A text message-based intervention to bridge the healthcare communication gap in the rural developing world

Technol Health Care. 2010;18(2):137-44. doi: 10.3233/THC-2010-0576.


Healthcare delivery in the rural developing world is limited by a severe shortage of health workers as well as profound communicative and geographic barriers. Understaffed hospitals are forced to provide care for patients that reside at a great distance from the institutions themselves, sometimes more than 100 miles away. Community health workers (CHWs), volunteers from local villages, have been integral in bridging this patient-physician gap, but still lose enormous of amounts of time in transit between hospital and village. We report the results of a retrospective mobile health (mHealth) pilot at St. Gabriel's Hospital in Malawi designed to eliminate many of these trips in favor of communication via text messages. A group of 75 CHWs were supplied with cell phones and trained to utilize the network for a variety of usage cases, including patient adherence reporting, appointment reminders, and physician queries. At the end of the pilot, the hospital saved approximately 2,048 hours of worker time, $2,750 on net ($3,000 in fuel savings minus $250 in operational costs), and doubled the capacity of the tuberculosis treatment program (up to 200 patients). We conclude that mHealth interventions can provide cost-effective solutions to communication barriers in the setting of rural hospitals in the developing world.

MeSH terms

  • Appointments and Schedules
  • Cell Phone*
  • Community Health Workers / economics
  • Community Health Workers / organization & administration*
  • Costs and Cost Analysis
  • Developing Countries*
  • Humans
  • Malawi
  • Patient Compliance
  • Retrospective Studies
  • Rural Health Services / economics
  • Rural Health Services / organization & administration*
  • Telemedicine / economics
  • Telemedicine / organization & administration*
  • Time Factors
  • Tuberculosis, Pulmonary / therapy