Co-produced mobile consulting for remote, marginalised communities in Africa

It is a United Nations Sustainable Development Goal to achieve universal health coverage with access to quality healthcare for all. Our network plans to evaluate the contribution to this goal of mobile consulting (mConsulting). This is when patients consult with health providers about their health using digital communication. Our concern is remote, marginalised communities in Africa that have difficulty accessing quality health care.

The digital infrastructure of Africa is its best infrastructure - much better than the roads, and most people own a mobile phone. We want to test whether using digital infrastructure for mConsulting improves access to quality healthcare for remote, marginalised communities and whether this is sustainable. mConsulting needs to be affordable to the community and for providers. However, improved healthcare can improve the health of the community and so increase economic activity and use of mConsulting can stimulate investment in digital infrastructure benefiting the community.

Commercial companies are delivering mConsulting services in Africa. Currently they target urban communities but could extend their reach to remote communities. In addition to good mobile signal and sustainable business models they need community acceptance and integration with local providers for certain diagnostic tests and treatments. Existing health services (public or private) can add mConsulting to their services e.g. a health worker using a mobile phone for consulting. This needs planning to ensure professional standards and patient acceptability.
We are academics/researchers, mConsulting providers and policy organisations. Four of the academic/research teams (Kenya, Nigeria, Tanzania and UK) have collaborated on research and research capacity building for ten years. We have extended our team to further organisations in our countries and in Uganda and Rwanda. Our expertise includes, technical, medical, nursing, education, social and behavioural science, health systems, economics and epidemiology.

We aim to evaluate the impact of mConsulting on healthcare access and health outcomes for remote marginalised communities and explore how it can be optimally delivered. We will do this in varied contexts of East and West Africa so we learn what works well (or not) in different places, with different histories, policies and health systems. Our results will be relevant to diverse settings across Africa.

To do this we will develop a research proposal for funding. We will first use the seed network funding to:
1. Extend and consolidate our networks to include all relevant and necessary people/organisations;
2. Work with remote community representatives, local healthcare providers, mConsulting providers, policy makers (and telecommunication providers where needed) to collaboratively identify plans for mConsulting including challenges to be overcome before implementation and evaluation;
3. Explore innovative ways of working across commercial, research and policy sectors to build research capacity and create opportunities for exchange.

We expect our follow-on research will evaluate mConsulting for primary care, for certain types of health problems e.g. acute conditions, long-term conditions, child and maternal health, mental health. Our choice will depend on what is priority for the communities. Our research objectives are to:
I) Evaluate whether mConsulting results in change in community access to healthcare and in measures of health outcomes for selected tracer conditions (e.g. blood pressure for hypertension, patient reported symptoms for depression);
II) Evaluate what aspects of mConsulting work well (or not), where, when and for whom. We will observe, interview and collect activity data;
III) Identify contextual factors that need to change to ensure scalability of mConsulting (e.g. professional training, regulations, financing).

The Network and follow-on study (longer-term) are expected to benefit and impact on:
a) Remote marginalised communities in the study sites, participating countries, regions and elsewhere through:
- Identification of relevant, implementable pathways to mConsulting, grounded in community needs/concerns (through co-production);
- Encouraging the implementation of accessible, affordable and acceptable mConsulting services (for users-providers) (follow-on grant and beyond);
- Quality mConsulting is anticipated to improve healthcare access and health outcomes in remote communities by reducing distances and cost barriers, and hoped to improve trust between communities/users and healthcare providers;
- Implementation of mConsulting will potentially attract investment in digital infrastructure and access for remote communities, increasing economic growth;
- Co-production will provide evidence for challenges and barriers to mConsulting, which may support community efforts to promote change/address key determinants.

b) Partner organisations (immediately) and other mConsulting providers (longer-term) delivering or planning mConsulting in remote marginal areas (commercial, not-for-profit, public sector) through:
- Interdisciplinary, inter-sectoral knowledge exchange and cross-site learning;
- Insights into potential markets for mConsulting, potentially contributing towards business growth which would feed into wider economic development;
- Planning (and implementation) of appropriate business models, with longer-term impact expected through sustainability and relevance of work;
- Evaluation and feedback for partners about their services, to enable their learning and adaptation;
- Efficiency gains and commercial opportunities to support innovative business solutions and digital health.

c) Local, national and regional health policies and systems through:
- Strengthening of regional networks and evidence-informed evaluation of mConsulting services in remote communities
- Providing evidence for scalability of mConsulting in different contexts in Africa, with identification of contextual factors that enable or inhibit its success in impacting on health need
- Strengthened research capacity in digital health research and innovation in Africa, particularly implementation of digital health solutions for marginalised communities.
- Reciprocal learning across all contexts.

d) Practitioners and Industry in Sub-Saharan Africa through:
- Development of pathways to mConsulting, with plans for how to 'get there'. These may prompt similar approaches and planning for pathways to mobile services in other industries seeking to capitalise on the continent's high mobile penetration rates;
- In the follow-on study, evidence for scalability of services may similarly support other forms of digital innovation and provide direction on where to focus investment, in a coordinated manner;
- Practitioners and Industry need to develop innovations that improve health and well-being yet many lack the skills to study and understand drivers of utilisation of services. Our study will provide a model to enable practitioners and industry representatives to work with researchers to address these skills gaps and related challenges.

e) Policy and decision-makers (inter/national, regional) with provision of evidence for:
- Use and scalability of digital technology in consultations in health and other sectors (e.g. agriculture);
- Planning, implementing and evaluating whether and how mConsulting can contribute to the UN Sustainable Development Goals of universal health coverage, gender equality, and industry, innovation and infrastructure.