Informal m-health: How are young people using mobile phones to bridge healthcare gaps in Sub-Saharan Africa?

The African communications 'revolution' has generated optimism that mobile phones might help overcome infrastructural barriers to healthcare provision in resource-poor contexts. However, while formal m-health programmes remain limited in coverage and scope, young people are using mobile phones creatively and strategically in an attempt to secure effective healthcare. Drawing on qualitative and quantitative data collected in 2012-2014 from over 4500 young people (aged 8-25 y) in Ghana, Malawi and South Africa, this paper documents these practices and the new therapeutic opportunities they create, alongside the constraints, contingencies and risks. We argue that young people are endeavouring to lay claim to a digitally-mediated form of therapeutic citizenship, but that a lack of appropriate resources, social networks and skills ('digital capital'), combined with ongoing shortcomings in healthcare delivery, can compromise their ability to do this effectively. The paper concludes by offering tentative suggestions for remedying this situation.

[1]  Sarah-Jayne Blakemore,et al.  Adolescence: a foundation for future health , 2012, The Lancet.

[2]  S. Whyte Second Chances: Surviving AIDS in Uganda , 2014 .

[3]  Anne Mills,et al.  Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage , 2012, The Lancet.

[4]  Gina Porter,et al.  Mobile Phones, Livelihoods and the Poor in Sub-Saharan Africa: Review and Prospect , 2012 .

[5]  Mauricio L. Barreto,et al.  Monitoring and Evaluating Progress towards Universal Health Coverage in Brazil , 2014, PLoS medicine.

[6]  Assa Doron,et al.  Great Indian Phone Book , 2013 .

[7]  Gina Porter,et al.  Youth, mobility and mobile phones in Africa: findings from a three-country study , 2012, Inf. Technol. Dev..

[8]  Arul Chib,et al.  mHealth Adoption in Low-Resource Environments: A Review of the Use of Mobile Healthcare in Developing Countries , 2015, Journal of health communication.

[9]  P. Bourdieu Forms of Capital , 2002 .

[10]  Yukiko Nishimura Japanese Keitai Novels and Ideologies of Literacy , 2011 .

[11]  J. Galvao Will to live: AIDS therapies and the politics of survival , 2009 .

[12]  V. Nguyen Antiretroviral Globalism, Biopolitics, and Therapeutic Citizenship , 2008 .

[13]  Omar S. Haque,et al.  Vulnerabilities to misinformation in online pharmaceutical marketing , 2013, Journal of the Royal Society of Medicine.

[14]  Clara B. Aranda-Jan,et al.  Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa , 2014, BMC Public Health.

[15]  Jonathan Donner,et al.  Research Approaches to Mobile Use in the Developing World : A Review of the Literature , 2007 .

[16]  T. Wardlaw,et al.  Progress for children: a report card on adolescents , 2012, The Lancet.

[17]  G. Mburu,et al.  Rights-based services for adolescents living with HIV: adolescent self-efficacy and implications for health systems in Zambia , 2013, Reproductive health matters.

[18]  Gina Porter,et al.  Mobile Phones and Education in Sub‐Saharan Africa: From Youth Practice to Public Policy , 2016 .

[19]  L. Degenhardt,et al.  Health of the world's adolescents: a synthesis of internationally comparable data , 2012, The Lancet.

[20]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[21]  K. Hampshire,et al.  Out of the reach of children? Young people's health-seeking practices and agency in Africa's newly-emerging therapeutic landscapes. , 2011, Social science & medicine.

[22]  S. d’Almeida,et al.  Monitoring and Evaluating Progress towards Universal Health Coverage in Ghana , 2014, PLoS medicine.

[23]  N. Ford,et al.  Substandard medicines in resource‐poor settings: a problem that can no longer be ignored , 2008, Tropical medicine & international health : TM & IH.

[24]  V. Chandra-Mouli,et al.  Standardizing and scaling up quality adolescent friendly health services in Tanzania , 2013, BMC Public Health.

[25]  V. Nguyen The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS , 2010 .

[26]  S. van der Geest,et al.  Editorial: Should medicines be kept away from children? African considerations , 2003, Tropical medicine & international health.

[27]  COMEDIANS, PASTORS, AND THE MIRACULOUS AGENCY OF CHARISMA IN GHANA , 2009 .

[28]  B. Meyer Christianity in Africa: From African Independent to Pentecostal‐Charismatic Churches , 2004 .

[29]  M. De Allegri,et al.  Gaps in universal health coverage in Malawi: A qualitative study in rural communities , 2014, BMC Health Services Research.

[30]  David Wheeler,et al.  Determinants of a Digital Divide in Sub-Saharan Africa: A Spatial Econometric Analysis of Cell Phone Coverage , 2008 .

[31]  J. L. Le Hesran,et al.  Where do pharmaceuticals on the market originate? An analysis of the informal drug supply in Cotonou, Benin. , 2011, Social science & medicine.

[32]  M. Sodemann,et al.  Knowing a medical doctor is associated with reduced mortality among sick children consulting a paediatric ward in Guinea‐Bissau, West Africa , 2006, Tropical medicine & international health : TM & IH.

[33]  Lavanya Vasudevan,et al.  Mobile health for non-communicable diseases in Sub-Saharan Africa: a systematic review of the literature and strategic framework for research , 2014, Globalization and Health.