mhealth as a Health System Strengthening Tool in China

China is now undergoing a rapid epidemiological transition. Long-term prevention and management of the non-communicable diseases (NCDs) has become a major public health priority. With rapid expansion of mobile infrastructure and capabilities, mobile telecommunications have the potential to revolutionise healthcare delivery. Although there have been pilot studies conducted to evaluate the feasibility and effectiveness of the mobile health (mHealth) interventions, the extent to which mHealth contributes towards the health system strengthening in China remains unknown. Therefore, this thesis aims to understand and determine the current and potential impact of mHealth in health system strengthening in China. This thesis consists of three interrelated studies, including a systematic review to characterise current mHealth interventions in China; a process evaluation of an intervention trial to understand potential factors influencing the scalability of mHealth interventions; and a stakeholder analysis to develop a broader knowledge base to inform the development of an integrated mHealth interventions for NCD management in Chinese primary care settings. The systematic review revealed that while there was a growing focus on NCDs, very few high quality mHealth interventions in China are reported in the scientific literature. Most were of limited scope with poor integration into existing health systems, and their evaluation largely lacked methodological rigour. Building on the findings from this review, a qualitative approach was used to understand the potential factors influencing system integration and the scalability of the mHealth interventions, using a pilot mHealth intervention for NCD management in a single province as a case study. This identified substantial challenges, from a technical perspective, but also relating to health system barriers at various levels. A broader stakeholder analysis involving several provinces provided more details into such perceived challenges and suggested that mHealth may have an important role to play in some but not all aspects in strengthening of the Chinese health system at the primary care level, especially in response to the growing burden of NCDs. We conclude with several recommendations for the future of mHealth in China