The International Labour Organisation estimated in 2015 that 56% of people living in rural areas worldwide do not have access to essential healthcare services. And in Ghana today, rural people can’t always get basic healthcare like antenatal checkups and vaccinations, because there aren’t enough quality healthcare facilities or trained personnel.

Mobile technology offers ways to address these gaps. It can reduce costs and connect people to health care providers.

Mobile health, or m-health, involves the use of portable devices to create, share and store information to improve patient safety and care. It includes using mobile phone applications such as SMS, voice calling and wireless data transmission to collect or disseminate health-related information. And to offer direct care in the form of advice.

M-health solutions have been used to monitor cardiovascular patients in China and the US, for example. And in Japan and South Africa, m-health allows people in remote areas of the country to communicate via wireless networks to get timely information to manage their own health.

Ghana could be a good candidate for m-health services because of its large, medically underserved rural population and its uptake of mobile technology.

The World Bank reports that Ghana had a rural population of nearly 44% in 2018. The ratio of doctors to patients in rural regions is about 1:18,257 compared to 1:4,099 in an urban region. In contrast to the scarcity of health personnel in rural Ghana, the country has the highest mobile penetration in West Africa and already outperforms many of its regional peers. By the end of 2019, mobile adoptionstood at 55%, higher than the regional average of 44.8%

This means a huge number of rural people could receive digital services. In our study, we explored how mobile health could be used or improved as part of the effort to broaden access to maternal health care for rural Ghanaians.

We developed a model to assess service quality in m-health. We wanted to know which aspects of service quality would influence user satisfaction and continued use of an m-health service.

Our study found that the quality of human interaction – in other words the person providing the service – had a positive and significant relationship with user satisfaction. We also established that people who are more vulnerable to health-related challenges might show much interest in health innovation such as m-health and might be more willing to continue to use the services than those who are healthy.

What we found

Ghana has seen a proliferation of m-health programmes alongside increasing rates of phone usage in the population. At least 22 different projects have been piloted since 2004.

The women surveyed in our study used m-health services to monitor common pregnancy related issues like the rate of development of their babies and their own individual health.

To assess service quality we measured three dimensions: system quality (users’ perceptions of the technical level of communication); interaction quality (communication between service provider and consumer); and information quality (benefits of information services).

All three m-health quality dimensions were positive and significant on continual use. But we found that of the three m-health service quality dimensions – interaction quality – had the strongest relationship with user satisfaction. In other words, what mattered most to the women who used the service was communication with the service provider.

We found that more than the cost of acquiring a hand set and reliable mobile networks, the patience of health personnel in explaining health issues and helping the respondents to navigate same, was the most important determinant of user satisfaction. This result contrasted with a study which found that all the service quality dimensions had a positive relationship with satisfaction.

We also found a significant relationship between user satisfaction and continual usage. Women who were satisfied with the service said they would continue to use it. Rural women who perceived m-health service costs (equipment and service access) as affordable also have a greater tendency to be satisfied and willing to continue using the system, in the absence of alternative care, than those who considered it expensive.

It could be argued that cost also contributes to continual usage and we found that the majority of the respondents (59%) were using shared phones from relatives and friends to access the services.

In spite of the importance of cost, we still conclude that what influences m-health quality, user satisfaction and usage the most is the human side of the service.

How to improve mobile health services

Policy makers and service providers can learn from our findings. We recommend that health personnel should deliver timely services and provide the right service the first time. They should provide information that is safe for maternal healthcare and customised to individuals.

Any additional cost such as an m-health service fee might discourage rural women from using the service. Policy makers and service providers should consider developing and deploying innovative m-health subsidy support schemes.

Finally, managers of m-health services must constantly identify the changing needs of their customers and continuously improve their services accordingly. The Ministry of Health and regional public sector health institutions could consider introducing or strengthening customer service units to oversee m-health programmes.

Service providers should also remember that societal needs change over time. Users’ desire for quality and preferences in technology services might change as they become more exposed to information technology and competitors’ services.