Mobile phone requirement for mHealth in Africa could exclude the most vulnerable

Newswise — Research shows women, older people, rural dwellers and people living in poverty are less likely to own a mobile phone. This means they cannot access mHealth services, despite representing the demographic with the greatest current need for mobile healthcare solutions.

Many health systems in Africa are under-resourced and difficult to access. Mobile health services have the potential to dramatically increase access to healthcare. If cost-effective, they would be invaluable in more rural areas where long journeys often prevent individuals from seeking treatment.

“mHealth services are currently being tested in trials in many African countries, but the requirement to own a mobile phone to use the services creates a barrier to access,” says first author Justin Okano, statistician at Department of Psychiatry and Biobehavioral Sciences, David Geffen. UCLA School of Medicine, Los Angeles, USA. “This is compounded by some services requiring a smartphone instead of a more basic phone. We sought to determine which demographic groups had the lowest rate of mobile phone ownership and therefore could be excluded from accessing mHealth services .

Okano and his colleagues used data from the 2017-2018 Afrobarometer survey for 44,224 people in 33 African countries. They looked for inequalities in mobile phone ownership based on gender, urban/rural residence, age and wealth. They also determined whether an individual had a basic phone or a smartphone. The team plans to analyze more recent data as it becomes available.

Overall, they found that 82% of individuals owned a mobile phone, which was also likely to be a basic phone or smartphone. Despite this high overall ownership rate, there was great variation between countries, which was even more pronounced with smartphones. There were also substantial variations within countries, with each having low and high ownership zones.

One of the most pronounced factors was proximity to health centers. Smartphone owners were more likely to live near a health center than basic phone owners, who in turn were more likely to live nearby than non-phone owners. More generally, people in urban areas were three times more likely to own a mobile phone and three times more likely to own a smartphone.

Men had higher ownership rates than women and were also more likely to own smartphones. The team also observed that the wealthiest people were much more likely to own a mobile phone, although some of the poorest people in all 33 countries owned a smartphone. This can be explained by existing programs to provide access to smartphones as they have increasingly become a means for people to improve their livelihoods. Notably, 13% of smartphone owners said they never used it to access the internet, possibly due to the high costs of internet services on the mainland.

The authors did not determine the factors underlying the inequalities found, although they plan to explore this in future studies. Suggested reasons include cultural norms of patriarchal societies reducing women’s agency, lower digital literacy among women, rural residents and poorer people, and inferior infrastructure in poorer/more rural areas.

“Country-level differences in mobile phone ownership across Africa had not been quantified before. The inequalities we found in phone ownership were for the same groups that already had inequalities in access to health care,” says lead author Sally Blower, professor of biomathematics in the Department of Psychiatry and Human Sciences. biobehavioral studies from the David Geffen School of Medicine at UCLA.

“For mHealth interventions to be successful and not exclude those members of society who need them most, a digital transformation must occur across the continent. It is not just the possession of mobile phones that needs to be addressed. Power grids need to be expanded, cellular coverage improved and bandwidth expanded while ensuring affordability and sustainability.

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