Pioneering mobile health (mHealth) in Africa: a nurses perspective from Malawi

If you visit Malawi, in south-east Africa, you will find a warm, sunny climate and a welcoming, friendly people who are largely based in rural town and communities north and south of Lilongwe, our capital. We love simple things in life like good nsima, which we get after farming the land and fishing in our wonderful Lake Malawi. But our economy, which is largely agricultural, relies on good weather to grow crops and sometimes severe droughts can cause food shortages and significant health problems especially for young children and older adults. We have a high infant mortality rate and a low life expectancy compared to other countries and HIV/AIDS is a big health problem here.

What you might not notice about Malawi as you travel through its landscape is the telecommunications infrastructure and network masts dotted around the countryside. Although they look quite inconspicuous this technology is helping us deliver healthcare to people all over Malawi. When you live in a resource-poor country, you have to think of clever ways to use what you have, to get what you need!! And although the number of nurses in Malawi is low for the volume of people we look after, over 17 million at the last count, registered nurses and community healthcare workers (CHWs) are utilising technologies to assess, diagnose and treat people with a range of infectious diseases and chronic conditions. As our technical infrastructure improved, mobile phones of different shapes and sizes have become widely available and high-speed 3G and 4G networks are being rolled out, nurses quickly realised how these devices and systems could be used to deliver healthcare in local areas.

Nurses in Malawi work mainly in the community, either at rural health centres or district hospitals. In fact, CHWs deliver a lot of the care in remote areas as we do not have the resources to fund a national network of nurses in primary care and so CHWs help us to deliver a range of child and adult health services in local areas. Mobile technology helps us get access to and manage all the clinical data that we need every day to assess patients accurately, diagnose them quickly and deliver effective treatments. This technology is ideal for nurses and CHWs in Malawi as it is affordable, portable and easy to use even in the most remote locations. Although some areas do not have network coverage, we can still use mobile devices offline to manage patients’ health information and upload or download clinical data when we return to areas that have broadband or Wi-Fi access.

Malawi also has strong historical connections with Scotland and the United Kingdom who helped establish and develop trade and transport here in the 1880’s. Our School of Nursing at Mzuzu University, which is one of the principal universities in Malawi, is working with several universities including Edinburgh Napier University (Scotland), Imperial College London (England), University College Cork (Ireland) and University College Dublin (Ireland) as well as a number of non-governmental organisations such as Luke International Norway and the Scotland Malawi Partnership on mobile health (mHealth) initiatives. One such project, funded by the European Commission, is developing and evaluating a clinical decision support application (app) to help healthcare workers look after young sick children who present at rural health clinics in the Northern region. We have helped in the design and development of the Supporting LIFE app, which is based on the World Health Organisation (WHO) Community Case Management of Childhood Illness guidelines. The app is currently being piloted with healthcare workers in the northern regions of Malawi to help them measure vital signs, triage children quickly by classifying the type of illness they have, and make correct clinical decisions about which drugs or treatments to deliver.  The plan is to develop the system further to enable data the app collects to be communicated to regional and national health centres, which feed into population health statistics. This will enable us to monitor the health of young children as it is happening on the ground.

From a capacity building perspective, there are a growing number of mHealth groups across Malawi including Baobab Health Trust and D-Tree International. Such organisations are working closely with the Malawi Ministry of Health, healthcare providers and CHWs to ensure that the relevant and most effective mHealth apps are delivered. In an effort to harmonise the mobile Health movement across Malawi, the Malawi eHealth Research Centre was established (Twitter: @eHealthMalawi). It is no surprise that one of the leading groups within the area of mHealth in the Nursing community. As nurses, we can learn so much about how mobile technology can be leveraged to look after people who are sick in Malawi, by working with colleagues in other fields and other countries. Our collective expertise is assisting nurses to pioneer mobile tech and address some of the serious health problems in Malawi. mHealth has the potential to revolutionise healthcare across sub-Saharan Africa and I am proud to say that nurses as frontline healthcare workers are leading the way.

_{Affiliations:}   

_{1 School of Nursing, Mzuzu University, Malawi}

_{2 School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom}

_{3 Global eHealth Unit, School of Public Health, Imperial College London, London, United Kingdom}