One of the building blocks for functioning health systems is Human resources for health (HRH).
The importance of people in carrying out health services and related activities cannot be overvalued as it is obvious that any health system that lacks HRH in sufficient quantities, mix, distribution and skill level will fail. Without them, the goal of achieving universal health coverage by 2030 will remain a myth. In many developing countries however, including Nigeria, this most basic requirement for healthy health systems is missing – both in the appropriate quantities and in distribution.
Nigeria, for a prime example, faces a huge shortage of heath workers across every cadre although worse in some regions than others. It is said to be caused by medical personnel emigration to more developed countries for better working and living opportunities, a clustering of medical personnel in urban regions and an underlying underproduction of healthcare workers from the few medical institutions the country has. This shortage has led to the task shifting policy where lower cadre staff perform tasks above their formal training level and with doubtful levels of effectiveness in many cases.
In many industries, including medicine, the use of technological advances to fill a gap in human resources, supplement human efforts or entirely replace humans is now ubiquitous in the twenty-first century. With the ever-increasing spread and penetration of mobile phone use in most regions of Nigeria, it is only logical to leverage on the digital revolution to improve the worsening HRH deficit in Nigeria.
And the advantages are obvious as well. From simple uses such as being able to call a supervisor or a more skilled colleague for guidance during any procedure and many other forms of provider-to-provider education, to continuous on-the-job training for front-line health workers; data collection, reporting and storage; clinical diagnosis and management of cases, mobile technology affords us many chances of delivering quality care to more people. Mobile phones have also been used to help improve quality of care delivered to clients by providing protocols and job-aids, and for signaling higher level hospitals for emergency referrals thus improving chances of timely and quality care at point of receipt.
The routine monitoring and evaluation of health projects landscape (including nationwide health projects) have been completely transformed today by mobile technology. Immunization programmes and disease surveillance have benefited from mobile technology with improved timeliness and higher reporting rates. For many of such projects, collation and storage have also been automated meaning that fewer health worker hours are spent doing these tasks.
An important downside to mobile phone use however is the cost, especially to implement at scale, as would be required in Nigeria. The costs of developing, testing and training health workers to use the technology is certainly deterring although research suggests that there is potential for cost-savings in the long-run. It is also important, for the sake of scarce public health resources, to implement projects that will deliver the most cost-effective health outcomes so that any mobile technology system deployed must be supported by rigorous cost-benefit analyses.
The vast HRH deficit in Nigeria requires urgent attention and substantial investment of resources before we can be on the way to universal health coverage. Alongside the other interventions needed to plug the HRH number and distribution gap, mobile technology may be an important intervention worthy of use as both stopgap and mainstay.