IT artifacts interact to support work, communication, and decision- making towards CHWs and and across peripheral of health systems boundaries. The data collecting started since March 2019 until April 2019. The interviews are semi-structured and open- ended to reveal the everyday work practice and the respondent’s use of Technology when at work. Although key informants can help identify relevant interviewees, participation in the research is strictly voluntary. Each interview was designed to last between one and two hours, and all interviews, will be conducted face- to-face at the respondents’ workplace, which provided us with contextual understanding and insights into the work process within different context. The sampling of interviews was purposeful (Strauss and Corbin 1990) focusing on CHWs and top, middle employees in the peripheries of Health System in Rwanda .

Results The results will be discussed as a larger response to growing issues in global health and how m-health applications can be used and adapted to support CHWs tasks, but this only happens when such interventions are complemented with continuous training, timely supervision and follow-up and provision of promt responses of medical equipment

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