Telephone hotlines for infectious disease outbreaks in Africa: a scoping review and qualitative study

Abstract

Abstract Background Mobile health interventions like telephone hotlines face challenges that may threaten their use, adoption and sustainability in Africa. We sought to understand the barriers and facilitators for sustainability of telephone hotlines used in infectious disease outbreaks in Africa using a scoping review and qualitative study. Methods The scoping review was conducted using PRISMA checklist. Medline, Embase, Global Health, PsycINFO, Google Scholar were searched for articles published between 1 January 1995 and 30 September 2022. For the scoping review, articles were included if they mentioned the use of a telephone hotline in outbreak response and the barriers and/or facilitators in operating the hotline. Data on the barriers and facilitators were extracted. Thirty participants from 12 African countries were interviewed online from 15 July 2021 to 30 November 2021, one-on-one and through focus group discussions. Emerging themes from the review were identified and synthesized to focus on barriers and facilitators for the sustainability of the hotlines. Results The search identified 1153 citations and 25 studies were finally included. The articles were from 20 African countries. The government was the main source of funding in four countries. Barriers with calls and data management were the most frequent. Human resource barriers such as limited staff, high staff turnover, lack of incentives and motivation were also significant. Financial barriers were the high cost of operation and huge dependence on external funders. Technological and infrastructural hurdles included limited internet and phone coverage, malfunction, and lack of interoperability of softwares. Transitioning to either complete or shared government ownership with diversification and integration of the hotline into routine use was the main facilitator for sustainability. Conclusion Strengthening technical capacity in telephone hotlines and ensuring financial sustainability are critical. More government support is needed. More studies on costing will help in developing financial sustainability models for Africa.