araya-thesis

Chapter 5
Turnover of health workers presented another non‐technical challenge. Three health
workers became pregnant and took maternity leave, while two workers got an
upgrading study program and left their work temporarily. Every time a health worker
left his or her job we had to train and employ another health worker for the study. One
health worker resigned and did not return the smartphone to the researchers for a
more than two months after she had left. Hence, we could not replace her with another
health worker and her health post was excluded from the study. Moreover, health
workers were frequently moving away from their working place for days for different
reasons including training, meetings, annual leave, and social reasons.
No phones were stolen and no health worker had lost their smartphone, though they
were worried of this possibility. One of the HEWs said:
“When we do house to house visit, we are carrying two mobile phones; our private
phone and the smartphone you gave us. We might drop the phones. Really I am scared
that, especially, the smartphone might be lost.”
Many health workers complained about carrying two phones. To avoid the fear of
losing and carrying discomfort, health workers began to use the smartphones as their
primary phone. Some requested we provide a smartphone with a dual SIM card slot so
they could use their private SIM card and the SIM card we provided in one phone.
Implementation
Within the six month period of the actual implementation of this feasibility study, a
total of 952 records were submitted comprising 405 registration, 347 ANC, 58 ANC lab
test, 70 delivery and 72 PNC records. Although there were no variations in incentives,
performance of health workers in using the application varied. Some had implemented
it very well while others used it only a few times. For instance, 347 (36.4%) records
were submitted by one midwife – a young and fresh graduate, while another midwife
submitted only 52 (5.5%). On average, HEWs submitted 65 records within the six month
period. The number of records submitted by each of the 9 HEWs varied from 46 to 104.
Integration
The challenge of integrating the application into daily and real practices was that there
were no standards for maternal care services at the health centers and health posts.
The health workers took pragmatic approaches when rendering maternal health
services. Correct and appropriate utilization of the application seemed dependent on
the knowledge, competency, motivation, and commitment of the health worker.
Working relationship between midwives and HEWs was not clearly defined and virtually
non‐existent.
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