Relevance of a Toll-Free Call Service Using an Interactive Voice Server to Strengthen Health System Governance and Responsiveness in Burkina Faso

Document Type : Original Article

Authors

1 UMI Resiliences, IRD (French Institute For Research on sustainable Development), Bondy, France

2 Pan American Health Organization, Portau-Prince, Haiti

3 CEO Africasys, Paris, France

4 NGO Action-GovernanceIntegration-Strengthening, Health and Development Working Group (AGIRSD), Ouagadougou, Burkina-Faso

5 IRD (French Institute For Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France

Abstract

Background
In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area.
 
Methods
This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service.
 
Results
The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people’s capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government.
 
Conclusion
This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world’s poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).

Keywords

Main Subjects

References

  1. Robert E, Lemoine A, Ridde V. Que cache le consensus des acteurs de la santé mondiale au sujet de la couverture sanitaire universelle? Une analyse fondée sur l'approche par les droits. Rev Can Etudes Dev. 2017;38(2):199-215. doi:10.1080/02255189.2017.1301250
  2. Olivier de Sardan JP, Jaffre Y. Une médecine inhospitalière: les difficiles relations entre soignants et soignés dans cinq capitales d'Afrique de l'Ouest. Karthala; 2003.
  3. Ebang Ondo E. Perception de l'hôpital public et offre de soins de santé au Gabon: analyse des enjeux des interactions entre personnels et usagers du centre hospitalier de Libreville (CHL). Sous la Direction de Marc-Eric GRUENAIS, thèse d’Anthropologie Sociale et Ethnologie soutenue le 09/01/2012 à l’EHESS/Marseille. Bull. Amades Anthropol. Médicale Appliquée Au Dév. À Santé (2012). Bulletin Amades. 2013;85.
  4. Toure L. La baisse de qualité, prix à payer pour un meilleur accès aux soins? Perceptions sur les politiques d'exemption de paiement des soins au Mali. Afr Contemp. 2012;243(3):49-63. doi:10.3917/afco.243.0049
  5. De Man J, Mayega RW, Sarkar N, et al. Patient-centered care and people-centered health systems in sub-Saharan Africa: Why so little of something so badly needed? Int J Pers Cent Med. 2016;6(3):162-173.
  6. Van Belle S, Mayhew SH. What can we learn on public accountability from non-health disciplines: a meta-narrative review. BMJ Open. 2016;6(7):e010425. doi:10.1136/bmjopen-2015-010425
  7. Bigdeli M. Health System Governance - Health System Institutions. presented at: the WHO - Health Systems Governance and Financing; Barcelona; March 3, 2016.
  8. World Health Organization (WHO). People-centred and integrated health services: an overview of the evidence. https://www.who.int/servicedeliverysafety/areas/people-centred-care/evidence-overview/en/.  Published 2015.
  9. Razafindrazaka D, Razafimamonjy L, Djao IL. A Madagascar, les citoyens déplorent l’ampleur considérable de la corruption. Afrobarometer; 2014.
  10. Yarney L, Buabeng T, Baidoo D, Bawole JN. Operationalization of the Ghanaian Patients' Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients. Int J Health Policy Manag. 2016;5(9):525-533. doi:10.15171/ijhpm.2016.42
  11. Rutebemberwa E, Ekirapa-Kiracho E, Okui O, Walker D, Mutebi A, Pariyo G. Lack of effective communication between communities and hospitals in Uganda: a qualitative exploration of missing links. BMC Health Serv Res. 2009;9:146. doi:10.1186/1472-6963-9-146
  12. Oyeyemi SO, Wynn R. The use of cell phones and radio communication systems to reduce delays in getting help for pregnant women in low- and middle-income countries: a scoping review. Glob Health Action. 2015;8:28887. doi:10.3402/gha.v8.28887
  13. BFA-INSD-EMC-2014. Rapport Enquête multisectorielle continue (EMC), Profil de pauvreté et d’inégalités. INSD; 2014.
  14. Mericskay B, Roche S. Cartographie 2.0: le grand public, producteur de contenus et de savoirs géographiques avec le web 2.0. Cybergeo. 2011. doi:10.4000/cybergeo.24710
  15. Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Glob Health Sci Pract. 2013;1(2):160-171. doi:10.9745/ghsp-d-13-00031
  16. Hampshire K, Porter G, Mariwah S, et al. Who bears the cost of 'informal mhealth'? Health-workers' mobile phone practices and associated political-moral economies of care in Ghana and Malawi. Health Policy Plan. 2017;32(1):34-42. doi:10.1093/heapol/czw095
  17. Huq NL, Azmi AJ, Quaiyum MA, Hossain S. Toll free mobile communication: overcoming barriers in maternal and neonatal emergencies in Rural Bangladesh. Reprod Health. 2014;11:52. doi:10.1186/1742-4755-11-52
  18. Schuster C, Perez Brito C. Cutting costs, boosting quality and collecting data real-time: lessons from a cell phone-based beneficiary survey to Strengthen Guatemala’s Conditional Cash Transfer Program. The World Bank; 2011.
  19. Aranda-Jan CB, Mohutsiwa-Dibe N, Loukanova S. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health. 2014;14:188. doi:10.1186/1471-2458-14-188
