Table 3 Bangladesh: interventions, scale-up strategy and implementation research
Scaling-up dimensions informed by IR | Nature of intervention and scale-up strategy | Findings from IR |
|---|---|---|
Implementing team | ICDDR,B in collaboration with a local for-profit mHealth company | |
Research aim and design | Aim to assess acceptability of mHealth, the effectiveness of the intervention and user satisfaction Initially designed as quasi experimental study with intervention and control, employing surveys of informal healthcare providers (VDs), exit interviews, household survey and routine data; evolved into more observational design, given widespread adoption of mHealth schemes | |
Attributes of the innovation or service | mHealth call centre to advise VDs and a self-diagnostic tool for use by villagers and VDs Aim to enhance the quality of care provided by untrained VDs | Appropriateness: Not assessed Fidelity: Not assessed |
Attributes of the target community | Interventions focused in Chakaria, a remote rural area of Bangladesh hosting a health and demographic surveillance site, where the implementer ICDDR,B had long-standing relations | Acceptability: Seeking advice from formal doctors was perceived by the VDs to undermine their own capacity and threaten their reputations; clients preferred face-to-face consultations to telephone ones, and preferred to consult with known doctors; they had limited trust in services provided from a distance by unknown doctors Intention to adopt: A survey of the local population’s readiness to adopt mHealth [34] found that only 50% of the population who owned a mobile phone knew how to text, and only 5% used the internet; overall, there was a lack of trust in mHealth approaches Coverage: Not assessed |
Context | Government policies very supportive of e-health; ICDDR,B had previously worked with informal healthcare providers in the area and had close relationships with them; rapid growth of e-health initiatives during the study period | Feasibility: Under the initial call centre model, a modest financial incentive had been set for the both the VDs and the call centre; given the low number of clients this proved too small to be meaningful to the call centre, leading to failure of the intervention |
Scaling-up strategy | Spontaneous scaling up – multiple private sector actors would scale-up proven interventions themselves | Implementation cost: Not assessed Sustainability: Intervention as originally designed proved unsustainable given low demand, and lack of willingness of for-profit company to continue to provide services given low revenues from the scheme |