Mobile health service as an alternative modality for hard-to-reach pastoralist communities of Afar and Somali regions in Ethiopia

Abstract

Background: Mobile Health Service (MHS) has been introduced as an alternative strategy to make health care services easily accessible in the Somali and Afar regions of Ethiopia to reach the mobile and hard-to-reach communities. However, the implementation status and effectiveness of the MHS program are not evaluated. Thus, this study aimed at exploring the dynamics and causes of poor health care utilization and implementation barriers and facilitators of MHS in the two regions, i.e. Somali and Afar regions of Ethiopia. Methods: This study employed the Reachness, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to understand the health care services utilization in pastoralist settings. Furthermore, the study demonstrates the proposed MHS programme components and their challenges encountered during the implementation phase. The researchers collected data from eighteen key informants and eight focused group discussions (FGDs). The data were categorized, coded, entered, and analysed using the NVIVO version 11 software. Results: The results of this study revealed that health service coverage increased in the districts of Somali and Afar regions where MHS was implemented. According to the results of this study, MHS provision has also increased access to and utilization of health services in general and RMNCH services in particular. The study indicated that the MHS provided the following main health care services: family planning, nutrition supply, timely referral with free transportation, immunization, and treatment of malnourished children. The MHS programme is considered as an effective health service modality in pastoralist areas compared to other modalities. This is mainly because it provides health services following the footsteps of settlement and movement route of the community in search of grazing land and water. However, the study revealed that the MHS programme lacks guidelines for procedural adoption to implement it both at national and regional levels. Conclusion: The Mobile Health Service has been a useful and effective mechanism to deliver Reproductive, Maternal, Newborn and Child Health (RMNCH) and family planning (FP). Hence, it also facilitates nutrition services to hard-to-reach communities with limited or no health facilities in the targeted woredas of the Somali and Afar regions. Based on the findings, the study recommends the MHS needs to be institutionalized and owned by the government as an alternative health care service delivery modality.