Sustainability of ‘mHealth’ interventions in sub-Saharan Africa: a stakeholder analysis of an electronic community case management project in Malawi

Background The global health community as well as the funding agencies are currently engaged in ensuring a greater focus on worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore the barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa. Methods Between January to March 2017, a qualitative approach was employed involving 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions on the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers. Results The findings indicate that, overall, the programme was successful in achieving its goals. However, absence of monetary resources, the limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management of the programme present challenges to its wider implementation and sustainability. Conclusions Future developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. They should also focus on building local capacity through training of trainers and ensure that training methods and guidelines are appropriately accredited based on national policies. These findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to inform evidence based policy in utilising technology for healthcare delivery across developing countries