A version of this article, “Reaching Health Workers, One Text Message at a Time,” was originally published on Ebola Deeply.
By Ebola Deeply
Thousands of health workers in Liberia, Sierra Leone and Guinea face logistical, financial. and information challenges, alongside the risks to their health. Ebola Deeply reports on a new communication tool that’s being created to plug the gap.
When Ebola broke out earlier this year in Lofa County, in northern Liberia, Ernestine Flomo stopped going to work. She had been working as a physician’s assistant for four years – spending her days busily checking patients’ temperatures and cleaning up after medical procedures – when the outbreak hit.
“My husband asked me to stay home,” Flomo told Ebola Deeply. “He said it wasn’t safe for me to be touching patients when we didn’t have enough equipment, enough gloves to cover ourselves, enough information about this Ebola.”
She was lucky enough to have financial support from her husband’s business. But it still wasn’t an easy decision to skip work.
“I asked myself, now why did I become a physician’s assistant?” she said. “I made that choice to help people. But I was afraid that I, myself, could die. I wanted to keep working. But I listened to my husband because I didn’t know about this disease they called Ebola.” Within weeks, Flomo had lost two of her colleagues to Ebola.
The Ebola emergency in Liberia, Sierra Leone and Guinea is primarily a crisis of weakened health systems, but its spread has been fueled by gaping information holes, long legacies of mistrust and ongoing communication failures.
Liberia has about 12,000 health workers, including drivers, cleaners and employees of the Ministry of Health and Social Welfare. More than 300 of them have been infected with Ebola, and at least 120 have died. Many are on short-term contracts, have been forced to sign waivers in case of sickness or death and are shackled by low or inconsistently paid wages.
Last month, Liberia’s National Health Workers Association called a strike to demand an increase in the wages of health workers treating Ebola cases. The fee is currently between $150 and $500 a month, depending on the individual’s position and the organization’s capacity to pay.
Moses Jefferey, 35, works at the Kumor Healthcare Center in rural Liberia. He told Ebola Deeply that there are “too many challenges” for healthcare workers dealing with the outbreak and its indirect impact on basic health services.
“Right now, things are difficult during the times of Ebola,” he said. “More than 300 health workers have died, and some of us are sick. The government is promising to improve the situation for us, but they are not yet delivering. We don’t get information about the changing situation, except from our close colleagues, and sometimes we don’t get paid on time.”
A new mobile communication tool is trying to fix that gap. IntraHealth International, which works to strengthen healthcare systems in developing countries, is rolling out a new platform in conjunction with UNICEF, known as mHero (Mobile Health Worker Ebola Response and Outreach).
The tool will allow Liberia’s Ministry of Health and Social Welfare to share critical information about the Ebola response with health workers all over the affected countries. It will distribute advice on preventative measures and tips on dealing with social stigma and salary payment dates. There are plans to introduce the program to Sierra Leone and Guinea.
“[We] did an analysis, asking what the barriers are to healthcare workers not showing up to work,” said Kate Tulenko, director of IntraHealth International.
“The main one is fear, because at the beginning, many didn’t have personal protective equipment or the training to use it,” she said.
“Another major barrier is that they weren’t being paid consistently. You’re asking someone who maybe hasn’t been paid in two or three months to risk their life, or to work with limited resources. Schools are closed, so if you’re a parent with young children, you may be trying to figure out, well, who’s going to take care of my children?”
Tulenko said that in addition to the logistical challenges, health workers are contending with a deficit of trust, lacking confidence in the capacity of local leaders. She believes that better communication would help begin to bridge the division.
Dykki Settle, the director of Informatics at InfraHealth, explained how the mHero technology will work.
“The tool taps into a wide database of health workers and allows them to receive messages … [they] can also dial into a code to ask questions, to get SMS responses. It’s even possible to send lab results via mobile phone,” Settle said.
He added that it can be translated into local languages and can bridge the literacy gap, using voice recordings to reach the less educated in the healthcare labor force.
“The main focus is to try to help health workers who might be a liability – because they aren’t armed with knowledge and resources – and help turn them into an asset,” he said.
But although the new software holds promise, commentators have raised concerns that gaps in communications infrastructure and limited access to electricity in some areas could hinder its effectiveness. As of 2013, less than half of the Liberian population had cell phone access, according to Telecompaper, an industry newsletter.
The country “lacks basic infrastructure … making the cost of connectivity extremely prohibitive and a barrier to [cell phone] penetration,” writes Darren Wilkins in his book, A Digital Liberia: How Electrons, Information and Market Forces Will Determine Liberia’s Future.
For now, mHero is planning to use what infrastructure they can to distribute mission-critical content.
“We need to focus our efforts on helping health workers do their job safely, and in the case of absenteeism, to get back to work,” said Tulenko. “Why bring in external workers when we have healthcare workers in Liberia who know the culture, who know the languages, who have a stake in this? We need to invest in them.”
Ebola Deeply is an independent digital media project, working to improve the state of information around around a global crisis.