  20. Merrill J, Hershow R, Gannett K, Barkley C. Pretesting an mHealth intervention for at-risk adolescent girls in Soweto, South Africa: Studying the additive effects of SMSs on improving sexual reproductive health & rights outcomes. In Proceedings of the 6th International Conference on Information and Communications Technologies and Development, ICTD; Cape Town, South Africa; December 7-10, 2013.
  21. Erlich A, Jung DF, Long JD, McIntosh C. The double-edged sword of mobilizing citizens via mobile phone in developing countries. Dev Eng. 2018;3:34-46. doi:10.1016/j.deveng.2017.11.001
  22. Jennings L, Ong'ech J, Simiyu R, Sirengo M, Kassaye S. Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study. BMC Public Health. 2013;13:1131. doi:10.1186/1471-2458-13-1131
  23. Barron P, Pillay Y, Fernandes A, Sebidi J, Allen R. The MomConnect mHealth initiative in South Africa: Early impact on the supply side of MCH services. J Public Health Policy. 2016;37(Suppl 2):201-212. doi:10.1057/s41271-016-0015-2
  24. Benoit M, Queuille L, Ridde V. Que sait on de l’utilisation du téléphone portable pour les interventions de santé (mHealth) en Afrique? http://www.equitesante.org/numero-vert.  Published 2013.
  25. Ippoliti NB, L’Engle K. Meet us on the phone: mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries. Reprod Health. 2017;14(1):11. doi:10.1186/s12978-016-0276-z
  26. Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC. Scaling up mHealth: where is the evidence? PLoS Med. 2013;10(2):e1001382. doi:10.1371/journal.pmed.1001382
  27. Free C, Phillips G, Watson L, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013;10(1):e1001363. doi:10.1371/journal.pmed.1001363
  28. Duclos V, Ye M, Moubassira K, et al. Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso. Health Res Policy Syst. 2017;15(Suppl 1):47. doi:10.1186/s12961-017-0211-y
  29. Leung MW, Yen IH, Minkler M. Community based participatory research: a promising approach for increasing epidemiology's relevance in the 21st century. Int J Epidemiol. 2004;33(3):499-506. doi:10.1093/ije/dyh010
  30. Potvin L, Haddad S, Frohlich KL. Beyond process and outcome evaluation: a comprehensive approach for evaluating health promotion programmes. WHO Reg Publ Eur Ser. 2001(92):45-62.
  31. Bilodeau A, Sampson L, Daher P, Belanger J, Gagnon F, Lussier N. [A participatory evaluation confirms the social relevance of a community intervention model in school success: consequences of the participation for the intervention]. Glob Health Promot. 2011;18(1):106-109. doi:10.1177/1757975910393192
  32. Ridde V, Dagenais C. Approches et pratiques en évaluation de programmes. Presses de l'Université de Montréal; 2012.
  33. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org/. Published 2013.
  34. Olivier de Sardan JP. La rigueur du qualitatif. Les contraintes empiriques de l'interprétation socio-anthropologique. Academia Coll; 2008:365.
  35. Paille P, Mucchielli A. L'analyse qualitative en sciences humaines et sociales. Armand  Colin; 2003.
  36. Shoveller J, Viehbeck S, Di Ruggiero E, Greyson D, Thomson K, Knight R. A critical examination of representations of context within research on population health interventions. Crit Public Health. 2016;26(5):487-500. doi:10.1080/09581596.2015.1117577
  37. Shohet L, Renaud L. Analyse critique des pratiques exemplaires sur la littératie en matière de santé. Can J Public Health. 2006;97(2):S10-S14. doi:10.1007/bf03405366
  38. Joshi A. Reading the local context: a causal chain approach to social accountability. IDS Bull. 2014;45(5):23-35. doi:10.1111/1759-5436.12101
  39. Agier I, Ridde V. Introduction des smartphones dans la collecte quantitative pour l’évaluation. Equitesante; 2015.
  40. Medhanyie AA, Moser A, Spigt M, et al. Mobile health data collection at primary health care in Ethiopia: a feasible challenge. J Clin Epidemiol. 2015;68(1):80-86. doi:10.1016/j.jclinepi.2014.09.006
  41. Asongu SA, Nwachukwu JC. The mobile phone in the diffusion of knowledge for institutional quality in sub-Saharan Africa. World Dev. 2016;86:133-147. doi:10.1016/j.worlddev.2016.05.012
  42. Pyone T, Smith H, van den Broek N. Frameworks to assess health systems governance: a systematic review. Health Policy Plan. 2017;32(5):710-722. doi:10.1093/heapol/czx007
  43. Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and Capacity to Manage Resilience of Health Systems: Towards a New Conceptual Framework. Int J Health Policy Manag. 2017;6(8):431-435. doi:10.15171/ijhpm.2017.36
  44. Fox JA. Social accountability: what does the evidence really say? World Dev. 2015;72:346-361. doi:10.1016/j.worlddev.2015.03.011
  45. Dagenais C, Mc Sween-Cadieux E, Some PA, Ridde V. A knowledge brokering program in burkina faso (West Africa): reflections from our experience. Health Syst Reform. 2016;2(4):367-372. doi:10.1080/23288604.2016.1202368
International Journal of Health Policy and Management
Volume 8, Issue 6
June 2019
Pages 353-364

Files

History

  • Receive Date: 22 January 2018
  • Revise Date: 24 February 2019
  • Accept Date: 25 February 2019
  • First Publish Date: 01 June 2019

Share

How to cite

Statistics