mHEALTH-INNOVATE: exploring healthcare workers’ informal and innovative uses of mobile phone messaging in LMICs.
The aim of this project is to explore how innovative informal uses of mobile phone messaging apps by healthcare workers can be used to strengthen health systems and inform digital health interventions in low and lower middle-income countries.
Summary
Healthcare workers around the world are using mobile phones more and more to solve problems in their work and provide health services. Most research has explored planned digital projects led by governments, researchers, and other organizations. But there has been much less attention on the simple, informal solutions that healthcare workers create themselves. The mHealth-Innovate project aims to find out how healthcare workers’ informal use of mobile phones can help improve health systems and guide better digital health solutions, particularly in low- and middle-income countries. In this project, we will: - review existing research on what healthcare workers think and experience when they use mobile phones informally to support their work - carry out our own research in Uganda with healthcare workers, policymakers, and other stakeholders to understand their views and experiences with informal phone use - study Uganda’s policies and rules about using mobile phones for delivering health services - develop practical suggestions for decision makers on how to address informal mobile phone use in their settings.
Healthcare workers across the world increasingly use mobile phones to overcome clinical and health systems challenges and deliver the services expected of them. Considerable research has focused on ‘top-down’ digital strategies initiated by researchers, governments and others. However, there has been far less focus on healthcare workers’ own, informal solutions.
The aim of the mHealth-Innovate project is to explore how informal use of mobile phones by healthcare workers can be used to strengthen health systems and inform digital health interventions, particularly in low-and middle income countries.
The project includes the following main elements:
- a global qualitative evidence synthesis exploring the views and experiences of healthcare workers regarding informal use of mobile devices to support their work
- primary qualitative research exploring the views and experiences of Ugandan healthcare workers, policy makers and other stakeholders regarding informal phone use
- a case study of the policies and regulations that govern the use of mobile phones for health service delivery in Uganda
- policy dialogues where decision makers and topic experts discuss our research results and suggest strategies that could harness the advantages and limit the disadvantages of informal mobile phone use
- a checklist / guidance for decision makers considering how to address informal mobile phone use in their setting
The following people have contributed to the project:
Susan Munabi-Babigumira is project Leader for the mHealth-Innovate project. She is associate professor at the Western Norway University of Applied Sciences and a researcher at the Norwegian Institute of Public Health. Munabi-Babigumira has extensive experience in health systems research in Uganda and other African settings, including conducting systematic reviews, evidence-informed decision-making processes and quality improvement initiatives.
Claire Glenton is co-Principal Investigator for the mHealth-Innovate project. She is Professor of Evidence-Based Healthcare at Western Norway University of Applied Sciences. Claire has extensive experience in conducting systematic reviews and developing methods to support their use in informing health systems guidelines and policy. This includes identifying and learning from the perspectives and practices of healthcare workers.
Nelson Sewankambo is co-Principal Investigator for the mHealth-Innovate project. He has led and worked extensively on national and regional transformative research initiatives aimed at strengthening Uganda’s health system through health workforce development and support. He has also been actively involved in developing a Comprehensive Health Information Management System for supporting frontline healthcare workers' professional development needs in Uganda.
Immaculate Nakityo Lwanga is Project Adminstrator/Manager for the mHealth-Innovate project, and is based at Makerere University College of Health Sciences. A former Community Engagement Specialist for HIV health systems and research, with over 20 years of experience, coordinating national and regional programmes in areas of HIV, Gender, Education, Reproductive health. She also has experience in developing and managing programmes for children, youth and young women.
Silje Gunlaug Yun Eng is Project Administrator for the mHealth-Innovate project. She is based at the Norwegian Institute of Public Health.
Smisha Agarwal is Associate Professor at Johns Hopkins School of Public Health. Her research focuses on improving maternal and newborn health in low-income settings, including Uganda, through strengthening community health systems and innovative technological solutions.
Unni Gopinathan is a researcher in the Centre for Epidemic Interventions Research and the Cluster for Global Health at the Norwegian Institute of Public Health, focusing on impact evaluation of public health and social measures for epidemic responses, how evidence can inform decisions about financing, governing and organizing health systems and participation of public in such processes.
Marit Johansen is an information specialist in the Cluster for Global Health, Division for health services at the Norwegian Institute of Public Health (NIPH)
David Kyaddondo: Is a medical anthropologist and research based at the Child Health and Development Centre at Makerere University. His work focuses on topics including communities and health systems linkage, with a focus on how both health workers and communities adapt to changing care systems.
