Developing a Covid-19-focused mHealth system in a low resource setting during the COVID-19 pandemic: Challenges and opportunities

Rosie Stenhouse^1,2*Wassie Gebbie Beshir³Demessie Girma⁴Gosaye Fida⁵Clara Calia¹Godana Guto³Maria Klara Wolters^6,7

• ¹School of Health in Social Science, University of Edinburgh, Edinburg, Scotland, United Kingdom
• ²Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
• ³Adama General Hospital and Medical College, Adama, Oromia Region, Ethiopia
• ⁴Oromia Tech plc, Adama, Ethiopia
• ⁵Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, United Kingdom
• ⁶Institute for Information Technology (OFFIS), Oldenburg, Lower Saxony, Germany
• ⁷School of Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom

Approximately three quarters of Ethiopia's population live in rural areas and access to healthcare is difficult with poor transport infrastructure and long travel times. Telemedicine has the potential to support healthcare access and to minimise COVID-19 transmission through reduced need to travel.Objectives: This Brief Research Report describes the analysis of qualitative data relating to the development of a mHealth system during the COVID-19 pandemic to support COVID-19 symptom management in the community in Oromia, Ethiopia.Methods: Data were 1) meeting notes and WhatsApp group discussions 2) focus group with medical staff 3) interview with a senior hospital leader. A framework method was used for analysis. Results: Three themes were identified: 1) Patient-physician relationship 2) New ways of using everyday technology 3) Infrastructure and digital access. Discussion: We discuss the challenges of developing an mHealth system during a pandemic alongside infrastructural challenges and the preparedness of medical staff and the general population communities for use of mHealth. There is a need for investment in information technology infrastructure and in access to digital networks alongside a need to improve the digital and health literacy of populations for successful implementation of a patient-facing mHealth system. Thus, whilst the policy aspirations are admirable, the potential for technological innovation is great, and the clinicians can see the benefit of using technologies to provide care to those who cannot reach clinics, there is a gap between what is possible given the current reality of infrastructure and patient preparedness and the requirements for a successful telemedicine intervention.