Manoeuvring in the mountains : Exploring the potential of an information and communication technology system for community health workers in Nepal

Abstract

Despite progress in global healthcare, rural communities remain marginalised from receiving healthcare access. Studies have recognised the importance of community health workers (CHW) in extending healthcare delivery to these communities as well as the transformative use of Information and Communication Technologies (ICT) for healthcare development. This research examines the potential of a sustainable ICT system for CHWs in Achham, Nepal, using the Technology-Community-Management-Vulnerabilities (TCMV) framework. The study examined the information and communication needs of stakeholders within the current system and assessed barriers to effectiveness. The research was conducted in conjunction with Nyaya Health, which operates the Bayalpata Hospital and runs a CHW programme in collaboration with the Nepali government. Qualitative research methods (n=57) respondents were engaged through focus group discussions and in-depth interviews. Findings revealed CHWs' work-related information needs were unmet due to inadequate communication infrastructure, medical training and education, and highly bureaucratic government protocols. Furthermore, CHWs were burdened by informational, economic, socio-cultural and physiological/psychological vulnerabilities. Based on the TCMV model, recommendations were made to equip CHWs with mobile handsets and to introduce SMSbased protocols to facilitate efficient patient scheduling and referral. This system should be accompanied by financial subsidy and training to operate the mobile technology. These proposals are small scale but can be adapted incrementally over time to ensure sustainability. Apart from informing policy, this research serves to guide the decisions of healthcare practitioners and influence local ownership in Achham's rural healthcare system.