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Midwives in Ghana provide the majority of rural primary and maternal healthcare services, but have limited access to data for decision making and knowledge work. Few mobile health (mHealth) applications have been designed for midwives. The study's purpose was to design and test an mHealth application (mClinic) that can improve data access and reduce the reporting burden for midwives at the Millennium Villages Project site in Ghana.

From the design science field, the Information Systems Research Framework guided this study through two research cycles: 1) Relevance, and 2) Design. The first phase of the Relevance Cycle took a user-centered approach to assess the people, organizations, and technology of the midwives’ environment through participant observation, contextual inquiry, and interviews. In the second phase, structured requirements specification was used to categorize the data into goals, system qualities, and constraints. From the categorized data, use cases were developed for patient registration, antenatal care, malaria, family planning, and referrals. Use cases then informed the development of functional requirements. In the Design Cycle, we first used functional requirements for patient registration and malaria to develop the mClinic prototype as part of a coded-in-country initiative. Next, we examined usability of the mClinic prototype by conducting field testing, heuristic evaluation, and usability surveys. Additionally, low-fidelity prototyping was used to determine applicability of the other use cases to the midwives’ environment.

Midwives reported inability to access critical data, high patient loads, and extensive reporting requirements. Low technical self-efficacy and inadequate infrastructure were identified as barriers to implementation. Heuristic evaluation noted issues related to hardware selection, workflow, and security. Midwives ranked the tool as useful in the usability survey; however, ease-of-use rankings were neutral. Interviews indicated this was related to low technical self-efficacy. Applicability checks found support for touch-entry prototypes over those that included lengthy forms or text-entry.

Around the world, countless lives are lost due to insufficient access to quality health information. The availability of accurate, timely, and analyzed data is directly relevant to the quality of an individual’s health and the healthcare system in general, the delivery of individual care, and the understanding and management of overall health systems.

This discussion paper:

1) Examines the role ICTs, and mobile technology in particular, can play in improving access to quality health information, review the ecosystem of health information related to patients,

2) Traces the data throughout the continuum of care, examine health information flows from patients in villages to international health organizations and the most important steps in between,

3) Identifies common ground on which technologists and public health professionals can develop innovative strategies and tools to strengthen health care systems by supporting health data flows, working from the premise that better data collection will lead to better health policies and health outcomes,

4) Focuses on three healthcare domains – surveillance systems, supply chain, and human resources – and through the perspectives of experts in these domains, identify critical gaps in health information flows that technology-based solutions could address. In the case of each of these three domains, we use maternal health as an example to show how technology-backed interventions can improve health information flows,

5) Identifies barriers, choke points, and other inefficiencies to guide the discussion of how modern ICTs can improve health information flows and health outcomes in the developing world,

6) Provides recommendations for using modern ICTs to make health information flow more efficiently and perhaps even transform the process of care delivery itself.

Both mHealth and MFS (Mobile Financial Services) are nascent industries and fragmented along multiple dimensions. The aim of this paper is to help reduce some of these uncertainties and reinforce dialogue on how the mobile communications platform can be leveraged to strengthen mutually positive outcomes related to both financial inclusion and health. With user-centric solutions that leverage common technologies, new efficiencies and capabilities can be created that serve to accelerate global scale.

Unlocking this potential will require the following questions to be addressed: 1. What will be the best method to drive awareness and adoption of the self-reinforcing dynamics of “wealth and health”? Who will lead these efforts? 2. How will the integration and interoperability of disparate technologies across multiple industry and public sector domains occur? 3. Who will build and manage the common infrastructure and distribution networks? 4. How will the various points of policy coordination work across sector domains?

Rural health workers in India do not always have the training, credibility or motivation to effectively convince clients to adopt healthy practices. To help build their efficacy, we provided them with messages on mobile phones to present to clients. We present a study which compared three presentations of persuasive health messages by health workers using a phonebased lecture-style message, a phone-based dialogic message that elicits user responses, or no additional aids.

We found that dialogic messages significantly improve the quality of counseling sessions and increase discussion between health workers and clients; however, we did not statistically measure an effect of either phone-based message on health behavioral outcomes. We analyze these results in light of the challenges we faced and compromises we made through the research process due to the interplay of social, cultural and environmental realities, and discuss how these factors affect ICTD projects at large.