Scaling-up Community Eye Care Services Using Short Message Service Technology and Mobilizing Community Volunteers: Evidence of mHealth Pilot Intervention from Rolpa District, Nepal

Background: In Nepal, disparities exist in the distribution of eye services and resources. In places where resources are limited and confined to urban areas, mHealth can play a vital role in increasing community referrals. This study attempted to scale up of the rural eye care services through the use of mHealth technology by mobilizing the community health volunteers known as female community health volunteers in Nepal. Methods: Pilot study was conducted in two phases: Phase-I (June to December 2016) and Phase-II (August 2017 to July 2018). During Phase-I, the performance of 209 female community health volunteers, making referrals to community eye centre, Rolpa using mHealth technology, was compared with 109 female community health volunteers making traditional paper-based referrals. In Phase-II, volunteers active in the Phase-I inclusive of a new cohort of school teachers retrained, and the incentive was provided coinciding per referrals. The findings from the Phase-II was then compared with the Phase-I. Results: Almost all (99%) cases attended to community eye centre for consultations had some form of eye illness. In Phase-I, an average referral rate of 1.5 patients per volunteer using mHealth technology was recorded in contrast to 0.4 patients per volunteer using the traditional referral approach. The community eye centre has experienced an influx of patients by 20% after the implementation of screening and referrals using mHealth technology. In Phase-II, both the number of registered and visit confirmed cases increased by around six times than in the Phase-I. Conclusion: The mHealth technology, when used in a low-resource setting by mobilizing community volunteers, can be effective in increasing community referrals and facility-based consultations.