Introduction
TheWHO has estimated that at least half of the world’s population cannot obtain essential health services due to a global shortage of health workers.1 One solution to help address this gap has been to train community health workers (CHWs) in low- and middle-income countries (LMICs). CHWs are lay people working within their own community in a health promotion and prevention role.2 As evidenced by major systematic reviews,3 4 CHWs play a crucial role in healthcare for vulnerable populations, resulting in major projects being funded by international donors (Department for International Development, United States Agency for International Development, etc) across Africa and Asia.
Aligned with this, smartphones are increasingly commonplace on sub-Saharan Africa. The Global System for Mobile Communications Assocation, (GSMA) estimates that by 2025 mobile internet penetration will rise to 40% (up from 21% in 2017) using 3G, 4G and 5G (62%, 29% and 3% of connexions).5 It is therefore not surprising that global health researchers, practitioners and policymakers have sought to use mobile phones to increase the reach of their programmes. While there are many mHealth platforms for clinical decision support, very few include a CHW training component in their software. Consequently, the role of mobile technology in the training of CHWs in LMICs remains poorly understood. The methods by which mobile phones can support the different aspects of training and supervision have not yet been fully established.6 In previous work, we found that the design of many training programmes is not underpinning by learning theory.7 These findings are further supported by a 2018 WHO report,8 9 in which the evidence-base for supportive supervision was found to be severely lacking. There remains a pressing need for a comprehensive study of the exact nature of the evidence-base regarding the use of mobile technology to support the training of CHWs. In this paper, we develop an evidence map to address this issue. It details the range of pedagogical approaches and technologies employed for training, and the type of implementations and study designs used across nine areas of global healthcare in LMICs, including the neglected areas of disability and mental health.
Evidence mapping is an evidence synthesis methodology to systematically source and organise a body of knowledge to provide a high-level overview of the size and nature of the available evidence to inform and facilitate the use of this evidence-base.10 Building an evidence map requires ‘a systematic search of a broad field to identify gaps in knowledge and/or future research needs that presents results in a user-friendly format, often a visual figure or graph, or a searchable database’.11 When visualised on an interactive evidence interface (eg, https://africacentreforevidence.org/wp-content/uploads/2018/10/mhealth-and-training-for-chws_v5.html), evidence maps allow decision-makers to directly engage with the evidence and to interrogate its relevance to their own contexts and needs. In summary, the evidence map will answer the following question: What is the role of mobile technology in the training of community health workers in LMICs?