An evaluation of the integration of an mHealth program into the Ministry of Health in Timor-Leste

Abstract

Introduction: mHealth programs have been shown in many health settings to be effective for short-term goals. However, the integration of such programs into sustainable structures within ministries of health has not been well documented. The Liga Inan mHealth program in Timor-Leste was developed by two non-governmental organizations (NGO) in partnership with the Ministry of Health (MoH) to strengthen maternal and newborn care services. The Liga Inan program is being scaled up nationally, and the process of program handover has been initiated in selected districts. This evaluation focuses on long-term sustainability of Liga Inan by assessing the process and results of handover of the program in three districts, identifying the opportunities and challenges of integrating mHealth interventions into the Timor-Leste public health system. Methods: A qualitative method evaluation compared utilization indicators for Liga Inan during a twelve-month period before and after the handover. Key informant interviews with stakeholders from government, NGO partners, donors, telecommunication service provider, and community leaders examined perceptions regarding the process of program handover. A program integration framework was used to guide the inquiry. Findings: Enrollment rates of pregnant women into the program were relatively steady, although substantial declines were observed for broadcast messaging by district health facility staff. Factors reported to facilitate the process of handover include a supportive policy environment for mHealth, government ownership, technical expertise of NGOs, and partnerships with community, private sector, and donors. However, there is a lack of clear communication among partners and lack of adequate technical and management capacity of MoH staff. Other key factors such as adapting to national political transitions, different operational environment of MoH and NGOs, MoH staff turnover also limit this process. Estimating the resources needed and establishing plans for maintaining the phones and covering other ongoing costs of the project will be required for achieving a successful transition. Discussion: Liga Inan continues to function during the transition to MoH management in these three districts. However, achieving a full handover of the program will require addressing several limiting factors. It is recommended that NGO partners need to develop clearly defined partnerships with each other and with the MoH for a fully effective transition and program sustainability. A transition plan outlining program costs, human resource requirements, their respective suggested duties, and transition timeline should be developed and shared among partners. Maintaining partnership with telecommunication service providers and ensuring financial commitments from the donor partners are essential to facilitate this transition process.