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Mobile Phones for Healthcare in Rural Thailand

Mobile Phones for Healthcare in Rural Thailand. By Thanomwong Poorisat Arul Chib Nanyang Technological University. Challenges of rural healthcare. Lack of staff, especially doctors Unavailability of medical resources

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Mobile Phones for Healthcare in Rural Thailand

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  1. Mobile Phones for Healthcare in Rural Thailand By Thanomwong Poorisat Arul Chib Nanyang Technological University

  2. Challenges of rural healthcare Lack of staff, especially doctors Unavailability of medical resources Transportation problems Diagnosis and treatment quality

  3. Literature • Most focused on success, benefits/barriers and adoption. • organic adoption of ICTs vs planned ICTD projects • Lack insights into how mobile phones are used • Lack generalizability • Time & Space literature sheds light on behaviors of mobile phone usage that help to infer the outcome.

  4. Objectives • Examine the mechanism of how mobile phones could improve healthcare delivery in rural areas • “How does the use of mobile phones among frontline health workers reconstruct the time and space domains?” • “How does power influence the reconstruction of time and space?”

  5. Method • Uttaradit, Thailand • In-depth interviews (1.5 hrs) • 31 frontline healthcare workers • 22 out of 90 community health centers • all 9 district hospitals • Apply concepts from the mobile communication literature

  6. Context Personnel: 2-5 Population: 462,951 Population density: 59 per sq km Distance the hub: 10 - 148 km Task: • 70% promotion and prevention • 30% diagnosis and treatment Community Health Center

  7. Findings: Time Reconstruction • Micro-coordination  make time flexible • Emergency “I just had a patient with fracture … it was a child … we called the hospital so that the specialist would be there when we arrived, ready to put in the oxygen tube” hospital nurse • Non-Emergency “We have a fixed schedule but we do not know what is going to happen that week … Something may come up and one of us may not be able to make it...You do not know until the day before.” CHC staff

  8. Findings: Time Reconstruction • Facilitate information flow  create more time • Emergency “You need time to grab the necessary equipments … it does not take long but it matters” hospital nurse • Non-Emergency “What the health district usually does is they would call us to inform about the content in the official letter, so that we can go ahead and work on it even before receiving the mail” CHC staff

  9. Findings: Time Reconstruction • Facilitate information flow  reduce time • Emergency “If it’s an emergency that happens during weekend … I will coordinate with the ER department for him [patient]…it’s the feeding tube… a patient cannot wait” hospital nurse • Non-Emergency Utilize tele-consultation when there is uncertainty, but … “If I called [the doctor] too often, I may loose face.” CHC staff

  10. Findings: Space Reconstruction • CHCs take on new meanings • Emergency “We can get to them faster than the ambulance” CHC staff • Non-Emergency Success of “Near & Trusted Health Centers” Project “Patients asked if they can get their treatment at the CHC itself.” CHC staff

  11. Findings: Space Reconstruction • Enabling multi-space management • Emergency “I got a call when I was in a meeting in town … I called a local asking him to go investigate it … then I called another organization to borrow the mosquito spray” CHC staff • Non-Emergency “Just do what you did [clean the wound] before, but slower.” staff on duty at the CHC instructing a caregiver

  12. Findings: Power Reconstruction “I do not want the doctor to think that I am asking a stupid question … although the doctor never said it to me” CHC staff • Virtual distance closely in line with physical proximity and the existing power structure • Facilitate informal horizontal communication

  13. Contributions • The reconstruction of time and space via mobile communication depends on … • task importance, • physical distance , and • existing power relationship. • Existing power relationships less influential on emergency cases • Power centralization rather than increasing autonomy for CHCs

  14. Practical Implications • Remote CHCs are most in need of tele-consultation, but they are less likely to use it. • Logistic rather than health information exchange • There is a need to reconsider CHCs’ existing practices as they take on new roles. • Mobile phones are suitable for health-related tasks that need to mobilize support from different parties

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