Simon Lewin is Professor of Health Management and Health Systems and co-investigator based at NTNU. He brings extensive experience in health policy and systems research, with a focus on how evidence, and especially systematic reviews of qualitative evidence, can be used to strengthen health systems.
Josephine Nabukenya: Professor of Information Systems and Health Informatics at Makerere University conducting extensive research in health informatics, digital health, health information systems, and data science to solve fundamental health challenges in order to transform Uganda’s health system. She’s core to the development of Uganda’s Digital Health Policy & Strategy and supporting its implementation in the country.
Josephine Namitala is a PhD candidate on the Mhealth Innovate Project, specifically working on Work Package 2, which explores how healthcare workers and managers informally use mobile phones within the health system to plug gaps in service delivery. She is a social development worker and adult educator based at Makerere University, where she serves as an Assistant lecturer. Her research aims to bridge the gap between formal health policies and everyday practices, contributing to Uganda's digital health agenda.
Rehema Namaganda is a social anthropologist whose research focuses on disability, aging, HIV, and health systems in Uganda and Sub-Saharan Africa. She is currently a Postdoctoral Researcher at the Medical Research Council (MRC/UVRI & LSHTM Uganda Unit), leading disability projects. She supported the project by leading a work package focusing on policy makers and informal mobile phone use.
Tom Neumark is a researcher at the Centre for Global Sustainability, University of Oslo. Tom is a social anthropologist with extensive research experience in East Africa concerning the social, cultural and moral dimensions of technology and welfare interventions.
Allen Nsangi is a Health Systems Researcher and Behavioural Scientist at the School of Medicine, Makerere University College of Health Sciences in Kampala, Uganda. Dr. Nsangi holds a PhD in Public Health from the University of Oslo (2020). Her work emphasizes community health, stakeholder engagement, and user-centered health service delivery.
Neil Pakenham-Walsh is Coordinator of the HIFA (Healthcare Information For All) campaign and co-director of the Global Healthcare Information Network. A former hospital doctor in the UK and rural health worker in Ecuador and Peru, he has spent the past 20 years focused on improving access to reliable healthcare information in low- and middle-income countries. He advocates for inclusive, interdisciplinary communication to address global health and development challenges.
Elizabeth Paulsen is an Assistant Professor in the Department of Nursing and Health Promotion at Oslo Metropolitan University. She previously worked at the Norwegian Institute of Public Health, focusing on health services research and project coordination. Elizabeth also served as Managing Editor of the Norwegian satellite of Cochrane Effective Practice and Organization of Care (EPOC), where she provided specialized editorial and methodological support to authors of systematic reviews.
Arash Rashidian is Director of Science, Information and Dissemination at the WHO Regional Office for the Eastern Mediterranean. He has led the WHO regional agenda on evidence-informed policy making, health information systems, digital health, research promotion and governance, and knowledge sharing. He is Affiliate Professor in the Department of Health Metrics Sciences at the University of Washington and Professor of Health Policy at the School of Public Health, Tehran University of Medical Sciences.
Geoff Royston is former head of strategic analysis and operational research in the Department of Health for England. He also led the national introduction of the telephone service NHS Direct (now NHS 111). He has a variety of experience in the international health arena including being a consultant for the WHO and is a member of the Steering Group for the Health Information for All (HIFA) network.
Tigest Tamrat is a Scientist in the Department of Sexual, Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing at the World Health Organization based in Geneva, Switzerland, where she leads research and normative work on the use of digital technologies, including artificial intelligence (AI), to advance sexual and reproductive health and rights (SRHR).
Referanselitteratur
mHealth-Innovate project outputs
Scientific publications
Glenton C, Paulsen E, Agarwal S, Gopinathan U, Johansen M, Kyaddondo D, Munabi-Babigumira S, Nabukenya J, Nakityo I, Namaganda R, Namitala J, Neumark T, Nsangi A, Pakenham-Walsh NM, Rashidian A, Royston G, Sewankambo N, Tamrat T, Lewin S. Healthcare workers’ informal uses of mobile phones and other mobile devices to support their work: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 8. Art. No.: CD015705. DOI: 10.1002/14651858.CD015705.pub2. Accessed 29 September 2025.
Glenton C, Nabukenya J, Agarwal S, Meltzer M, Mukendi E, Lwanga IN, Namitala J, Reddy S, Royston G, Tamrat T, Pakenham-Walsh N. Using an online community of practice to explore the informal use of mobile phones by health workers. Oxf Open Digit Health. 2023 Jan 4;1:oqac003. doi: 10.1093/oodh/oqac003. PMID: 40231271; PMCID: PMC11932412.